The Tilted Disc Syndrome

We gratefully thank Dr. Semes for his letter and observations about superior segmental optic nerve head hypoplasia. Although tilted disc syndrome (TDS) does have an association with diabetes, superior segmental optic nerve head hypoplasia has an even greater association. However, we chose not to discuss this entity because it is truly different from TDS and therefore outside the scope of our paper. The articles that Dr. Semes cites are brief, well-written overviews of this little-known condition. I highly recommend the interested reader to consult these excellent citations. Because of the number of eye findings, including inferior visual field defects, that occur in superior segmental optic nerve head hypoplasia, it is important for optometrists to be aware of this condition, if only to avoid mistaking this condition for more serious optic neuropathies and other causes of inferior visual field defects.