This patient presented with asymptomatic 20/30 vision OD and subtle macular thickening coming from an optic nerve pit along the temporal aspect of the optic nerve.
OCT shows a direct communication between the pit and the prominent inner macular schisis. Patients can also have subretinal fluid, which our patient did not. The left eye was completely normal.
Our patient opted for no treatment due to the lack of symptoms and fairly good vision.
Learning Points:
Optic pits are most commonly located within or along the inferior-temporal disc margin and usually appear as a gray depression. They are thought to be caused by incomplete closure of the optic fissure during gestation.
While most optic pits are asymptomatic, they can cause vision loss by forcing fluid into the inner and outer retina and, ultimately, the subretinal space (optic pit maculopathy). The source of the fluid remains a subject of ongoing debate, with origins in either the vitreous or the subarachnoid space.
A host of treatments have been suggested over the years. However, a recent meta-analysis suggested that a plain old vanilla vitrectomy without gas tamponade is as successful as any other procedure (Zheng et al Ophthalmology Retina 2020;4;289-299).
