The disc-macula distance to disc diameter ratio (DM:DD ratio) has been advocated as a method of supporting the diagnosis of optic nerve hypoplasia. A DM:DD ratio of 3.00 has been claimed to be a satisfactory threshold value for this purpose. This study has critically evaluated the above claim and found a value of 3.00 to be too low. The threshold DM:DD ratio values for the diagnosis of unequivocal ONH for an adult population, 5 and 2 years of age were found to be respectively 4.20, 3.93 and 3.70, the values for the diagnosis of mild ONH being 3.68, 3.44 and 3.23. Lower computed values reduce the predictive power. The method of computation of the DM:DD ratio was modified to abolish potential error due to disc rotation and foveal displacement. In an adult population, there was no correlation between the DM:DD ratio and amblyopia or disc ovalness. There was a trend of increasing DM:DD ratio towards myopia and decreasing DM:DD ratio towards hypermetropia; the DM:DD ratio may therefore be falsely high in high myopia. DM:DD ratio values below threshold should therefore be interpreted with care until formal optic disc biometry can be performed.