Purpose: To present an association between acquired pits of the optic nerve (APON) and prior laser-assisted in situ keratomileusis (LASIK). Materials and methods: A retrospective case series of patients with an optic disk pit on clinical exam and a history of LASIK. Spectralis Optical Coherence Tomography images and Humphrey Visual Fields were reviewed from prior visits. Extended-depth optical coherence tomography was performed of the optic nerve head at subsequent visits after patients were identified. Results: Seven patients, aged 45–73 years, were identified each with unilateral optic disk pits. Optic disk pits were located inferior in six patients and centrally in one patient. All demonstrated thinning on optical coherence tomography and six patients had corresponding visual field defects. Four patients identified these defects after their LASIK procedure while two patients were unaware of their reproducible visual field defects. All patients were treated with drops initially. One patient underwent laser trabeculoplasty, and three underwent a trabeculectomy after demonstrating progression on maximum tolerated medical therapy. Conclusion: This series describes a possible association between LASIK and APON. Given the similarity and severity of vision loss associated with the optic nerve pits in these patients after LASIK, increased awareness and caution is suggested while considering LASIK in susceptible individuals.
Choi YJ, Lee EJ, Kim BH, et al. Microstructure of the optic disc pit in open-angle glaucoma. Ophthalmology 2014;121(11):2098–2106.e2. DOI: 10.1016/j.ophtha.2014.06.005.
Lee SH, Lee EJ, Kim TW. Structural characteristics of the acquired optic disc pit and the rate of progressive retinal nerve fiber layer thinning in primary open-angle glaucoma. JAMA Ophthalmol 2015;133(10):1151–1158. DOI: 10.1001/jamaophthalmol.2015.2453.
Moghimi S, Zangwill LM, Manalastas PIC, et al. Association between lamina cribrosa defects and progressive retinal nerve fiber layer loss in glaucoma. JAMA Ophthalmol 2019;137(4):425–433. DOI: 10.1001/jamaophthalmol.2018.6941.
Nduaguba C, Ugurlu S, Caprioli J. Acquired pits of the optic nerve in glaucoma: prevalence and associated visual field loss. Acta Ophthalmol Scand 1998;76(3):273–277. DOI: 10.1034/j.1600-0420.1998.760304.x.
You JY, Park SC, Su D, et al. Focal lamina cribrosa defects associated with glaucomatous rim thinning and acquired pits. JAMA Ophthalmol 2013;131(3):314–320. DOI: 10.1001/jamaophthalmol.2013.1926.
Faridi OS, Park SC, Kabadi R, et al. Effect of focal lamina cribrosa defect on glaucomatous visual field progression. Ophthalmology 2014;121(8):1524–1530. DOI: 10.1016/j.ophtha.2014.02.017.
Fazio MA, Johnstone JK, Smith B, et al. Displacement of the lamina cribrosa in response to acute intraocular pressure elevation in normal individuals of African and European descent. Invest Ophthalmol Vis Sci 2016;57(7):3331–3339. DOI: 10.1167/iovs.15-17940.
Yan DB, Coloma FM, Metheetrairut A, et al. Deformation of the lamina cribrosa by elevated intraocular pressure. Br J Ophthalmol 1994;78(8):643–648. DOI: 10.1136/bjo.78.8.643.
Ohno-Matsui K, Akiba M, Moriyama M, et al. Acquired optic nerve and peripapillary pits in pathologic myopia. Ophthalmology 2012;119(8):1685–1692. DOI: 10.1016/j.ophtha.2012.01.047.
Quigley H, Arora K, Idrees S, et al. Biomechanical responses of lamina cribrosa to intraocular pressure change assessed by optical coherence tomography in glaucoma eyes. Invest Ophthalmol Vis Sci 2017;58(5):2566–2577. DOI: 10.1167/iovs.16-21321.
Vetter JM, Schirra A, Garcia-Bardon D, et al. Comparison of intraocular pressure during corneal flap preparation between a femtosecond laser and a mechanical microkeratome in porcine eyes. Cornea 2011;30(10):1150–1154. DOI: 10.1097/ICO.0b013e318212110a.
Zhao H, Ai Y, Niu C, et al. Research on influences of transient high IOP during LASIK on retinal functions and ultrastructure. J Ophthalmol 2009;2009:230528. DOI: 10.1155/2009/230528.
Hwang ES, Stagg BC, Swan R, et al. Corneal biomechanical properties after laser-assisted in situ keratomileusis and photorefractive keratectomy. Clin Ophthalmol 2017;11:1785–1789. DOI: 10.2147/OPTH.S142821.
Seah SK, Prata Jr JA, Minckler DS, et al. Hypotony following trabeculectomy. J Glaucoma 1995;4(2):73–79. DOI: 10.1097/00061198-199504000-00002.