Optic atrophy is a pathological term referring to optic nerve shrinkage caused by the degeneration of retinal ganglion cell axons

Aetiology

Acquired causes

• Multiple sclerosis
• Papilloedema (longstanding)
• Raised intraocular pressure (e.g. glaucoma, tumour)
• Retinal damage (e.g. choroiditis, retinitis pigmentosa)
• Ischaemia
• Toxins: tobacco amblyopia, quinine, methanol, arsenic, lead
• Nutritional: vitamin B1, B2, B6 and B12 deficiency

Congenital causes

• Friedreich's ataxia
• Mitochondrial disorders e.g. Leber's optic atrophy
• DIDMOAD - the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)

Clinical presentation

• Reduced visual acuity
• Reduced contrast sensitivity
• RAPD

Investigations

• Usually involves MRI, further imaging/investigations may be indicated depending on underlying aetiology