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A 34 year old woman is referred because a superior nerve fiber bundle visual field defect was found in the left eye on a routine optometric examination. Visual acuities are normal in both eyes, but there is an afferent pupil defect in the left eye. The right optic fundus appears normal. This is what the left optic fundus shows.

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    The diagnosis is

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    This cavity in the inferior portion of the optic disc is a congenital anomaly, perhaps a mild form of optic disc coloboma. Because the cavity has no retinal ganglion cell axons, the patient will manifest a corresponding nerve fiber bundle visual field defect, which may be the abnormality that brings this condition to medical attention. Often confused with glaucoma, it may generate fruitless intraocular pressure-lowering treatment. The cavity and the visual field are stationary. There may be an associated serous detachment of the macula.