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This pleasant 8-year-old child was seen in the office on May 12, 2011. It was picked up on two school exams that his vision was poor in the left eye and his last normal exam was in preschool. You saw him for an evaluation, noticed a problem with the vision in the left eye and with the macular in the left eye, suggest he come here for an evaluation. VISUAL ACUITY: OD 20/30, OS 5/200. IOP: 14 OU. SLIT EXAMINATION: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. The macula is flat and healthy. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment. OCT SCAN: The OCT scan confirms a serous macular detachment with what looks to be inner retinal schisis, which is typical around the optic nerve pits. Photos confirm clinical findings and I did not do a fluorescein angiogram. IMPRESSION: 1. OPTIC DISC PIT/COLOBOMA WITH SEROUS MACULAR DETACHMENT DISCUSSION: I explained to the patient’s mother that these optic disc pits will sometimes spontaneously close and the serous macular detachment will resolve on their own. I suggest for at least a few months that we watch this. Based on the pigment epithelium in the back of the eye it does look like the retinal detachment is relatively fresh. If in two months it is no better, there are two treatments that are currently accepted, are laser or vitrectomy, both of which are reasonably effective at closing the pit. I think given the risk benefits of the two, especially given his age, it is reasonable to start with a little bit of laser around the optic nerve to try to seal up the area. He will return urgently if there is a problem and see you back regularly.

nervepitrd_dafr01.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS536 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr02.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS409 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr05.jpg
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS640 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr06.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS427 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
33333
(1 votes)
nervepitrd_dafr07.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS367 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr08.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS383 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr09.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS314 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr10.jpg
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS416 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr11.jpg
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS344 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr12.jpg
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS264 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
nervepitrd_dafr13.jpg
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - 5/200 Vision OS364 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.
00000
(0 votes)
pitrdfreshlaser_dafr01.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - Fresh Laser493 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.

No better after 3 months observation.
00000
(0 votes)
pitrdfreshlaser_dafr02.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - Fresh Laser433 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.

No better after 3 months observation.
00000
(0 votes)
pitrdfreshlaser_dafr03.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - Fresh Laser464 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.

No better after 3 months observation.
00000
(0 votes)
pitrdfreshlaser_dafr04.png
Optic Nerve Pit Retinal Detachment - Macular Detachment - 8 Year Old - Fresh Laser390 views8-year-old child on two school exams that his vision was poor in the left eye and his last normal exam was in preschool.

VISUAL ACUITY: OD 20/30, OS 5/200. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment.

No better after 3 months observation.
00000
(0 votes)
 
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This pleasant 8-year-old child was seen in the office on May 12, 2011. It was picked up on two school exams that his vision was poor in the left eye and his last normal exam was in preschool. You saw him for an evaluation, noticed a problem with the vision in the left eye and with the macular in the left eye, suggest he come here for an evaluation. VISUAL ACUITY: OD 20/30, OS 5/200. IOP: 14 OU. SLIT EXAMINATION: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. The macula is flat and healthy. OS: Vertical C/D ratio is 0.2. There is a whitening on the temporal edge of the optic nerve consistent with an optic disc pit and there is a serous macular detachment. OCT SCAN: The OCT scan confirms a serous macular detachment with what looks to be inner retinal schisis, which is typical around the optic nerve pits. Photos confirm clinical findings and I did not do a fluorescein angiogram. IMPRESSION: 1. OPTIC DISC PIT/COLOBOMA WITH SEROUS MACULAR DETACHMENT DISCUSSION: I explained to the patient’s mother that these optic disc pits will sometimes spontaneously close and the serous macular detachment will resolve on their own. I suggest for at least a few months that we watch this. Based on the pigment epithelium in the back of the eye it does look like the retinal detachment is relatively fresh. If in two months it is no better, there are two treatments that are currently accepted, are laser or vitrectomy, both of which are reasonably effective at closing the pit. I think given the risk benefits of the two, especially given his age, it is reasonable to start with a little bit of laser around the optic nerve to try to seal up the area. He will return urgently if there is a problem and see you back regularly.