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Foteini Faye Barampouti, Hibba Soomro, Peng Yong Sim, Gianfranco Ventura, Michael Karampelas; Enhanced Depth Imaging Optical Coherence Tomography of Optic Nerve Head Drusen in Children. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4139. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Optic nerve head drusen (ONHD) remains a challenging diagnostic dilemma for which multimodal imaging tools represent a cornerstone in diagnosis. ONHD may simulate true disc oedema and this misdiagnosis can lead to unnecessary investigations. In adult patients, EDI-OCT has shown promise in the accurate detection of ONHD when compared to current gold standard imaging, B-scan ultrasonography. There is however a dearth of literature investigating a similar utility of EDI-OCT in the paediatric population. In this study, we assess the value of EDI-OCT in ONHD detection in children compared with other imaging modalities.
We performed a retrospective cross-sectional case series of consecutive paediatric patients (age £18 y/o) with ONHD. Eyes with ONHD were examined with ultrasound B-scan, EDI-OCT, fundus autofluorescence (FAF) and standard automated perimetry. The ONHD detection rate between EDI-OCT and ultrasound B-scan was compared using McNemar’s test.
Twenty-two eyes of 12 patients (mean age 12 years; 64% female) with definite ONHD as confirmed by ultrasound B-scan were identified. Of these, EDI-OCT, FAF and visual field had positive findings in 19, 15 and 2 eyes, respectively. There was no significant difference in the detection rate of OHND between ultrasound B-scan and EDI-OCT (22/22 eyes vs. 19/22 eyes: p=0.08). Similar to adults, EDI-OCT detected ONHD at different levels with most located anterior to the lamina cribrosa. ONHD detected on EDI-OCT appeared as hypo-reflective ovoid regions bordered by hyper-reflective material or isolated hyper-reflective bands without a hypo-reflective core. The mean greatest diameter of ONHD seen on EDI-OCT was 454.4 (SD ±119.8) mm.
EDI-OCT has a comparable detection rate of ONHD in children compared to current gold standard B-scan ultrasonography. Given its practicality and convenience over ultrasound B-scan, our results suggest that non-invasive EDI-OCT has the potential to be an effective alternative first-line diagnostic and monitoring tool for ONHD; particularly buried drusen in children. This study also found the mean greatest diameter of ONHD to be smaller than that of the adults. Further studies on optic disc EDI-OCT will establish the relationship of ONHD with structure, anatomy and optic nerve function in children.
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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