Differentiating retinal from optic nerve syndromes

Differentiate between optic nerve and retinal disease that share common characteristics utilizing clinical history, examination, and ancillary testing.

Autofluorescence is a quick and noninvasive test that is helpful in detecting macular edema and deposition of lipofuscin. Optical coherence tomography (OCT) is becoming an indispensable tool in detecting subtle macular abnormalities that can be missed on funduscopic examination. Multifocal electroretinogram can also help in early screening of focal macular dystrophy.

Many patients present to the ophthalmology clinic with decreased vision, and occasionally it can be difficult to find a clear cause to the vision loss. Such situations, not infrequently, require the ophthalmologist to differentiate between optic nerve and retinal diseases that can share some common characteristics. The ability to use the clinical history and examination along with additional ancillary testing including OCT, electrophysiology, and fluorescein angiography to differentiate optic nerve from retinal disease can be very helpful in formulating a differential and ultimately establishing a diagnosis.