Progressive Visual Field Loss Associated with Optic Disc Drusen over 25 Years

Purpose To examine long-term data on optic disc drusen (ODD) from an outpatient hospital series that indicated more cases with advanced visual field constriction than is apparent from other clinical reports. The underlying pathophysiology is discussed, also with regard to enlarged blind spot, which, in view of the small disc at risk, may seem a paradox. Methods This is an observational retrospective study on an eye clinic series (n = 49), focusing on visual acuity, kinetic/static perimetry, and longitudinal trends, to include the question of eventual visual incapacity. Results Forty-nine patients (32 female and 17 male; bilateral ODD in 45) aged 5-76 years (median age 29 years for both sexes) were included in the study. Observation time was 1-54 years, with serial data recorded over at least 3 years in 25 patients. Visual field defects were found in 32 patients, with ODD considered responsible for the visual field defects demonstrated. Advanced unilateral concentric constriction (for the largest Goldmann object) was recorded in 10 patients, and bilaterally in 2. With regard to nonexplanatory side diagnoses, 2 patients had pituitary adenoma, 1 had a cavernous sinus meningioma, and 1 had neurosurgery for an arachnoid cyst. Conclusions We found more cases of marked visual field constriction than reported in other clinical series. A few such cases appeared acute and vascular, but the main trend was clinically quiet over time. All 49 patients could manage visually in daily life.

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The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

Ophthalmology ◽

10.1016/j.ophtha.2010.02.015 ◽

2010 ◽

Vol 117 (11) ◽

pp. 2061-2066 ◽

Cited By ~ 49

Author(s):

Felipe A. Medeiros ◽

Luciana M. Alencar ◽

Pamela A. Sample ◽

Linda M. Zangwill ◽

Remo Susanna Jr. ◽

...

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Optic Disc ◽

Visual Field Loss ◽

Pressure Reduction ◽

Disc Hemorrhage ◽

Intraocular Pressure Reduction ◽

The Relationship

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Topographic Quadrant Analysis of Peripapillary Superficial Microvasculature in Optic Disc Drusen

Frontiers in Neurology ◽

10.3389/fneur.2021.666359 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yan Yan ◽

Xiao Zhou ◽

Zhongdi Chu ◽

Laurel Stell ◽

Mohammad Ali Shariati ◽

...

Keyword(s):

Visual Field ◽

Optic Disc ◽

Function Analysis ◽

Nerve Fibers ◽

Quadrant Analysis ◽

Mean Deviation ◽

Structure Comparison ◽

Parallel Change ◽

Optic Disc Drusen ◽

Temporal Quadrant

Background: Limited information is known about the topographic effect of optic disc drusen (ODD) on peripapillary retinal nerve fibers and microvasculature.Objective: This study aims to understand the structural and functional impact of ODD in different quadrants of the optic disc.Methods: We performed a retrospective case-control study of 22 ODD patients (34 eyes) and 26 controls (33 eyes) to compare optical coherence tomography (OCT) retinal nerve fiber layer (RNFL), OCT angiography (OCTA), and corresponding static perimetry mean deviation (MD) calculated using the modified Garway-Heath map in different quadrants of the optic disc. OCTA was analyzed using custom MATLAB script to measure six parameters in a peripapillary annulus with large vessel removal: vessel area density (VAD), vessel skeleton density (VSD), vessel perimeter index (VPI), vessel complexity index (VCI), flux, and vessel diameter index (VDI).Results: Quadrant analysis revealed that OCTA VAD and VCI were significantly decreased in superior, nasal, and inferior but not temporal quadrant. RNFL, VSD, and VPI were significantly impacted only in the superior and nasal quadrants. Corresponding visual field MDs in all ODD eyes were not different in the four quadrants, although eyes with MD equal or worse than −5 dB (32%) had worst visual field corresponding to the superior quadrant of the optic disc (inferior arcuate visual field). Structure-structure comparison of OCT and OCTA showed high correlation of RNFL with multiple OCTA measurements in the superior, nasal, and inferior quadrants but not temporal quadrant. Structure-function analysis revealed significant correlation of VAD and VCI and visual field MD in every quadrant, but RNFL was only significantly correlated in the superior and inferior quadrants.Conclusions: Peripapillary VAD and VCI are decreased in more quadrants than RNFL, supporting the clinical utility of performing OCTA in addition to OCT. Consistent with the most common locations of ODD, five OCT/OCTA measurements (VAD, VCI, RNFL, VSD, VPI) are decreased in the superior and nasal quadrants. OCT/OCTA measurements were significantly impacted in contrast to the relatively mild effect on corresponding visual field MD, consistent with the idea that a decrease in objective structural and vascular measurements occurs without parallel change in subjective visual function in ODD.

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Retinal hemorrhages as one of complications of optic disc drusen during pregnancy

Medicinski pregled ◽

10.2298/mpns1406185t ◽

2014 ◽

Vol 67 (5-6) ◽

pp. 185-189

Author(s):

Marija Trenkic-Bozinovic ◽

Predrag Jovanovic ◽

Gordana Zlatanovic ◽

Dragan Veselinovic ◽

Aleksandra Aracki-Trenkic ◽

...

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Visual Field ◽

Optic Disc ◽

Optic Nerve Head ◽

Ganglion Cells ◽

Therapeutic Interventions ◽

Visual Field Defects ◽

Retinal Hemorrhages ◽

Optic Disc Drusen

Introduction. Drusen of the optic nerve head are relatively benign and asymptomatic. They represent retinal hyaline corpuscles resulting from impaired axoplasmic transport of the retinal ganglion cells of optic nerve in front of the lamina cribrosa. They are usually detected accidentally, during a routine ophthalmologic examination. Most patients with optic disc drusen are not aware of the deterioration of their eyesight because of the slow progression of visual field defects. Damage in visual acuity due to optic disc drusen is rare. Case Report. A 27-year-old female patient in the sixth month of pregnancy visited an ophthalmologist because of a visual impairment described as the appearance of mist and shadows over her right eye. When first examined, her visual acuity in both eyes was 20/20. The retinal hemorrhages framing the bottom half of the optic nerve were seen. Complete laboratory and clinical testing as well as specific ophthalmic examinations (photofundus, computerized visual field, optical coherence tomography, and ultrasound) were performed to exclude systemic causes and they presented no risk for the pregnancy. Echosonographic examination confirmed the presence of bilateral optic nerve head drusen. Conclusion. Hemodynamic changes during pregnancy are possible factors for the development of optical disc and retinal hemorrhages. Since treatment of optic disc drusen is limited, recognition of optic nerve drusen as a cause of hemorrhage during pregnancy prevents unnecessary diagnostic and therapeutic interventions.

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