Abstract
Purpose :
To study visual field (VF) deterioration in patients with optic disc drusen (ODD) with or without glaucoma and identify possible factors associated with faster rates of VF progression.
Methods :
Single-center, retrospective, comparative study including patients with a diagnosis of ODD, with > 2 reliable standard automated perimetry (SAP) tests obtained either by Humphrey or Octopus, and > 12 ≥months of follow-up. Rates of change in SAP mean deviation (MD) were obtained by linear mixed model regression and categorized as slow (<0.5 dB/year) or moderate/fast (>0.5 dB/year). Characteristics at baseline including demographics, glaucoma diagnosis, comorbid conditions, intraocular pressure (IOP), use of pressure-lowering medications, retinal nerve fiber layer (RNFL) thickness, and past ocular surgery were compared between groups, as well as IOP and use of medications during follow-up.
Results :
82 eyes of 45 patients were included with a mean age of 56.6 ± 16.0 years and mean follow-up time of 53.7 ± 40.0 months (range 13.0-181.0 months). 65 eyes were classified as slow and 17 eyes were classified as moderate/fast. Glaucoma was diagnosed in 33/65 eyes (50.8%) in the slow group and 8/17 eyes (47.1%) in the moderate/fast group, with no significant difference. No significant differences in demographics, medical and surgical history, or mean IOP existed at baseline between groups. Patients in the moderate/fast group were on more glaucoma medications (1.29 vs. 0.40, P=0.003) and had a lower RNFL thickness (65.7 µm vs. 80.2 µm, P=0.032) at baseline compared to the slow group.
Conclusions :
The moderate/fast progression group had lower RNFL thickness and more glaucoma medications at baseline compared to the slow group, regardless of glaucoma diagnosis. Notably, some eyes with ODD exhibited significant VF progression even without glaucoma, despite similar baseline IOP. These results suggest the importance of close monitoring for ODD patients and potential treatment consideration for those with significant RNFL thinning, even with normal IOP. Our findings emphasize the inherent challenge in distinguishing glaucoma and ODD, as evidenced by the similar distribution observed in both the slow and moderate/fast progression groups.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.