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Edward Bloch, Odysseas Georgiadis, Marko Lukic, Lyndon daCruz; Optic disc pit maculopathy: a retrospective natural history study of the characteristics and clinical course. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3152.
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© ARVO (1962-2015); The Authors (2016-present)
There is currently no consensus on the optimal management of optic disc pit (ODP) maculopathy and existing literature on the natural history of the disease is limited. We designed a retrospective, observational clinical study to examine the baseline characteristics and long-term visual outcomes of monitored patients with serous macular detachment and/or macular schisis associated with congenital ODP.
A medical records review identified patients who presented at Moorfields Eye Hospital with new or existing ODP maculopathy within the last 15 years. Identified patients were divided in four groups according to duration of available follow-up. Groups A: 6-24 months, B: 2-5 years, C: 5-10 years and D: more than 10 years. Data collection included baseline patient demographics, laterality, ODP physiognomy and visual acuity (VA). Regression analyses were performed on a square root transformation of logMAR VA to estimate correlations with baseline characteristics.
65 eyes of 65 patients (43 females; 26 right eyes) with a mean (±SD) age of 42.1 (±20.6) were identified and divided into the four groups. Mean (±SD) duration of follow-up was 64.9 (±81.4) months and median 28.1 months. The mean (±SD)/median change in logMAR VA from baseline was 0.15 (±0.30)/0.05 for group A, 0.09 (±0.30)/0.00 for group B, 0.01 (±0.17)/0.00 for group C and 0.17 (±0.55)/0.00 for group D (figure 1). No statistical significant associations were found between age, gender, ethnicity, laterality, pit size or location and change in VA.
Our results suggest potential long-term stability of VA despite macular involvement. The variance and the discrepancy between mean and median VA in groups A, B and D suggest that there is a subgroup of patients whose vision deteriorates, but no significant associations were identified with subject demographics or optic disc pit physiognomy in this study. Our results challenge the current trend, which considers surgical treatment as the first-line option for ODP maculopathy, and instead we propose vigilant observation to detect patients who decline to poor vision, who are more likely to benefit from intervention. Prospective case-control studies are required to identify causality and allow risk-stratification of cases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Figure 1: Change in VA (logMAR): 1st quartile, median and 3rd quartile (box), minimum and maximum (whiskers), outlier (rhombus) and mean (cross)
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