SEMINAR

APPLIED ANATOMY OF VISUAL PATHWAY MOERATOR-Dr. SUJATA LAKHTAKIA

Dr. SYED IMRAN

INTRODUCTION

The afferent visual pathway which is responsible for mapping the external world into our consciousness begins with the anterior segment and via the retina, optic nerve, optic chiasm, optic radiations end in the visual cortex.

INTRODUCTION

Components of afferent visual pathway : Retina - Rods and Cones Bipolar cells Ganglions cells Optic nerve (Ganglion cell axons) Optic chiasm Optic tracts Lateral geniculate body Optic radiations Visual cortex

INTRODUCTION

OPTIC NERVE

The optic nerve is formed by the axons of the ganglion cells . It represents the second order neurons of the visual pathway.

80% of the fibers originate from the macular region which represents 90% of retinal ganglion cells.
There are 2.2 to 2.4 million fibers in the two optic nerves representing 42% of all fibers entering and leaving the cns.

OPTIC NERVE

The optic nerve is not really a nerve .it is actually a tract ( a part of cns). Its axons are myelinated by oligodendrocytes and not schwan cells.

OPTIC NERVE

Humans have two types of retinal ganglion cell system. P cell system M cell system

OPTIC NERVE

P cell system : 90% of ganglion cells Small cells (small receptive fields) Small caliber axons (slow conduction) Concentrated in macula Project in parvocellular layer of LGN(3,4,5,6) Mediate spatial resolution and color perception

OPTIC NERVE
M cell system 10% of ganglion cells Large cells (large receptive field) Large caliber axons (fast conduction) Concentrated in perepheral retina Project in magnocellular layers of LGN (1,2) Mediate motion detection This explains in part the high sensitivity we have for light and motion detection (fast transmition) while color detection is slow.

OPTIC NERVE

Koniocellular pathway : Smallest ganglion cells (W cells in cat) Very large receptive fields Terminate in the interlaminar zone and superfical layer of LGN Functions not known

OPTIC NERVE

OPTIC NERVE

Divisions of optic nerve Intraocular portion (in the globe) Intraorbital portion ( in the muscle cone) Intracanalicular portion ( in the optic canal) Intracranial portion (in the cranial cavity)

OPTIC NERVE

Dimensions of optic nerve (in mm) LENGTH 1.0 25 DIAMETER 1.5 to 1.75 3 to 4

SEGMENT Intraocular Intraorbital

Intracanalicular
Intracranial

4 to 10
10

3 to 4
4 to 7

OPTIC NERVE

Intraocular portion It is the shortest portion (1mm) It extends from superficial nerve layer to the posterior margin of sclera The nerve fibers are non myelinated

It can be divided into Superficial nerve fiber layer Pre laminar region Laminar region Retrolaminar region

OPTIC NERVE

Superficial nerve fiber layer made up of axons of ganglion cells

It is

Temporal fibers Nasal fibers

Papillomacular bundle

NERVE FIBRE LAYER ANALYSIS

Technique : Fundus examination(Green light) Confocal scanning technique OCT Scanning laser polarimetry

OPTIC NERVE

Prelaminar portion It extends from the surface of the optic disc to the posterior margin of the choroid. It can be further divided into -Pars retinalis -Pars choroidalis

OPTIC NERVE

Optic disc or Optic nerve head:

The optic nerve head is a 'plug-hole' down which over 1 million nerve fibers descend through a sieve-like sheath known as the lamina cribrosa It is -Oval -Horizontally1.5mm -Vertically 1.75 mm

OPTIC NERVE

Arrangement of nerve fibers within the optic nerve head:

Peripheral retinal fibers superficial

Central retinal fibers deep

OPTIC NERVE

OPTIC NERVE

Laminar portion (pars scleralis) It is enclosed in the scleral canal Scleral canal is 0.5mm long Lamina cribrosa It is a sieve like connective tissue meshwork integrated with the sclera It has 10 connective tissue plates with 200 to 300 pores They transmit axonal bundles

OPTIC NERVE

Retrolaminar portion posterior to pars scleralis

Just

Fibers get myelinated by oligodendrocytes causing a doubling of the thickness of the nerve to 3mm Nerve gets surrounded by menengial sheaths

OPTIC NERVE

Intra orbital portion It extends from the back of the eye to the optic canal It runs backwards and medially 25 to 30 mm long 3 to 4 mm thick

This length is far more than the distance between the back of globe and optic canal which is 18mm

OPTIC NERVE
For this reason the nerve is slack or S shaped in primary position It allows eye movements without stretching

OPTIC NERVE
Annulus of zinn It is a tough fibrous sheath Located at the orbital apex Gives origin to the four recti Because superior and medial recti partly originate from the nerve sheath itself inflammatory optic neuropathy may be associated with pain on ocular movements

OPTIC NERVE

Intracanalicular portion Optic canal is -8 to 10 mm long -5 to 7 mm wide It runs superiorly and medially

The optic nerve passes through the canal accompanied by opthalmic artery (inferiorly ) and sympathetic nerves

OPTIC NERVE

The nerve inside the canal is immobile and fixed This makes it highly vulnerable to injury by blunt trauma Optic nerve edema in this area can produce compartment syndrome further causing nerve damage

OPTIC NERVE

Intracranial portion Its length varies from 5 to 16 mm Average 10mm Diameter 4.5mm It is not covered by menenges It is related bellow and temporally to the anterior loop of internal carotid artery The anterior cerebral artery crosses over the nerve It terminates in the chiasm

OPTIC NERVE

At its intracranial exit the optic nerve passes under a fold of dura ( Falciform ligament ) that may impinge on the nerve, especially if it is elevated by lesion of sphenoid or sella.

OPTIC CHIASM

OPTIC CHIASM

It is a junction at which the two optic nerves join to allow hemidecussation of nasal fibers to opposite optic tracts and the direct passage of temporal fibers to the ipsilateral optic tracts.

Thus, all visual information from the right visual space is transmitted to left cerebral cortex and vice versa.

OPTIC CHIASM

It is 12 8 4mm in size Situated 10mm above the pituitary and seperated from it by the suprasellar cistern

It is related-- laterally to the supraclinoid segment of carotid arteries -- inferolaterally to the cavernouss sinuses It has an inclination of 45to the horizontal

OPTIC CHIASM
1.Optic nerve 2.Optic chiasma 3.Optic tract 4.Tuber cinereum 5.Mamillary bodies 6.Anterior perforated substance 7.Olfactory trigone 8.Pons 9.Uncus

Upper nasal fibers Macular fibers Lower nasal

Third ventricle Craniopharangioma Chiasm Diphragma sellae

Anterior clenoid Pituitary

Posterior clenoid

Dorsum sellae

OPTIC CHIASM

Chiasmal nerve pathways Lower nasal :Pass low and anterior More vulnerable to damage by pituitary lesion Wilibrands knee : Some inferonasal fibers loop forwards into the contralateral optic nerve It may be affected in lesions of the terminal part of optic nerve

OPTIC CHIASM
Upper nasal : Pass high and posteriorlly They are involved in lesions above the chiasm Macular fibers : decussate throughout the chiasm

LESIONS OF OPTIC CHIASM

Anterior Chiasmal Lesions Damage to ipsilateral optic nerve and Knee of Wilibrand
RE LE

Rt Anterior Chiasmal lesion

VISUAL FIELD DEFECTS IN PITUITARY ADENOMAS

LE RE HM CF

Decussating fibers are most vulnerable

VISUAL FIELD CHANGES IN

CRANIOPHARANGIOMA
LE RE CF HM

Posterior crossing fibers most vulnerable

Meningioma
LE RE Junctional scotoma Tuberculum Sella meningioma

Sphenoid ridge meningioma Olfactory groove meningioma

OPTIC CHIASM

Anatomical variations : Variations in the length of optic nerve alters the relative position of the chiasm to the sellar structures Central 80%

Prefixed--10%
Postfixed 10%

CENTRAL 80%

PREFIXED 10%

POSTFIXED 10%

OPTIC TRACTS

OPTIC TRACTS
Each optic tract contains ipsilateral temporal and contralateral nasal fibers They wind round the cerebral peduncle of the rostral midbrain and each divide into Lateral root

Medial root

OPTIC TRACTS
Lateral root : Large ( 90%) Concerned with conscious visual functions Terminates in Lateral geniculate body Medial root : Small ( 10%) Not concerned with conscious visual functions Contains six groups of fibers

OPTIC TRACTS
Termination of medial root fibers : -Superior Colliculus -three groups Visual grasp reflex Automatic scanning of images Visual association pathways -Pretectal nucleus Pupilary light reflex

OPTIC TRACTS
-Parvocellular reticular formation Arousal function in response to light -Suprachiasmatic nucleus of hypothalamus It is called Retinoypothalamic tract Photoperiod regulation Beneficial effect of sunshine on mood

OPTIC TRACTS

Arrangement of Fibers : Fibers from superior retina remain superiorly while those from inferior remain inferiorly Fibers from corresponding parts of the retina do not pair This explains the incongruous nature of visual field defects seen in optic tract lesions Magnocellular axons dominate the periphery while Parvocellular dominate the center

OPTIC TRACTS

As temporal visual is 1.5 times the size of nasal field The contralateral nasal retina supplies more axons (55% ) than the temporal retina of ipsilateral (45% ) eye This is the reason for monocular temporal crescent ( 60 to 90) in contralateral visual field caused by damage to the most anteromedial part of occipital cortex

OPTIC TRACTS

Lesions of optic tract cause incongruous homonymous hemianopia contralateral to the affected optic tract RE LE

Rt Optic tract lesion

LATERAL GENICULATE NUCLEUS

LATERAL GENICULATE NUCLEUS

It is a synaptic zone (relay center ) for higher visual projections Located in the posteroinferior part of thalamus It is divided into six layers by medulated nerve fibers Numbered 1 to 6 from below upwards Arranged in a dome shaped pattern

In the early 1960s, David Hubel and Torsten Wiesel (who won the Nobel Prize for Medicine in 1981) were the first to use microelectrodes to explore the receptive fields of the neurons in the lateral geniculate nucleus and the visual cortex

LATERAL GENICULATE NUCLEUS

Magnocellular fibers layer 1,2 Parvocellular fibers layer 3,4,5,6 Koniocellular fibers interlaminar zone superficial layers Contralateral axons layer1,4,6 Ipsilateral axons layer 2,3,5

LATERAL GENICULATE NUCLEUS

In LGN the retinal representation rotates to almost 90 Superior fibers move superomedially Inferior fibers move inferolaterally Macular fibers move superolaterally

LATERAL GENICULATE NUCLEUS

The LGN also receives inputs from cortex, reticular formation, occulomotar center, superior colliculus and pretectal nucleus The visual impulses are modified in accordance to the impulses from these centers and relayed to the visual cortex

LATERAL GENICULATE NUCLEUS

Lesions of Lateral geniculate nucleus cause incongruous homonymous hemianopia contralateral to the to the affected optic tract RE LE

Rt Optic tract lesion

OPTIC RADIATION

OPTIC RADIATIONS

Also called Geniculocalcarine tracts

These consists of nerve fiber bundles whose cell bodies lie in the LGN

They terminate in the visual cortex

OPTIC RADIATIONS

Along the radiations the fibers from corresponding retinal elements lie progressively closer together This is the reason why lesions in posterior radiations cause more congruous hemianopia than anterior

LGN

Myers loop Inferior fibers

Superior fibers

Lateral ventricle (Posterior cornu )

Visual cortex

LESIONS OF OPTIC RADIATIONS

Temporal Lobe (Myers loop) : Conralateral superior wedge shaped incongruous homonymous hemianopia (Pie in the sky defect ) sparing the central vision

LESIONS OF OPTIC RADIATIONS

Parietal lobe : Conralateral inferior wedge shaped incongruous homonymous hemianopia sparing the central vision

LESIONS OF OPTIC RADIATIONS

Main radiations : Complete homonymous hemianopia on contralateral side

VISUAL CORTEX

VISUAL CORTEX

It can be divided into 1.Primary visual area ( V1, Area 17, striate cortex ) 2. Secondary visual areas -Area V2 ( Area 18 , Parastriate cortex) -Area 19 (Peristriate cortex) -Area V3a and Area V3 -Area V4 -Area V5 ( MT ) -Area V6

VISUAL CORTEX

To date, researchers have discovered nearly 30 different cortical areas that contribute to visual perception

VISUAL CORTEX

Primary visual cortex ( Area 17 ) -Also called striate cortex because of prominent white bands of fibers the stria of Gennari -Located within the depths of calcarine sulcus -Envelops the posterior pole upto 1.5 cm

- Measures 20 to 45 sqcm

VISUAL CORTEX

Projection of fibers -Superior retinal Upper lip of calcarine quadrants sulcus -Inferior retinal Lower lip of calcarine quadrants sulcus -Macular fibers Posterior most portion of cortex

VISUAL CORTEX

50 to 60 % of visual cortex responds to central 10of retina and 80% of the cortex to central 30 of retina

VISUAL CORTEX
Hitologically it has 4 different layers Layer 4 is most cellular Called the internal granular layer Optic radiations mainly terminate this layer The predominant cell type not being pyramidal but small stelate It is further subdivided into 4a,4b and 4c Magnocellular inputs 4c alpha Parvocellular inputs 4c beta

VISUAL CORTEX

The cells of Lamina 2,3 Secondary visual cortex Lamina 5 Superior colliculus Lamina 6 LGN

VISUAL CORTEX

Secondary visual areas : Nonstriate cortex They are Visual association areas They lie above and bellow the Area 17 and extend into the lateral surfaces of the cortex They show the usual six layers but layer 4 is less extensive

They receive inputs from area 17, thalamus, basal ganglia, and other areas of cortex

VISUAL CORTEX

There connections mainly fallow Dorsal and Ventral pathways Dorsal outputs (Magnocellular ) V5 in parietal cortex Stereopsis and movement detection Ventral output (Parvocellular ) to V4 in inferotemporal cortex Analysis of color and form

VISUAL CORTEX

Area V2 : Parastriate cortex or Area 18 Located adjacent to Area 17 Connected to V1, V3 of same side and V1 and V2 of opposite Also connects to other areas of cortex and mid brain It is a site of integration of information

VISUAL CORTEX
Area V3 andV3a : In lunate and parietooccipital sulci They are sensitive to motion and direction Area V4 : Located in lingual and fusciform gyrus Sensitive to color Area V5 : Located anterior and lateral to area V4 Highly sensitive to speed and direction of moving stimulus

LESIONS OF OPTIC RADIATIONS AND VISUAL CORTEX

Anterior visual cortex dysfunction Caused by PCA occlusion Contralateral Congruous homonymous hemianopia With Macular sparing

Macular Cortex lesion Severe hypotension Contralateral Homonymous hemianopia involving only the Fixation region

Contralateral Monocular temporal crescent is seen in lesions of the most anteromedial part of the visual cortex

BLOOD SUPPLY

BLOOD SUPPLY

The blood supply of optic nerve varies from segment to segment The central retinal artery : Branch of ophtalmic artery It enters the optic nerve 10-12mm behind the globe It divides into superior and inferior arcades

BLOOD SUPPLY

Intraocular Optic nerve Nerve fiber layer Central retinal artery Prelaminar Nerve Short post ciliary Recurrent choroidal arteries Laminar Nerve Short post cillary arteries Branches from circle of Haller and Zinn Retrolaminar Nerve Pial Short post cillary arteries

BLOOD SUPPLY
Intraorbital Part : Proximally Pial vascular network Branches of Opthalmic artery Distally Intraneural branches of CRA Most anteriorly Post cillary arteries

BLOOD SUPPLY

Intracanalicular part Opthalmic artery Intracranial part Internal carotid arter Opthalmic artery OPTIC CHIASM Sup hypophysial artery Internal carotid artery Post communicating artery Ant cerebral artery Ant communicating artery

BLOOD SUPPLY

OPTIC TRACT Ant chorotdal artery (br of ICA) LATERAL GENACULATE NUCLEUS Ant choroidal artery Posterolateral choroidal artery ( br of PCA)

BLOOD SUPPLY

OPTIC RADIATIONS Commencement Ant choroidal arteries Posterior fibers Lateral striate (deep optic) branches of PCA

VISUAL CORTEX Penetrating branches of Cortical arteries mainly Calcarine and parieto-occipital branches of PCA Anastamosis between MCA and calcarine artery

REFERENCES
Ophthalmology, 2nd edition : Yanoff & Duker Clinical Neuroophthalmology :Walsh & Hoyts American academy of ophthalmology :Basic and clinical science course Clinical Ophthalmology : Kanski Parsons basic diseases of the eye : Radhika Tandon, Ramanjeet Sihota ; 20th edition Clinical Ophthalmology : A.K. Khurana ; 3rd edition Anatomy and Physiology of Eye: A.K. Khurana 2nd ed.

Thank You

DEVELOPMENT OF OPTIC NERVE

DEVELOPMENT OF OPTIC NERVE

It develops from the optic stalk that connects the optic vesicle and fore brain The optic stalk is Fluid filled tube Lined by Neuroectoderm It has two separate regions Distal crescent shaped invaginated segment (choroidal fissure) Proximal non invaginated circular segment

DEVELOPMENT OF OPTIC NERVE

At the 6th week (17mm stage) nerve fibers begin to grow and the embryonic cleft begins to close

DEVELOPMENT OF OPTIC NERVE

This results in a double layer of neuroectoderm with obliteration of the fluid filled cavity The invagination process leads to incorporation of hyaloid vessels and surrounding mesenchyme

DEVELOPMENT OF OPTIC NERVE

The ganglion cell axons run through the inner neuroectodermal layer towards the brain At about the end of 6th week, optic nerve fibers penetrate the under surface of forebrain, in 7th week optic chiasm is formed, and at 9thweek optic tracts are formed. The outer neuroectodermal layer differentiate into peripheral glial mantle and glial components of lamina cribrosa

DEVELOPMENT OF OPTIC NERVE

Initially there is increase in the number of axons 10 to 12 wks 1.9 million 16th wk 3.7 million Later attrition of axons occur 33rd wk - 1.1 million Myelination Begins in the LGN 5th month of gestation Reaches Chiasm - 6 to 7th month of gestation Lamina cribrosa Term

APPLIED ANATOMY

CONGENITAL ANOMALIES

Prepapillary loop : vascular loop extending from the disc margin into vitreous cavity

CONGENITAL ANOMALIES

Bergmeister papilla : This cone shaped mass of tissue derived from the retinal cells is present at the presumptive optic disc during fetal life It involutes during development The degree of atrophy determines the depth of physiological cup -Complete atrophy Deep cup -Moderate atrophy Shallow cup -Minimal atrophy -Substantial glial elements present on cup called persistent Bergmeister papilla

CONGENITAL ANOMALIES

CONGENITAL ANOMALIES

Medulated nerve fibers Seen in 0.3 to 0.6 % population Whitish patch with feathery margins usually adjoining the disc margins

CONGENITAL ANOMALIES

Tilted disc : This occurs due to oblique entry of optic nerve into the globe

CONGENITAL ANOMALIES

Optic disc pits : Herniation of dysplastic retina into the nerve substance Round to oval grey white depression in the disc usually temporally

CONGENITAL ANOMALIES

Optic nerve hypoplegia Decreased number of axons with normal mesodermal components Small pale disc with surrounding double ring

sign

CONGENITAL ANOMALIES

Megalopapilla : optic disc (>2mm)with large CD ratio

Large

CONGENITAL ANOMALIES

Optic disc Coloboma : An inferior segmental form of optic nerve hypoplasia. Disc appears enlarged with a sharply demarcated glistening white bowl shaped excavation.

Inferior rim thinner ; only remaining neural tissue lies superiorly in a C shaped / Moon shaped crescent. neural tissue lies superiorly in a C shaped / Moon shaped crescent

OPTIC DISC DRUSENS

BURRIED

EXPOSED

CONGENITAL ANOMALIES

MORNING GLORY SYNDROME this is unilateral congenital anomaly, with enlarged and excavated disc with annular pigmented retinal tissue around it.

PAPILLEDEMA

Optic disc edema, usually bilateral resulting from raised ICP. Purely hydrostatic, non-inflammatory phenomenon, Pathophysiology; blockage of axoplasmic transport along with edema and vascular congestion.

EARLY

FULLY DEVELOPED

CHRONIC

OPTIC NEURITIS

Optic neuritis: Inflammatory, infective or demyelinating process affecting the optic nerve. Classified as Papillits Neuroretinitis Retrobulbar neuritis

PAPILLITIS

NEURO RETINITIS

OPTIC ATROPHY

Condition of the disc following degeneration of the optic nerve. Primary Optic Atrophy: Lesions affecting the visual pathway from the retrolaminar portion of the optic nerve to the LGB. No ophthalmoscopic evidences of previous local inflammation

OPTIC ATROPHY

Secondary or Postneuritic optic atrophy: Follows an injury or direct pressure affecting the visual nerve fibers in any part from lamina cribrosa to LGB, preceded by swelling of optic nerve head.

PRMARY Pale Flat disc Distinct margins

POSTNEURITIC
Dirty grey disc Indistinct margins

REFERENCES

OPTIC NERVE

Meningial sheaths are supplied by sensory nerves, which account in part for the pain experienced by patients inflammatory optic nerve diseases

with

OPTIC NERVE

Microglia They are immune derived cells

Protect the optic nerve from infections

Apoptosis of ganglion cells which occur in various diseases and during development is modulated by these cells

OPTIC NERVE

Oligodendrocytes These are specialized glial cells Provide myelination to axons In up to 0.6% myelination may extend to the peripapillary retinal nerve fiber layer

OPTIC NERVE

Meningial sheaths Pia mater Arachnoid mater Dura mater Pia mater It is the inner most layer It sends numerous septa into the nerve dividing the nerve axons into bundles These septa continue throughout the nerve and end just before the chiasm

OPTIC NERVE

Dura mater Anteriorly it fuses to the outer layer of sclera Posteriorly it splits at the orbital opening, majority continuing around the optic nerve and a thin portion blending with the periostium around the optic canal This completely immobilizes the nerve Blunt trauma to brow area may transmit forces to this area causing tear between dural sheath and its attachment .This leads to interruption of blood vessels and severe nerve damage

OPTIC NERVE

Arachnoid mater It is connected to the pia across the subarachnoid space by vascular trabeculae The subarachnoid space ends anteriorly at the lamina cribrosa and posteriorly it is continious with the subarachnoid space of the brain The central retinal vessels cross the subarachnoid space and are therefore vulnerable particularly the vein in case of raised ICT

OPTIC NERVE
Astrocytes These are specialized glial cells They have extensive neurofibrilary processes spread among nerve fibers

Functions : Forms blood brain barrier Provide nutrition and support to axons When axons are lost they proliferate and fill the empty space

Formation