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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 OS577 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 OS453 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 OS694 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 OS470 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 OS411 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 OS422 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 OS351 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 OS458 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 OS380 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 OS308 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 OS404 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 Laser533 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 Laser476 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 Laser509 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 Laser432 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.