Etiological analysis of pale optic disc and its association with six-month visual outcome in patients attending a tertiary care hospital: a prospective observational cohort study.

Yeshamalla Bhavana; Boddupally Soujanya; Beatrice Choppara

doi:10.51168/sjhrafrica.v7i2.2754

Authors

Dr. Yeshamalla Bhavana Senior Resident, Department of Ophthalmology, Government Medical College, Nalgonda, Telangana, India
Dr. Boddupally Soujanya Senior Resident, Department of Ophthalmology, Government Medical College, Nalgonda, Telangana, India
Dr. Beatrice Choppara Assistant Professor, Department of Ophthalmology, Government Medical College, Nalgonda, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2754

Keywords:

best-corrected visual acuity, optic atrophy, optic neuritis, pale optic disc, prospective cohort, traumatic optic neuropathy, visual outcome

Abstract

Background

Pale optic disc indicates established optic nerve damage caused by inflammatory, ischemic, traumatic, compressive, infectious, toxic, or metabolic disorders. Etiological identification is important because visual recovery varies substantially across causes.

Objectives

To determine the etiological spectrum of pale optic disc and assess its association with six-month best-corrected visual acuity outcome.

Methods

This prospective, hospital-based observational cohort study included 50 adults with optic disc pallor attending a tertiary-care ophthalmology department. Participants underwent standardized ocular examination, colour vision and visual field assessment, selected electrophysiology, laboratory investigations, and neuroimaging when indicated. Visual improvement was defined as a gain of at least one Snellen line at six months. Etiology and visual outcome were compared using Pearson's chi-square test and the Fisher-Freeman-Halton exact test.

Results

The mean age was 38.68 ± 12.09 years, and 56.0% were male. Traumatic optic neuropathy was the leading etiology (28.0%), followed by optic neuritis and tumor-related optic neuropathy (22.0% each) and primary optic atrophy (16.0%). Overall, 17 of 50 patients improved (34.0%; 95% CI, 22.4%-47.8%). Improvement occurred in 72.7% of optic neuritis cases (95% CI, 43.4%-90.3%), 54.5% of tumor-related cases (95% CI, 28.0%-78.7%), and 21.4% of traumatic optic neuropathy cases (95% CI, 7.6%-47.6%). Visual improvement differed significantly by etiology (Pearson χ²(9)=17.62, p=0.040; Fisher-Freeman-Halton exact p=0.011; Cramér's V=0.59).

Conclusion

Pale optic disc had heterogeneous causes and generally guarded visual outcomes. Optic neuritis showed the most favourable recovery, whereas established primary optic atrophy showed no improvement.

Recommendations

Early neuro-ophthalmic assessment, directed imaging, cause-specific treatment, and structured follow-up should be prioritized.

Author Biographies

Dr. Yeshamalla Bhavana, Senior Resident, Department of Ophthalmology, Government Medical College, Nalgonda, Telangana, India

is a Senior Resident in the Department of Ophthalmology at Government Medical College, Nalgonda, Telangana, India. She is involved in clinical ophthalmology services, outpatient evaluation, ocular surface assessment and academic activities. Her areas of interest include anterior segment disorders, pterygium, dry eye disease, ocular surface evaluation and comprehensive ophthalmic care.

Dr. Boddupally Soujanya, Senior Resident, Department of Ophthalmology, Government Medical College, Nalgonda, Telangana, India

is a Senior Resident in the Department of Ophthalmology at Government Medical College, Nalgonda, Telangana, India. She is involved in clinical ophthalmology practice, patient evaluation, ophthalmic diagnostics and academic work. Her areas of interest include ocular surface disease, tear film assessment, anterior segment disorders, pterygium and dry eye-related clinical research. ORCID iD: https://orcid.org/0009-0004-4677-2556

Dr. Beatrice Choppara, Assistant Professor, Department of Ophthalmology, Government Medical College, Nalgonda, Telangana, India

is an Assistant Professor in the Department of Ophthalmology at Government Medical College, Nalgonda, Telangana, India. She is actively involved in undergraduate teaching, clinical ophthalmology services, outpatient care and academic research. Her areas of interest include anterior segment disorders, ocular surface disease, dry eye evaluation, pterygium and patient-centred ophthalmic care.

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