Differentiation of Optic Nerve Head Drusen and Optic Disc Edema with Spectral-Domain Optical Coherence Tomography

doi:10.1016/j.ophtha.2010.09.006

Ophthalmology

Volume 118, Issue 5, May 2011, Pages 971-977

https://doi.org/10.1016/j.ophtha.2010.09.006 Get rights and content

Purpose

To evaluate the efficacy of spectral-domain optical coherence tomography (SD-OCT) in differentiating optic disc edema (ODE) and optic nerve head drusen (ONHD) and to reveal the differential points.

Design

Comparative case series.

Participants

Forty-five patients with ONHD, 15 patients with ODE, and 32 normal controls.

Methods

Spectral-domain optical coherence tomography was performed with scans on the optic nerve head and measurements of retinal nerve fiber layer thickness.

Main Outcome Measures

Qualitative findings of optic nerve head scans and retinal nerve fiber layer thickness profiles on SD-OCT.

Results

Optic nerve head drusen was visualized as a focal, hyperreflective, subretinal mass with a discrete margin on SD-OCT. The retinal nerve fiber layer was deformed and showed pseudoedema and high reflectance. The outer nuclear layer smoothly covered the drusen, which led to a hyporeflective, boot-shaped area adjacent to the drusen. In ODE, peripapillary retinal nerve fiber layers were significantly thicker in all sections than ONHD (average thickness of ODE: 174.1±53.5 μm vs ONHD: 119.2±20.2 μm vs control: 103.4±19.1 μm, P < 0.001). Retinal nerve fiber thickness in the nasal section provides a good differential marker for ODE from ONHD (area under receiver operating characteristic curve = 0.866).

Conclusions

With the use of SD-OCT, noninvasive and accurate differentiation of ONHD and ODE is possible.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and 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.

Sixty consecutive patients with disc swelling on fundus examination from September 2009 to March 2010 were included. The degree of optic disc swelling was variable from subtle to severe. Exclusion criteria were as follows: age <5 years or >70 years, high hyperopia >+7.00 diopters (D), high myopia >−7.00 D.

Diagnosis of ODE required

Results

The best-corrected visual acuity was not significantly different among the 3 groups (ONHD, ODE, and normal controls), whereas the age and refractive errors showed a significant difference: The patients in the ONHD and control groups were younger and more myopic than those of the ODE group (Table 1). In all (100%) cases of ONHD, SD-OCT directly visualized ONHD, whereas in 1 (6.7%) of 15 cases of ODE, combined ONHD was visualized by SD-OCT.

In 32 eyes of normal controls, SD-OCT showed normal

Discussion

Optic nerve head drusen occurs in 3.4 to 24 people per 1000 and is bilateral in approximately 75% of patients.⁸ It is composed of calcium and phosphorus and is primarily the result of axonal degeneration.⁹ Although impairment of visual acuity due to ONHD is rare,¹⁰ visual field¹ and RNFL defects² have been reported. However, even in those cases showing visual impairment, the rate of progression was slow (1.6% per year).¹ Sometimes, ONHD resembles ODE¹¹ and differentiating ONHD from ODE is

Limitations

Our study has several limitations. First, the age and refractive errors were different between groups; this may create a bias in the comparison of the RNFL thickness between groups. Second, the ODE group was relatively small and heterogeneous in terms of diagnosis. Nevertheless, we obtained statistically significant results and the differential points were definite.

In conclusion, spectral-domain optical coherence tomography may be a useful tool in the noninvasive differentiation of ODE and ONHD.

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To determine the prevalence of peripapillary hyperreflective ovoid mass–like structures (PHOMS) in a population-based child cohort and to study their association with other optic nerve head features and myopia.
Observational, population-based cohort study of 1407 children aged 11-12 years.
Optical coherence tomography scans of optic nerve heads were graded for PHOMS, disc tilt, prelaminar hyperreflective lines, and scleral canal diameter and investigated for associated prenatal and ocular parameters. Children with optic disc drusen or optic disc edema were excluded.
PHOMS were found in 8.9% of children. The location of PHOMS was predominantly in the superonasal section of the optic disc. Myopia and optic nerve head tilt were more common in children with PHOMS than in children without PHOMS (P < .001 and P < .001, respectively). Prelaminar hyperreflective lines were found in 17.9% of children with PHOMS compared to 7.3% of children without PHOMS (P < .001). Prelaminar hyperreflective lines with and without PHOMS were associated with a shorter axial length of the eye (P < .001). There were no prenatal factors associated with PHOMS. Prelaminar hyperreflective lines were associated with higher birth weight and continued maternal smoking during pregnancy (P = .01 and P = .02, respectively).
PHOMS had a prevalence of 8.9% in healthy children without optic disc drusen or optic disc edema and was associated with increasing myopic refraction and the presence of a tilted optic nerve head and prelaminar hyperreflective lines. Given the high prevalence of PHOMS, they should not unreservedly be taken as evidence of optic neuropathy.
Peripapillary hyperreflective ovoid masslike structures in a pediatric population referred for suspected papilledema
2022, Journal of AAPOS
Peripapillary hyperreflective ovoid masslike structures (PHOMS) are now considered a common cause of pseudopapilledema in the pediatric population.
The medical records of all patients ≤18 years of age with PHOMS, confirmed on optical coherence tomography, seen at single pediatric neuro-ophthalmology clinic between 2017 and 2021 were reviewed retrospectively.
A total of 47 patients (35 females), with median age of 12.7 years at initial visit, were included. Of these, 24 (51%) of patients were optometry referrals. Headache was a common symptom. PHOMS were present bilaterally in all patients and were 360° around the disk in 57 of 94 eyes (61%). Patients with elevated intracranial pressure were more likely to have a reduction in the size of PHOMS at follow-up (P = 0.0133). Of the 47, 40 (85%) had diagnostic neuroimaging as a part of their papilledema workup. The retinal nerve fiber layer was thicker in patients with concomitant papilledema rather than optic disk drusen (P = 0.002) and compared with patients with PHOMS alone (P = 0.00051).
Pediatric patients with PHOMS may be referred because their clinical appearance can be suggestive of papilledema. In our study cohort, PHOMS were bilateral and frequently occurred concurrently with other ophthalmic conditions.
Quantified Retinal Morphology and Its Association With Papilledema and Visual Acuity in Syndromic and Complex Craniosynostosis: An Optical Coherence Tomography Study
2022, American Journal of Ophthalmology
This study is the first to evaluate the prevalence of retinal thinning and the correlation with papilledema and visual acuity (VA) in a large population with craniosynostosis.
Prospective clinical cohort study.
All and complex patients syndromic and complex with craniosynostosis who visited the only national referral center between 2018 and 2020 were included. Retinal layers were segmented using optical coherence tomography. Patients were seen by an ophthalmologist for VA assessment and fundoscopy. Multivariate regression models were developed to evaluate correlations between retinal thickness, papilledema and VA.
We included 127 patients. Retinal thinning was most prevalent in the peripapillary retinal nerve fiber layer (≤38%). A longer duration of papilledema in early childhood correlated with an increased peripapillary retinal nerve fiber layer and total retinal thickness optic nerve head later in life (+0.3 ± 0.2, P = .04 and +1.0 ± 1.0, P = .003); however, its thickness was not correlated with the VA (P = .20 and P = .53). Macular retinal thinning was associated with a worse VA (P = .01); however, it was not correlated with the duration of papilledema (P = .95).
Following a preventative treatment strategy for syndromic and complex craniosynostosis, the prevalence of retinal ONH thinning is low. Although the prevalence of peripapillary retinal nerve fiber layer thinning is considerable, its thickness is not correlated with VA. In contrast, macular thinning is correlated with worse VA scores and should, therefore, be evaluated during follow-up. Future studies should evaluate the (1) causative mechanism for macular thinning, (2) correlation between the time to surgery and macular thinning, and (3) results of reactive treatment strategies and compare those results to the current study.
Utility of spectral domain OCT in differentiating optic disc drusen from papilledema in children
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The purpose of this study was to test the diagnostic accuracy of optical coherence tomography (OCT) in differentiating optic disc drusen (ODD) from papilledema in children.
Retrospective cross-sectional study at a tertiary-care pediatric hospital.
Children with high-quality OCT imaging of ODD or papilledema.
Quantitative OCT parameters and qualitative OCT features were compared for diagnostic accuracy.
There were 41 eyes with ODD and 21 eyes with papilledema. Both the quantitative and qualitative OCT parameters showed highly statistically significant differences between ODD and papilledema (p ≤ 0.01 for all). For quantitative parameters (Bruch's membrane opening and retinal nerve fiber layer thicknesses), the area under the curve from the receiver operator curves ranged from 0.81 to 0.90. For qualitative parameters, the sensitivity for ODD ranged from 27% to 100% and specificity ranged from 67% to 100%. The presence of at least 1 of 3 qualitative OCT parameters (hyporeflective boot-shaped area, isolated/clustered hyperreflective bands, or signal-poor regions in the core) had a sensitivity of 90% and a specificity of 100% for ODD.
Both quantitative and qualitative OCT parameters differed significantly between ODD and papilledema in this cohort of children. A combination of several qualitative OCT features had high sensitivity for ODD while effectively ruling out papilledema.
La présente étude avait pour objectif de vérifier l'exactitude diagnostique de la tomographie par cohérence optique (OCT) pour ce qui est de distinguer les drusen du disque optique (DDO) de l’œdème papillaire chez l'enfant.
Étude rétrospective transversale réalisée dans un hôpital de soins tertiaires pour enfants.
Enfants pour lesquels on disposait d'images de DDO ou d’œdème papillaire de grande qualité obtenues à l'OCT.
On a comparé les paramètres quantitatifs et qualitatifs de l'imagerie OCT quant à leur exactitude diagnostique.
On a recensé 41 yeux dans le groupe DDO et 21 yeux dans le groupe œdème papillaire. Les paramètres OCT quantitatifs et qualitatifs ont mis au jour des différences très significatives sur le plan statistique entre les DDO et l’œdème papillaire (p ≤ 0,01 pour l'ensemble des mesures). Selon l'analyse de la courbe de fonction d'efficacité du récepteur, l'aire sous la courbe (ASC) pour les paramètres quantitatifs (ouverture de la membrane de Bruch et épaisseur de la couche de fibres nerveuses de la rétine) s’échelonnait de 0,81 à 0,90. Dans le cas des paramètres qualitatifs, la sensibilité pour les DDO oscillait entre 27 % et 100 %, tandis que la spécificité oscillait entre 67 % et 100 %. La présence d'au moins 1 des 3 paramètres OCT qualitatifs (zone hyporéflective en forme de botte, bandes hyper-réflectives isolées/groupées ou zones de signal de qualité médiocre dans le noyau) avait une sensibilité de 90 % et une spécificité de 100 % dans le cas des DDO.
Les paramètres OCT quantitatifs et qualitatifs présentaient des différences significatives, selon qu'il s'agissait de DDO ou d’œdème papillaire au sein de cette cohorte d'enfants. Une association de plusieurs paramètres OCT qualitatifs avait une sensibilité élevée pour les DDO et permettait d’éliminer efficacement l’œdème papillaire.
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Features of Peripapillary Hyperreflective Ovoid Mass-Like Structures in Nonarteritic Anterior Ischemic Optic Neuropathy Patients and Normal Controls
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: Manuscript no. 2010-612.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported by the Korea Science and Engineering Foundation grant funded by the Korea government (MEST) No. R01-2005-000-10875-0.

^⁎: Kyoung Min Lee and Se Joon Woo equally contributed to the work and therefore should be considered equivalent authors.

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Original articleDifferentiation of Optic Nerve Head Drusen and Optic Disc Edema with Spectral-Domain Optical Coherence Tomography

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients and Methods

Results

Discussion

Limitations

Am J Ophthalmol

Surv Ophthalmol

Ophthalmology

Ophthalmology

Visual field defects and retinal nerve fiber layer defects in eyes with buried optic nerve drusen

Am J Ophthalmol

Accuracy of papilledema and pseudopapilledema detection: a multispecialty study

J Fam Pract

Photoreceptor layer thinning over drusen in eyes with age-related macular degeneration imaged in vivo with spectral-domain optical coherence tomography

Ophthalmology

Differentiating optic disc edema from optic nerve head drusen on optical coherence tomography

Arch Ophthalmol

Original article
Differentiation of Optic Nerve Head Drusen and Optic Disc Edema with Spectral-Domain Optical Coherence Tomography