AFFERENT VISUAL

PATHWAY
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▸The first cell in the pathway : a special

sensory cell, the photoreceptor 
converts light energy into a neuronal signal
that is passed to the bipolar cell and the
amacrine cell and then to the ganglion cell
 all these cells and synapses lie
within the retina  The axons of the
ganglion cells exit the retina via the optic
nerve, with the nasal fibers from each eye
crossing in the optic chiasm and terminating
in the opposite side of the brain  The
optic tract carries these fibers from the
chiasm to the LGN  The fibers leave the
LGN as the optic radiations  terminate
in the visual cortex of the occipital lobe
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RETINA
❑ The afferent visual pathway begins within the retina
❑ Absence of retinal receptors over the optic disc  physiologic scotoma (the blind
spot), located approximately 17° from the fovea and measuring approximately 5° ×
7°.

❑ The fovea (approximately 1.5 mm, or 1 disc diameter) is located approximately 4

mm (or 2.5 disc diameters) from and 0.8 mm lower than the optic disc.

❑ The retinal pigment epithelium (RPE) is in direct contact with the retinal
photoreceptor cells. Between the outer and inner retinal layers, the retinal signal
starting is processed primarily through the bipolar cells to the retinal ganglion cells
(RGCs)

❑ A newly described subset of RGCs  melanopsin  intrinsically photosensitive

retinal ganglion cells (ipRGCs)  serve primarily nonvisual light-dependent
functions such as the pupillary light reflex.
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RETINA
❑ Horizontal, amacrine, and interplexiform cells  signal processing within
the retinal layers.

❑ Glial support cell (Müller cells and astrocytes)  affect image processing
and probably play a metabolic role

❑ There is a variable ratio of photoreceptor cells to ganglion cells in different

regions of the retina.
❑ The ratio is highest in the periphery (at more than 1,000:1)
❑ The lowest at the fovea
❑ Because of the increased density of ganglion cells centrally (69% within
the central 30°), the bipolar cells are oriented radially within the macula.
This radial arrangement of the axons of the bipolar cells (the Henle layer) is
responsible for fluid accumulation in a star-shaped pattern.
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RETINA
❑ Another key anatomical feature  the location of the optic
disc and the beginning of the optic nerve nasal to the fovea.
❑ ganglion cell fibers coming from the nasal retina can
travel directly to the disc
❑ those coming from the temporal retina must avoid the
macula  separating to enter the disc at either the
superior or the inferior pole.
❑ Some of the nasal fibers (nasal within the macula) enter
the disc on its temporal side (papillomacular bundle).
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PATTERN OF THE NERVE FIBER LAYER OF

AXONS FROM GANGLION CELLS TO THE OPTIC
DISC.

SUPERIOR, INFERIOR, AND NASAL FIBERS TAKE

A FAIRLY STRAIGHT COURSE.

TEMPORAL AXONS ORIGINATE ABOVE AND

BELOW HORIZONTAL RAPHE (HR) AND TAKE AN
ARCHING COURSE TO THE DISC.

AXONS ARISING FROM GANGLION CELLS IN THE

NASAL MACULA PROJECT DIRECTLY TO THE
DISC AS THE PAPILLOMACULAR BUNDLE (PM)
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OPTIC NERVE
❑ The optic nerve begins
❑ anatomically at the optic disc
❑ physiologically and functionally within
the ganglion cell layer that covers the
entire retina.

❑ The optic nerve may be divided into the

following 4 topographic areas
❑ intraocular region of the optic nerve:
optic disc, or nerve head; prelaminar
area; and laminar area
❑ intraorbital region
❑ intracanalicular region (located within
the optic canal)
❑ intracranial region (ending in the optic
chiasm)
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❑ First portion of the optic nerve  the confluence of 1.0–1.2 million

ganglion cell axons, traverses the sclera through the lamina cribrosa,
which contains approximately 200–300 channels.

❑ The combination of small channels and a unique blood supply (largely

from branches of the posterior ciliary arteries)  probably plays a role
in several optic neuropathies.

❑ Axonal transport (anterograde and retrograde) of molecules, subcellular

organelles, and metabolic products occurs along the length of the optic
nerve and is an energy-dependent system requiring high concentrations
of oxygen.

❑ The axonal transport system is sensitive to ischemic, inflammatory,

metabolic, toxic, and compressive processes.
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❑ Posterior to the sclera :

the optic nerve acquires a dural sheath that is contiguous with the
periorbita of the optic canal and an arachnoid membrane that
supports and protects the axons and is contiguous with the arachnoid
of the subdural intracranial space through the optic canal  permits
free circulation of CSF around the optic nerve up to the optic disc.

❑ Posterior to the lamina cribrosa :

the optic nerve also acquires a myelin coating  increases its
diameter to approximately 3 mm (6 mm in diameter, including the optic
nerve sheath) from the 1.5 mm of the optic disc. The myelin investment
is part of the membrane of oligodendrocytes that join the nerve
posterior to the sclera.
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❑ The intraorbital optic nerve extends approximately 30 mm to the optic canal.

❑ As the optic nerve enters the optic canal, the dural sheath fuses with the
periorbita. It is also surrounded by the annulus of Zinn

❑ Within the canal, the optic nerve :

❑ Accompanied by the Ophthalmic artery inferiorly and separated from the
superior orbital fissure by the optic strut
❑ The optic canal normally measures approximately 8–10 mm long and 5–7
mm wide but may be elongated and narrowed by processes that cause
bone thickening (eg, fibrous dysplasia, intraosseous meningioma)
❑ The optic nerve is relatively anchored and can easily be injured by
shearing forces transmitted from blunt facial trauma
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❑ At its intracranial passage, the optic nerve passes under a

fold of dura (the falciform ligament) that may impinge on the
nerve, especially if it is elevated by lesions arising from the
bone of the sphenoid (tuberculum) or the sella.

❑ Once it becomes intracranial, the optic nerve no longer

has a sheath. The anterior loop of the carotid artery usually
lies just below and temporal to the nerve, and the proximal
anterior cerebral artery passes over the nerve. The 8–12 mm
intracranial portion of the optic nerve terminates in the optic
chiasm.
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OPTIC CHIASM

❑ approximately 12 mm wide, 8 mm long in the

anteroposterior direction, and 4 mm thick.

❑ supplied by small branches off the proximal anterior

cerebral and anterior communicating arteries.

❑ located anterior to the hypothalamus and the anterior third

ventricle (forming part of its anterior wall and causing an
invagination) and approximately 10 mm above the sella. The
exact location of the chiasm with respect to the sella is
variable (Most of it is directly superior)
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OPTIC CHIASM
❑ The inferior nasal retinal fibers are inferior in the anterior chiasm; they cross to
the other side, and many loop into the terminal part of the opposite optic nerve
before turning to run back through the chiasm into the contralateral optic tract.

❑ These anterior loops (anterior knees of Wilbrand) bring fibers from the opposite
eye into the posterior optic nerve. Some investigators believe that these “knees”
are artifacts and suggest that the fibers shift into such a location after loss from
fiber degeneration

❑ The superior nasal fibers enter the superior chiasm, where they cross and then
leave the chiasm in the contralateral optic tract; some of these fibers loop
posteriorly into the optic tract on the same side before crossing. The fibers were
historically called the posterior knees of Wilbrand. The fibers from the temporal
retina course directly back through the chiasm into the optic tract. The nasal
macular fibers also cross and are spread throughout most of the chiasm
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OPTIC TRACT
‣ The fibers exiting from the chiasm proceed
circumferentially around the diencephalon
lateral to the hypothalamus and in contact
with the ambient cistern

‣ Just prior to the LGN, the fibers involved in

pupillary pathways exit to the pretectal
nuclei; other fibers exit to the superficial
layers of the superior colliculus via the
brachium of the superior colliculus

‣ These fibers originate from ipRGCs and are

likely the sole source of pupillomotor input
from the retina to the midbrain. These
ipRGCs also project to the suprachiasmatic
nucleus of the hypothalamus, which is
probably responsible for light-induced
diurnal rhythms
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LATERAL GENICULATE NUCLEUS

‣ The LGN is located in the posterior thalamus
below and lateral to the pulvinar and above the
lateral recess of the ambient cistern. The LGN
is a peaked, mushroom-shaped structure that is
divided into 6 levels

‣ The 4 superior levels are the termini of P-cell

axons, which are the ganglion cells with smaller
receptive fields and are responsible for
mediating maximal spatial resolution and color
perception.

‣ The 2 inferior layers receive input from the M-

cell fibers, which are the ganglion cells with
larger receptive fields and are more sensitive to
detecting motion.
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LATERAL GENICULATE NUCLEUS

P4
K6
P3
‣ Axons originating in the contralateral eye K5
terminate in layers 1, 4, and 6; the P2
ipsilateral fibers innervate 2, 3, and 5
K4
‣ Overall, the retinal representation rotates
almost 90°, with the superior fibers P1
moving medially and the inferior fibers
laterally. The macular fibers tend to move K3
superolaterally.
M2
‣ It is a complex system, that Cortical and K2
subcortical pathways may modulate
activity in the LGN. In addition, the cortex,
superior colliculus, and pretectal nuclei M1
project back to the LGN.

K1
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OPTIC RADIATIONS
‣ Following a synapse in the LGN, the axons
travel posteriorly as the optic radiations to
terminate in the primary visual (calcarine)
cortex in the occipital lobe
‣ The most inferior of the fibers first travel
anteriorly, then laterally and posteriorly to
loop around the temporal horn of the lateral
ventricles (Meyer loop)
‣ More superiorly, the fibers travel posteriorly
through the deep white matter of the parietal
lobe.
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OPTIC RADIATIONS
‣ Following a synapse in the LGN, the axons travel
posteriorly as the optic radiations to terminate in the
primary visual (calcarine) cortex in the occipital lobe
‣ The most inferior of the fibers first travel anteriorly, then
laterally and posteriorly to loop around the temporal horn of
the lateral ventricles (Meyer loop)
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OPTIC RADIATIONS
‣ The macular (central) fibers course laterally, with the peripheral fibers concentrated more at the
superior and inferior aspects of the radiations.
‣ Injury to fibers within the radiations produces a homonymous hemianopia, a contralateral visual field
defect that respects the vertical midline.
‣ If the corresponding fibers from the 2 eyes are in close proximity, the field defect is identical in each
eye (congruous).
‣ Congruous field defects occur with lesions involving the calcarine cortex. More anterior involvement
often produces incongruous field defects, suggesting that the corresponding fibers lie farther apart
more anteriorly in the visual pathways.
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PRIMARY VISUAL CORTEX

‣ The primary visual cortex (known variously as V1, striate cortex, or Brodmann area 17) is
arrayed along the horizontal calcarine fissure, which divides the medial surface of the occipital
lobe.

‣ Terminations of the optic radiations:

‣ Fibers of the optic radiations terminate in the fourth of the 6 layers in the primary visual
cortex.
‣ The macular fibers terminate more posteriorly
‣ Fibers from the most lateral (temporal crescent) visual field (originating only in the
contralateral eye) terminate most anteriorly.
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PRIMARY VISUAL CORTEX

The primary visual cortex has a thickness of about 2 mm and is organized into horizontal layers and verti-
cal columns.

Layer I, the most super cial layer, contains a few scattered neurons.

Layer II contains neurons that send axons only to deeper cortical layers.

Layer III con- tains neurons that communicate with both near and far cortical locations.

Layer IV contains the stria of Gennari and is subdivided into strata, one of which receives infor- mation
from the magnocellular layers and another that receives information from the parvocellular layers. Layer IV
sends axons to more superficial visual cortex, as well as other visual cortical areas. Layer V sends axons
to the superior colliculus and other areas in the brainstem. Layer VI sends projections back to the LGN.
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PRIMARY VISUAL CORTEX

‣ The cortex is heavily weighted to central retinal activity, with 50%–60% of the cortex
responding to activity within the central 10° and approximately 80% of the cortex devoted to
macular activity (within 30°).
‣ The superior portion of the cortex continues to receive information from the inferior visual field
in a retinotopic distribution. This retinotopic mapping throughout the afferent visual pathways
allows lesions to be localized on the basis of visual field defects. In addition, the anterior-medial
portion of the striate cortex represents the far monocular temporal visual field of the
contralateral eye (temporal crescent). Therefore, a far monocular temporal visual field defect
localizes the lesion to the contralateral anterior occipital cortex
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PRIMARY VISUAL CORTEX

The parastriate cortex (also called V2, or

Brodmann area 18) is contiguous with the
primary visual cortex and receives its input
from V1.

Area V3 lies primarily in the posterior parietal

lobe and receives direct input from V1

V3 has no sharp histologic delineation from V2

and sends efferent information to the basal
ganglia (pulvinar) and the midbrain. Cells in
this area are thought to be capable of
responding to more than one stimulus
dimension, suggesting that visual integration
occurs in this region.
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PRIMARY VISUAL CORTEX

V4, located within the lingual and fusiform

gyrus, seems to be particularly sensitive to
color. Damage to this area is probably
responsible for most cases of cerebral
achromatopsia.

Anterior and lateral to area V4, V5 (posterior

and within the superior temporal sulcus and
gyrus subangularis) is very sensitive to
movement and direction

The V5 area, which corresponds to the

medial temporal visual region, receives
ipsilateral input from V1 and direct input
from the M-cell layers of the LGN.
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BLOOD SUPPLY
‣ The blood supply to the LGN : anterior choroidal artery, lateral choroidal, posterior
choroidal branches of the posterior cerebral artery.

‣ The anterior choroidal artery, a branch of the internal carotid, is a primary supplier of
the optic tract, although small branches from the middle cerebral artery also contribute.

‣ The optic radiations divided to 3:

‣ (1) the anterior radiations, which pass laterally over the inferior horn of the
ventricle, are supplied by the anterior choroidal artery and the middle cerebral
artery

‣ (2) the middle group of bers passing lateral to the ventricle is supplied by the deep
optic branch of the middle cerebral artery; and

‣ (3) branches of the posterior cerebral artery, including the calcarine branch, supply
the posterior radiations as they spread out in the occipital lobe. Branches from the
middle cerebral artery also contribute.

‣ The calcarine branch of the posterior cerebral artery is the major blood supply for the
striate cortex, often supplemented by the posterior temporal or parietooccipital branch
of the posterior cerebral artery or the occipital branch of the middle cerebral artery.
Clinical Anatomy & Fisiology of the Visual Field