Dysversion of the optic disc and axial length measurements in a presumed amblyopic population

Our purpose was to evaluate anatomic variations of eyes presumed to be amblyopic.

Computer imaging and photography of the optic discs of 205 amblyopic subjects were performed and the axial lengths of 183 of the subjects were measured. The paired optic nerve images were evaluated for symmetry of disc contours and orientation of central blood vessels to detect optic nerve head dysversion. Dysversion of the optic nerve head, which is also referred to as segmental hypoplasia, is a congenital disorder characterized by the central retinal vessels emerging temporal to the vertical midline of the disc and being directed nasally or the nerve head tilting in a vertical direction resulting in a downward or oblique tilting of the discs with the blood vessels emerging at the superior or inferior disc rim.

Ninety-three subjects had optic nerve dysversion. There was a greater degree of anisometropia (P< or =.004) in subjects with dysversion (anisometropia factor of 2.51+/-2.15) than in the subjects with symmetric discs (anisometropia factor of 1.76+/-1.63). Axial lengths of the amblyopic eyes were significantly smaller (P<.0001) than those of the nonamblyopic eyes. There was no statistical difference (P< or =.879) in length between amblyopic eyes with dysversion and those with symmetric discs.

Optic disc dysversion was identified in 45.4% of patients who were previously assumed to be amblyopic. There are anatomic malformations in the eyes of a significant proportion of the presumed amblyopic population. This suggests that, in these individuals, congenital peripheral factors rather than impaired cortical development may be responsible for decreased unilateral acuity.