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Stephanie Muylaert, Sung Chul Park, Rafael Furlanetto, Yiyi Liu, Camila Netto, Rudrani Banik, Jeffrey Liebmann, Robert Ritch; Structure-Function Relationship in Optic Nerve Head Drusen. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3235.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the relationship between optic nerve head drusen (ONHD) and retinal nerve fiber layer (RNFL) or visual field (VF) loss.
Patients with ultrasound B-scan positive ONHD and no other ocular or systemic disease that could affect RNFL or VF were recruited. Each participant had standard automated perimetry (SAP; 24-2 SITA-standard, Humphrey Field Analyzer), circumpapillary RNFL thickness measurement using optical coherence tomography (OCT), and serial enhanced depth imaging (EDI) OCT of the optic nerve head (interval between scans, ~30 μm). After delineating the ONHD mass in each EDI OCT scan, 3-dimensional images were created and ONHD volume was calculated for each eye. ONHD volume, RNFL thickness and VF sensitivity were correlated.
37 eyes with ONHD (23 patients; mean age = 58±15 years) were included. Mean ONHD volume, VF mean deviation (MD), and RNFL thickness were 0.242±0.232 (range, 0.005 to 0.855) mm3, -4.5±4.6 (range, -17.0 to -0.1) dB and 76±19 (range, 42 to 113) µm, respectively. ONHD were most prevalent in the nasal quadrant (36 eyes, 97%), followed by superior, inferior and temporal quadrants (33 [89%], 28 [76%], and 15 [41%] eyes). 22 (59%) eyes had VF defects and 32 (86%) had focal or diffuse RNFL defects. ONHD volume had a moderate correlation with average RNFL thickness (p<0.001, R=-0.677; Fig A) and VF MD (p<0.001, R=-0.739; Fig B). 19 eyes had abnormal and asymmetric VF (mean VF sensitivity difference between hemifields > 1 dB). Among these 19 eyes, VF sensitivity was worse in the hemifield corresponding to the ONH side (superior vs. inferior half) with larger ONHD in 12 eyes (p=0.153, Cramér’s correlation coefficient V = 0.328), whereas RNFL was thinner in the same ONH side as larger ONHD in 14 eyes (p=0.027, Cramér’s V = 0.452).
ONHD mass is formed before detectable RNFL or VF loss. ONHD volume had a moderate correlation with RNFL thickness and VF MD. ONHD had a significant spatial correlation with RNFL, but not with SAP, probably because ONHD occur preferably in the nasal quadrant (Fig C-G).
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