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Epidemiology of the optic nerve grey crescent in the Reykjavik Eye Study

¹ Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden
² University of Ottawa Eye Institute and Ottawa Health Research Institute, Ottawa, Canada
³ Department of Ophthalmology, University of Iceland, Reykjavik, Iceland
⁴ Department of Physiology, University of Iceland, Reykjavik, Iceland
⁵ Kanazawa Medical University, Uchinada, Japan

Correspondence to:
Correspondence to:
Karim F Damji
University of Ottawa Eye Institute, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6; kdamji{at}ohri.ca

Aim: To establish the epidemiology of the grey crescent in a white population within the age range most susceptible to glaucoma.

Methods: Bruce Shields was first to use this term to describe a localised, physiological pigmentation of the optic nerve neuroretinal rim tissue that is distinct from peripapillary pigmentation. An experienced glaucomatologist (KFD) evaluated stereofundus photographs of the participants of the Reykjavik Eye Study (RES)—a random sample from the national population census including people 50 years and older. 1012 right eyes could be evaluated for grey crescent.

Results: The prevalence of grey crescent in the right eyes was 22.0% (95% CI 10 to 25). It was more commonly found in women (27.0%: 95% CI 23 to 30) than in men (17.0%: 95% CI 14 to 21), and was most often located temporally (36.9%), 360° (15.9%), or nasally (15.4%). The spherical equivalent was +1.30 dioptres (D) for those with and +0.80 D for those without grey crescent (p = 0.002), respectively. Vertical optic disc diameters were 0.203 v 0.195 units (p<0.001). There was no difference in the prevalence of grey crescent in glaucomatous or non-glaucomatous eyes (OR = 1.05, 95% CI 0.49 to 2.26). The prevalence of a grey crescent was inversely related to the prevalence of peripapillary atrophy (p = 0.001).

Conclusions: The grey crescent needs to be recognised as a physiological variant in order to avoid falsely labelling eyes as having glaucomatous optic nerve damage.

Abbreviations: PPA, peripapillary atrophy; RES, Reykjavik Eye Study

Keywords: optic disc; glaucoma; neuroretinal rim; parapapillary atrophy; grey crescent

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