title: Familial cavitary optic disk anomalies: clinical features of a large family with examples of progressive optic nerve head cupping.
abstract: OBJECTIVE
  To describe a multigenerational family with autosomal dominant inheritance of cavitary optic nerve head (ONH) anomalies and abnormal ONH vasculature.
  
  
  METHODS
  Description of a single family with inherited eye disease.
  
  
  METHODS
  A four-generation pedigree was investigated. Examination included visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, and ophthalmoscopy. Visual fields and fundus photography were obtained when possible.
  
  
  RESULTS
  Seventeen clinically affected individuals and two obligate carriers were identified. Most (64.7%) affected persons had bilateral involvement. Visual acuity in affected eyes ranged from 20/20 to no light perception. Although the appearance of affected nerves varied greatly, most lacked a well-formed central retinal artery and instead had multiple radial cilioretinal arteries. Prominent cupping was seen in most affected nerves. Four individuals for whom information was available were treated for glaucoma, but none had documented elevated IOP. Four eyes of two patients demonstrated progressive ONH cupping at normal IOPs. Nine (56.3%) of the 16 individuals for whom we had data had evidence of serous macular detachments; five of these had bilateral macular disease.
  
  
  CONCLUSIONS
  A large family with autosomal dominant inheritance of cavitary ONH anomalies and abnormal vasculature is presented. Clinical phenotypes varied markedly. Progressive ONH cupping was documented in four eyes of two patients. Genetic linkage analysis of this family has identified the chromosomal location of a gene responsible for ONH development. This may provide insight into the pathogenesis of glaucomatous ONH damage.
authors.affiliation: Department of Ophthalmology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Honkanen
authors.forename: Lee M
authors.initials: LM
authors.lastname: Jampol
authors.forename: John H
authors.initials: JH
authors.lastname: Fingert
authors.forename: Michael D
authors.initials: MD
authors.lastname: Moore
authors.forename: Christine M
authors.initials: CM
authors.lastname: Taylor
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Stone
authors.forename: Wallace L M
authors.initials: WL
authors.lastname: Alward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005124:Eye Abnormalities / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D005451:Fluorescein Angiography; D005799:Genes, Dominant; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000002:abnormalities* / Q000098:blood supply; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000235:genetics*; D010375:Pedigree; D012161:Retinal Artery / Q000002:abnormalities; D014786:Vision Disorders / Q000235:genetics; D014792:Visual Acuity; D014794:Visual Fields