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Faith Birnbaum, Gabriella M Johnson, Lenworth N Johnson, Bokkwan Jun, Jason T Machan; Getting Stoned From Being Too High: Optic Disc Drusen May Arise From Papilledema in Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4542.
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© ARVO (1962-2015); The Authors (2016-present)
Conventionally, clinicians have viewed optic disc drusen (ODD) and papilledema as independent disorders. However, this may not be true as recent reports have suggested that reduced axoplasmic flow may cause ODD formation. Papilledema is associated with axonal flow stasis. We sought to evaluate the prevalence of ODD in the setting of papilledema from idiopathic intracranial hypertension (IIH), and to assess if the coexistence of both conditions may worsen the visual outcomes as compared with either condition alone.
Observational retrospective review of 372 consecutive participants with ODD or resolved papilledema (rPAP) from IIH evaluated over a 25-year period. The prevalence of ODD among participants with rPAP was calculated. One eye from each of 372 participants was used to assess logMAR visual acuity and visual field mean deviation (MD) outcomes.
Participants included 170 ODD alone, 159 rPAP alone, and 43 combined ODD with rPAP (cODD-rPAP). The prevalence of ODD at 19% among eyes with rPAP alone and combined was almost 10 times greater and significantly higher (P<0.001) than the prevalence of ODD in the general population. Eyes with exposed drusen had significantly worse (P=.025) visual acuity at 0.14 logMAR (~ 20/30 Snellen) as compared with eyes with buried drusen at 0.029 logMAR (~ 20/20 Snellen). Eyes with exposed drusen had significantly worse visual field MD at -9.88 dB as compared with buried drusen at -3.35 dB (P< 0.001), rPAP at -4.80 dB (P< 0.001), and rPAP with exposed drusen at -6.02 dB (P= 0.047). There was no difference in visual acuity or visual fields between eyes with cODD-rPAP and eyes with rPAP alone.
The high prevalence of ODD with rPAP suggests a non- coincidental relationship, and that in some cases ODD may develop secondary to papilledema. Additionally, the presence of ODD in the setting of papilledema does not portend worse visual outcome. Our investigation supports the theory that conditions causing axonal distress, specifically papilledema, may contribute to the formation of ODD.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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