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Ji Kwan Park, Andrew Sumnicht, Jan Irene Lloren, Timothy Winter; Visual Functions in Children with Optic Disc Drusen and Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2194.
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© ARVO (1962-2015); The Authors (2016-present)
Literature on visual functions in children with optic disc drusen (ODD) in the setting of elevated cerebrospinal fluid opening pressures (CSF-OP) is scarce. We performed a retrospective, observational clinical study to describe and compare visual function data in pediatric patients who have ODD coexisting with idiopathic intracranial hypertension (IIH).
A retrospective chart review of patients 18 years of age and less with the diagnoses of IIH, ODD, or ODD coexisting with IIH (ODD+IIH) between years 2013 and 2017 was performed. Patients with pseudopapilledema other than ODD or alternate diagnoses that explain optic nerve head elevations were excluded. Recorded data included visual acuity, age, gender, body mass index (BMI) percentile, symptoms, acetazolamide use, B-scan ultrasound (US), fluorescein angiography (FA), fundus autofluorescence (FAF), Humphrey Visual Field (HVF) test, and CSF-OP results. HVF results with false positive >=20% and false negative >=30% were excluded. Diagnosis of IIH was verified using the latest modified Dandy criteria. ODD was confirmed with US, FA and/or FAF results. At least one eye per patient was included in the analysis.
A total of 65 patients were identified. Eleven patients had confirmed bilateral ODD alone. Among three patients found to have bilateral ODD+IIH, the mean visual acuity of the worse seeing eye was logMAR 0.03(Standard Deviation [SD] 0.06). HVF mean deviations of the corresponding eye was -4.45 dB(SD 2.29 dB). Average CSF-OP was 42.15 cmH20(SD 13.22 cmH20). The mean age of onset was 14.33 years with 2:1 male:female distribution. Average BMI was 95.7th percentile. Two patients had headaches while one patient had nausea and/or vomiting. All patients received acetazolamide. Comparisons between IIH, ODD, and ODD+IIH groups for each variable showed no statistical significance except for the use of acetazolamide (p-value <0.001). Patients with ODD alone had 18.1 cmH20 lower mean CSF-OP than those with IIH (p-value 0.0573). Patients with CSF-OP >= 28 cmH20 had 96.2% less odds of finding any ODD (Odds Ratio 0.038 [0.006, 0.235], p-value 0.0004). Conversely, patients with CSF-OP <28 cmH20 had 26.32 times greater odds of finding any ODD (p-value 0.0004).
Visual functions were similar between pediatric eyes with IIH, ODD, or ODD coexisting with IIH. However, CSF-OP <28 cmH20 was strongly associated with finding any ODD in our study.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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