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Abstract #3558 Published in IGR 4-2
Population prevalence of tilted optic discs and the relationship of this sign to refractive error
Vongphanit J; Mitchell P; Wang JJAmerican Journal of Ophthalmology 2002; 133: 679-685
PURPOSE: To assess the prevalence of tilted discs and its association with refractive error and visual field defects. DESIGN: Population-based cohort study. METHODS: The Blue Mountains eye study examined urban Australians aged 49 years or older between 1992-1994. Of 4433 eligible participants, 3654 (82.4%) participated. The eye examination included logMAR visual acuity, standardized refraction, cover testing, stereoscopic optic disc photography, and Humphrey automated perimetry. Inferior or nasal optic disc tilting was graded from stereoscopic photographs. RESULTS: Of 3583 participants with gradable photographs, inferior or nasal optic disc tilting was observed in 77 eyes of 56 participants (1.6%). The prevalence of tilted discs increased from 0.4% in eyes with astigmatism < 1.0 D to 17.9% in eyes with astigmatism ≥ 5.0 D. The mean astigmatic error was 2.2 D in eyes with tilted disks compared with 0.7 D in eyes with normal disc appearance (p < 0.001). Myopia was present in 66.2% of eyes with tilted discs compared with 12.4% of eyes with a normal disc appearance (p < 0.001). The most common associated features were astigmatism (93.5%), pallor, and tessellation of the adjacent chorioretinal tissues (74.0%), situs inversus of the retinal vessels (70.1%), beta-peripapillary atrophy (64.9%), strabismus (30.4%), visual field defects (19.4%), posterior staphyloma (18.2%), inferonasal pigmentary accumulation (9.1%), and chorioretinal atrophy (5.2%). Superotemporal (33.3%) and superior (25.0%) visual field defects were most frequent. CONCLUSIONS: A tilted disc appearance was not a rare finding in the study population and was strongly associated with astigmatism and higher levels of spherical refractive error, particularly myopia. The tilted disc and its associated visual field defect should be distinguished from other sinister causes.
Dr. J. Vongphanit, Department of Ophthalmology and the Save Sight, Westmead Millennium Institutes, University of Sydney, Sydney, Australia
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
