Abstract
Purpose :
Optic disc drusen (ODD) are known to be associated with slowly progressive peripheral visual field defects. It may be difficult to differentiate these visual field defects from those caused by other optic neuropathies such as glaucoma. Analyzing the visual field defects and other characteristics of patients at first diagnosis of ODD may help elucidate the underlying cause of neuropathy associated with this finding and may therefore better inform management of these patients.
Methods :
In this retrospective chart review, patients with pseudopapilledema from optic disc drusen were identified and evaluated. Patients were not included in this study if they had a history of prior optic neuropathy, optic nerve trauma, known sarcoidosis or other systemic illness known to commonly cause optic nerve involvement, brain or CNS mass/lesion that could be contributing to increased ICP, media opacity that could obscure accurate acquisition/interpretation of imaging or exam findings. All subjects had intraocular pressure measurement and visual field testing. 15 patients with confirmed optic disc drusen in at least one eye were analyzed for age at diagnosis, unilateral or bilateral presence of drusen, lens status, presence and type of presenting visual field defects, presenting intraocular pressures, and treatment with ocular hypotensive agents.
Results :
The mean age of diagnosis was 35.33 years with range of 14-59. 14 subjects had bilateral drusen (93.3%). All were phakic. 21 eyes had visual field defects at the time of diagnosis (70%), 11 eyes had arcuate defects (36.67%), 3 had edge defects (10%), 3 had enlarged blind spots (10%) and 4 had nasal steps (13.33%). Average IOP was 17mmHg right and 17.33mmHg left. 1 eye (3.33%) was treated with an ocular hypotensive agent for ocular hypertension although there was not a visual field defect present in that eye.
Conclusions :
93% percent of patients had bilateral drusen, but only 70% of eyes had visual field defects, and the majority of visual field defects were arcuate or nasal steps. Furthermore 2 of 3 ocular hypertensive eyes had visual field defects while 19 normotensive eyes had visual field defects. At this time there is not enough data to determine if pressures correlate to the presence of visual field defects. Further work is necessary to differentiate visual field loss from disc drusen to other optic neuropathies, specifically glaucoma.
This is a 2020 ARVO Annual Meeting abstract.