Optic Nerve

A disease of the optic nerve in which the nerve fibers carrying the electrical impulses from the eye to the brain start to die off. In such cases the optic nerve has a pale or whitish appearance compared to the normal pink color. Optic atrophy is associated with poor reading vision and often the cause of legal blindness. May be associated with a serious medical condition and requires further medical examination to determine the cause of the atrophy. Not reversible.  See Q and A Archives section about Optic atrophy.

Nothing.  Drusen of the optic nerve are little whitish or translucent bodies of various size that are in the nonmyelinated part of the optic nerve head.   Both eyes are usually affected.  In general they are not associated with any systemic or eye conditions, so your friend's headaches and fatigue are probably unrelated.   Typically, drusen of the optic nerve cause no problems unless they're big and/or start to interfere with blood flow or compress the optic nerve fibers (rare conditions).   Their size tends to increase with age.  Since no one knows what causes drusen of the optic nerve or how they occur, your friend can probably do nothing to help the condition.

Nothing will reverse optic atrophy.  If the condition/disease that caused the optic atrophy is identified and corrected, if possible, then the optic atrophy and associated vision loss may not worsen.  Whenever a patient is identified with optic atrophy, it is very important that the cause of the atrophy be identified.  Often, extensive laboratory tests and imaging tests (MRI, CT scan) are used to help identify the reason for the optic atrophy and associated loss of vision.   Unfortunately, particularly in infants and young children, the cause of the optic atrophy is sometimes never identified.

Papilledema, also called chocked disk, is a swelling (edema) of the optic nerve disk - that part of the optic nerve that the eye doctor can see when looking in the back of the eye.  The optic nerve runs from the eye to the early visual centers of the brain.  Papilledema is usually caused by an increase in intracranial pressure (pressure inside the head/brain), obstruction of the central retinal vein or malignant hypertension.  The presence of papilledema is never a good sign and often requires extensive testing to determine the exact cause.   Sometimes the cause of the papilledema is never found.  Also go to pseudo tumor for more information.

Retrobulbar neuritis is an inflammation behind the eye of the optic nerve.  It is essentially an optic (nerve) neuritis which does not show-up in the eye itself.  Treatment depends on the cause of the optic neuritis.   However, in the majority cases the optic neuritis is associated with multiple sclerosis (MS).  The treatment for optic neuritis is limited. 

A scotoma is an area of reduced vision in one or both eyes.  A scotoma can take-on almost any appearance, and the shape sometimes reflects the disease or cause of the scotoma (see Simulations).  In your case, the scotoma is shaped like a crescent - something like a crescent of the moon.  It is likely off to the side - in your peripheral visual field.  A crescent scotoma is sometimes seen in retinal diseases.  As a rule-of-thumb, if you see the scotoma only in one eye then the cause of the scotoma or disease process is within the affected eye (retina) or along the early part of the optic nerve (before the optic chiasm) in the affected eye.  If the scotoma is present in both eyes and looks very similar in each eye, then it is likely that the cause or disease process is in the brain at the optic chiasm or further back along the visual pathways.  [Note: the optic chiasm is where the optic nerves from the two eyes cross and, more or less, join together.  Thus, anything that happens to the visual system that occurs at or after the optic chiasm almost always affects both eyes to more or less the same extent.  Conversely, anything that happens along the visual pathways before the optic chiasm most likely affects one eye.]  However, as the disease process progresses, like in a retinal degeneration that affects both eyes, eventually both eyes will become affected, even though the disease process is at the retinal or eye level on the visual system.

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