Sir,
We would like to thank Dr Shukla for his comments related to our recent case report relating to a child with an outer retinal layer anomaly at the fovea.1 Shukla claims that we were incorrect to classify this as a full-thickness macula hole. We note that we did not claim that this was a full-thickness macular hole, and our case report highlights that the defect was only affecting the outer retinal layers,2 which when defined by Gass would fit with a stage I macula hole.
However, we agree that we were incorrect to classify this curious outer retinal layer dehiscence with macula hole nomenclature, as on reflection we agree that this is more likely to be a case of an occult optic disc pit with macular schisis. We read with interest the case series of Shukla et al's relating to the optic disc pit,3 but regret that we were unaware of this article at the time of our initial case presentation, which was submitted for publication before Shukla et al's published case series.
We are impressed that Shukla found this case of optic disc pit to be ‘open-and-shut’. Even on subsequent review of our images, we find that the optic disc is the same size as the fellow eye and this is atypical, as 79% of optic disc pits occur in discs that are larger than the fellow eye.4 Further, although the disc image (Figure 1) is suggestive of a probable disc pit temporally, the disc OCT (Figure 2) does not clearly demonstrate this.
In summary, we therefore agree with Shukla that this case is probably an optic disc pit associated with macular schisis, and we are glad that their management would have been similar and indeed the patient has done well post-operatively. We do, however, feel that this case is not that typical, and overall there remains more to be learnt about optic disc pits and macular schisis. Hopefully, more information will be obtained about optic disc pits from the planned UK prospective study in association with the British Ophthalmic Surveillance Unit.
References
Shukla D . Optic pit with macular schisis: subtle but discernible. Eye 2013; 27 (10): 1218–1219.
Park JC, Frimpong-Ansah KN . Idiopathic macular hole in a child. Eye 2012; 26: 620–621.
Shukla D, Kalliath J, Tandon M, Vijayakumar B . Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence. Retina 2012; 32: 1337–1342.
Brown GC, Shields JA, Goldberg RE . Congenital pits of the optic nerve head II. Clinical studies in humans. Ophthalmology 1980; 87: 51–65.
Acknowledgements
We would like to thank Mr CK Patel (Consultant Ophthalmologist, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK) and Mr David Steel (Consultant Ophthalmologist, Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, Tyne and Wear, SR2 9HP) for helping to review the images related with this case.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Park, J., Frimpong-Ansah, K. Occult optic disc pit with macular schisis. Eye 27, 1219–1220 (2013). https://doi.org/10.1038/eye.2013.157
Published:
Issue Date:
DOI: https://doi.org/10.1038/eye.2013.157