Korean J Ophthalmol.  2019 Apr;33(2):173-180. 10.3341/kjo.2018.0084.

Development of Optic Disc Torsion in Children

• Kim JA
• Kim TW
• Lee EJ
• Hwang JM

• KMID: 2442622
• DOI: http://doi.org/10.3341/kjo.2018.0084

Abstract

PURPOSE
To document the development of disc torsion.
METHODS
Consecutive disc photographs obtained at an interval of at least 1 year were reviewed retrospectively in 173 eyes of 173 Korean children. The angle of the vertical disc axis (AVDA) was measured in each fundus photograph with the fovea-disc center axis set at 0°. The associated change in the morphology of the optic disc was assessed by measuring the ratio of the horizontal to vertical disc diameters and the ratio of the maximum parapapillary atrophy width to vertical disc diameter. Eyes were divided into two groups with respect to the development of disc torsion: torsion and non-torsion group. Progressive torsion was defined as a change in AVDA between baseline and follow-up photographs beyond the coefficient of intraobserver repeatab ility. Factors associated with optic disc torsion were evaluated using logistic regression analysis.
RESULTS
Mean subject age and refractive error at the time of baseline fundus examination were 6.8 ± 1.7 (range, 2 to 11) years and 0.2 ± 2.6 (range, −6.0 to +5.5) diopters, respectively. Mean follow-up period was 44.8 ± 21.1 (range, 12 to 103) months. Forty-two eyes (24%) were classified as torsion group who showed changes in AVDA that were greater than the intraobserver measurement variability (4.5°) during the follow-up period. The development of optic disc torsion was associated with greater myopic shift, a decrease in horizontal to vertical disc diameters, and an increase in parapapillary atrophy width to vertical disc diameter.
CONCLUSIONS
Progressive optic disc torsion was a common phenomenon in the children included in this study. Torsion occurred as the result of optic disc tilt in an oblique axis in most cases. The findings provide a framework for understanding torsion-related glaucomatous optic nerve damage.

Keyword

Disc tilt; Disc torsion; Optic disk

MeSH Terms

Atrophy
Child*
Follow-Up Studies
Humans
Logistic Models
Optic Disk
Optic Nerve
Refractive Errors
Retrospective Studies

Figure

• 

  Fig. 1 Measuring the vertical disc axis. (A,B) Baseline and follow-up red-free fundus photograph and disc photograph (inset). The angle of the vertical disc axis (solid line) was measured from the reference line connecting the fovea and the disc center (dashed line).

• 

  Fig. 2 Representative cases showing the development of optic-disc torsion. (A) Baseline fundus photograph of a 4-year-old girl. (B) Baseline fundus photograph of a 3-year-old girl. (C) Superior optic-disc torsion was observed 6 years later. (D) Inferior optic-disc torsion was observed 3 years later. (E) When the baseline and follow-up photographs were superimposed using the blood vessels as references, the nasal disc margin of the two photographs overlapped, indicating that the apparent torsion resulted from disc tilt on an oblique axis. (F) The disc margin of the two photographs did not overlap at any region when the two photographs were superimposed. The current disc margin is vaguely seen (arrows). (C,D) Note that the vertical disc axis (dashed line) and direction of the longest parapapillary atrophy width (black line) are approximately perpendicular.

• 

  Fig. 3 Frequency distribution of the degree of torsion. Note that inferior torsion was more common than superior torsion.

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