a congenital anomaly , optic nerve pit is often ( 50% ) associated with serous retinal detachment which can lead to vision loss over time.1 the advent of optical coherence tomography ( oct ) has provided evidence in support of a schisis cavity progressing to involve the outer retinal layers in patients with optic nerve pits.25 our case report depicts atrophy of the outer retina in a patient with an optic nerve pit highlighted on spectral - domain oct ( sd - oct ) and fundus autoflourescence ( faf ) imaging . an 80-year - old male presented for a routine follow up for dry age - related macular degeneration ( amd ) . fundus examination revealed the presence of a temporal optic nerve pit od ( figure 1 ) , with pigmentary changes and fine drusen in the macula ou . sd - oct ( spectralis ; heidelberg engineering , heidelberg , germany ) sections through the pit demonstrate excavation in the optic nerve ( figure 2a ) . in addition , an area of outer retinal atrophy is noted adjacent to the optic nerve pit with preservation at the fovea ( figure 2b ) . no communication between the pit and the adjacent retina was identified on high resolution scanning . retinal thickness mapping using automated analysis highlighted an area of retinal thinning that extended inferior temporally from the pit ( figure 3a ) . hyperflourescence was present on faf ( spectralis ; heidelberg engineering ) imaging in the area of retinal thinning ( figure 3b ) . mp-1 ( nidek , gamagori , japan ) revealed significant reduction in threshold in this region , with preserved function at the fovea and sparing of retina superiorly ( figure 3c ) . sixty - three percent of optic nerve pits are temporal with the natural history of associated serous maculopathy resulting in vision loss over time.1 in one report , 80% of patients had a final visual acuity of 20/200 or worse , with an average follow - up of nine years.2 subsequently , oct findings have illustrated the connection between the serous detachment and optic nerve pit and confirmed the presence of a schisis cavity , which has been proposed to develop secondarily.35 in our case , spectralis oct showed preservation of photoreceptor outer segments at the fovea which correlated with normal threshold values on microperimetry and preserved snellen visual acuity . outer retinal thinning , marked by discontinuity of the inner segment  outer segment ( is  os ) line , was seen adjacent to the optic nerve pit , in an area of prior serous detachment . a recent case report describes retinal nerve fiber layer thinning ( rnfl ) in the papillomacular bundle in a young patient without corresponding changes on goldman visual field testing.5 however , data from mp-1 testing , in our case , confirm the relationship between photoreceptor loss and scotoma development , with preservation of the rnfl in this region . it has been hypothesized that vitreous is a source of the schisis fluid and vitrectomy has been advocated as a treatment modality to collapse the schisis.6,7 however , in our case , we could not neither demonstrate any vitreous syneresis overlying the pit nor observe any kind of communication between the pit and the subretinal space . faf imaging revealed hyperflourescence in the area of the scotoma , indicating the accumulation of lipofuscin.8 spectralis oct did not demonstrate defects in the underlying retinal pigment epithelium , suggesting the pathology is limited to the retina . in conclusion , our report describes consecutive outer retinal atrophy in vivo with corresponding reduction in functional testing but preserved central vision in a patient with an optic disc pit .
a congenital anomaly , optic nerve pit is often associated with serous retinal detachment involving macula . 
 long standing serous detachment leads to outer retinal atrophy and decrease in visual sensitivity . recently 
 , spectral - domain optical coherence tomography ( oct ) has been reported to demonstrate a communication between the optic nerve sheath and the subretinal space . 
 vitreous cavity is proposed as an alternate source of fluid for accumulation in the subretinal space . 
 we imaged a patient with optic nerve pit with spectralis oct and report the findings seen including the presence of an area of peripapapillary retinal atrophy , due to the spontaneous resolution of associated long - standing retinal detachment .