Original article
Morphologic Characteristics of Optic Nerve Head Drusen on Spectral-Domain Optical Coherence Tomography

https://doi.org/10.1016/j.ajo.2013.01.024Get rights and content

Purpose

To evaluate the morphologic characteristics of optic nerve head drusen.

Design

Retrospective case series.

Methods

setting: Institutional (Seoul National University Bundang Hospital). patients: Sixty-one patients with optic nerve head drusen. observation procedure: Visible and buried optic nerve head drusen were identified using funduscopy, whereas homogenous and nonhomogenous optic nerve head drusen were identified using spectral-domain optical coherence tomography images. Buried optic nerve head drusen were classified according to the size. main outcome measures: Classification of optic nerve head drusen.

Results

Of 99 eyes in 61 patients, optic nerve head drusen were buried in 95 eyes and visible in 4 eyes. The patients with visible optic nerve head drusen were older on average than those with buried optic nerve head drusen (53.3 ± 8.6 years vs 13.5 ± 7.1 years; P < .001) and exhibited larger disc diameters (1643 ± 265 μm vs 1287 ± 185 μm; P = .016). All 4 eyes with visible optic nerve head drusen exhibited hyperreflective borders, which were not found in patients with buried optic nerve head drusen. Of 95 eyes with buried optic nerve head drusen, 64 eyes (67%) showed homogenous internal reflectivity, whereas 31 eyes (33%) showed nonhomogenous reflectivity with lobulations. Large optic nerve head drusen were associated with a small optic disc diameter, nonhomogenous internal reflectivity, a partial highly reflective border, intraretinal cysts, and increased temporal retinal nerve fiber layer thickness.

Conclusions

Optic nerve head drusen have a diverse spectrum of spectral-domain optical coherence tomography findings associated with patient age and disc size.

Section snippets

Methods

This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital and adhered to the tenets of Declaration of Helsinki. This study was designed as a retrospective case series. Sixty-one patients with optic nerve head drusen seen at our institution from September 2009 through May 2012 were included in this study. All patients underwent a full ophthalmologic examination initially, including measurement of best-corrected visual acuity, funduscopic examination

General Characteristics and Classification of Optic Nerve Head Drusen

Optic nerve head drusen were identified in 99 eyes from 61 patients and were not found in the other 23 eyes. Among this group, 44 patients (72%) were women and 38 patients (62%) had bilateral optic nerve head drusen. Optic nerve head drusen were visible in 4 eyes from 3 patients by funduscopic examination (Figure 2), whereas buried optic nerve head drusen were detected in 95 eyes from 58 patients with SD OCT (Figure 1; Table 1). Ninety-five eyes with buried optic nerve head drusen were

Discussion

This study presents the detailed SD OCT features of optic nerve head drusen, which were used to classify optic nerve head drusen subtypes (visible or buried; small, medium, or large). On SD OCT images, visible optic nerve head drusen contained heterogeneous materials presented as multiple internal cysts with hyperreflective walls, suggestive of calcification. Buried optic nerve head drusen exhibited a broad spectrum of internal homogeneity and lobulations according to size. The differences

Kyoung Min Lee, MD, received his medical degree from Seoul National University in 2006, and completed a medical internship and a residency in ophthalmology at Seoul National University Hospital in 2011. He currently performs his military duties at Aerospace Medical Center, South Korea Air Force.

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  • Morphologic Features of Buried Optic Disc Drusen on En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography

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    Compared to other imaging modalities, en face OCT offers supreme visualization of buried ODD in both 2- and 3-dimensional images. In our previous study, the halo sign (defined as the presence of a bright-colored, smooth-contoured strip between the nasal disc margin and the juxtapapillary retina) on fundus photography and subretinal hyperreflective mass on SDOCT strongly favored a diagnosis of buried ODD rather than ODE.12,17 The en face OCT features in the current study correspond to those previously observed using other imaging modalities.

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Kyoung Min Lee, MD, received his medical degree from Seoul National University in 2006, and completed a medical internship and a residency in ophthalmology at Seoul National University Hospital in 2011. He currently performs his military duties at Aerospace Medical Center, South Korea Air Force.

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