Which description fits optic disc drusen?

Benign acellular deposits that elevate the disc Optic disc drusen are a usually bilateral, asymptomatic optic neuropathy in which benign acellular deposits elevate the disc and blur its margins.

Inflammatory swelling of the optic nerve head

Vascular malformation on the disc surface

Glial remnant of the hyaloid artery

What are optic disc drusen mainly composed of?

Hyaline material from Bruch's membrane

Which features characterise buried optic disc drusen?

Uncalcified, not visible, mostly in children Buried drusen are uncalcified and not seen at the optic nerve head and are mostly present in children, whereas superficial drusen are clearly visible.

Calcified, glistening, mostly in the elderly

Clearly visible on the disc surface in adults

Always unilateral with marked disc pallor

Buried optic disc drusen are most often confused with which condition?

Papilloedema The elevated disc with blurred margins mimics papilloedema, disc swelling caused by raised intracranial pressure, which makes the distinction challenging.

Which investigation confirmed optic disc drusen in the article's 15-year-old with elevated discs?

B-scan ultrasonography After dilated fundoscopy showed elevated discs with blurred margins in both eyes, a B-scan was done to confirm optic disc drusen.

What did fundus autofluorescence show in the article's case of optic disc drusen?

Hyperautofluorescence of both discs Fundus autofluorescence showed hyperautofluorescence of both optic discs.

Hypoautofluorescence of both discs

A peripapillary hypoautofluorescent ring

No autofluorescence change at all

What did OCT show of the retinal nerve fibre layer in the article's optic disc drusen case?

Thinning of the nerve fibre layer OCT confirmed retinal nerve fibre layer thinning together with disc elevation and blurred, irregular margins.

Thickening with intraretinal fluid

Splitting of the nerve fibre layer

What happens to optic disc drusen with age?

They calcify and enlarge, causing field loss With age the drusen become calcified and larger, compressing normal nerve structures and leading to visual field defects and vision loss.

They regress and disappear completely

They stay unchanged throughout life

They soften and become more deeply buried

When are IOP-lowering drugs given in optic disc drusen?

Borderline IOP with marked field defects No treatment reverses the visual loss, but IOP-lowering drugs can be given to patients with borderline IOP and marked visual field defects.

Only when a disc haemorrhage occurs

Which complication carries an increased risk in optic disc drusen?

Anterior ischaemic optic neuropathy Patients with optic disc drusen have an increased risk of anterior ischaemic optic neuropathy (AION).

Central serous chorioretinopathy

Rhegmatogenous retinal detachment

Optic disc drusens: ALL YOU NEED TO KNOW

CASE REPORT

A 15-year-old child presented with a headache for a few months. His visual acuity came out as 6/6 in both eyes.

Dilated Fundoscopy revealed elevated discs and blurring of the margins in both eyes. B scan was done to confirm the diagnosis of optic disc drusens.

OCT confirmed the thinning of the retinal nerve fiber layer and elevation of the optic disc along with blurry and irregular margins. FAF showed hyper autofluorescence of both discs.

Optic disc drusens entity

Optic disc drusens are progressive, usually bilateral, and asymptomatic types of optic neuropathy in which benign and acellular deposits appear at the optic disc thus making the disc elevated and its margins blurry.

These drusens are mostly mucoproteins or mucopolysaccharides which are Remnants of degenerated retinal ganglion cells. The exact cause of optic disc drusens is not known but is predicted to be due to the abnormal flow of materials in optic nerve cells. There may be a family history of ODD but can also be non-inherited.

These drusens can be classified as buried or superficial. Buried drusen are uncalcified and not seen at the optic nerve head, but the optic disc is elevated with blurry margins due to which they can be misdiagnosed with another term called papilloedema which refers to swelling of the optic disc along with blurring of its margins due to increased intracranial pressure.

Due to their buried nature, it is a challenging task for an ophthalmologist to differentiate between papilloedema and ODD. These are mostly present in children. Superficial drusens are clearly visible at the optic nerve head.

With age optic nerve drusens get calcified and larger, thus compressing normal nerve structures ultimately resulting in visual field defects and vision loss.

Test your knowledge 10 questions from this article

MANAGEMENT of Optic disc drusens

No treatment is available to reverse the visual loss caused by optic disc drusens, although IOP-lowering drugs can be given in patients who have borderline IOP and marked visual field defects.

Complication

They have an increased risk of anterior ischemic optic neuropathy (AION).

Prognosis

ODD usually has a good prognosis for central vision, although visual field defects may progress slowly over time.

REFERENCES

Thompson AC, Bhatti MT, El-Dairi MA. Bruch’s membrane opening on optical coherence tomography in pediatric papilledema and pseudopapilledema. J AAPOS. 2018;22:38–43.
Tuğcu B, Özdemir H. Imaging Methods in the Diagnosis of Optic Disc Drusen. Turk J Ophthalmol. 2016;46:232–236.
Thurtell MJ, Biousse V, Bruce BB, Newman NJ. Optic nerve head drusen in black patients. J Neuroophthalmol. 2012;32:13–16.
Auw-Haedrich C, Staubach F, Witschel H. Optic disk drusen. Surv Ophthalmol. 2002;47:515–532.
Lam BL, Morais CG Jr, Pasol J. Drusen of the optic disc. Curr Neurol Neurosci Rep. 2008;8:404–408.

Test yourself

A few questions straight from this article.

1 / 10 0 correct

Which description fits optic disc drusen?
Optic disc drusen are a usually bilateral, asymptomatic optic neuropathy in which benign acellular deposits elevate the disc and blur its margins.
What are optic disc drusen mainly composed of?
They are mostly mucoproteins or mucopolysaccharides, the remnants of degenerated retinal ganglion cells.
Which features characterise buried optic disc drusen?
Buried drusen are uncalcified and not seen at the optic nerve head and are mostly present in children, whereas superficial drusen are clearly visible.
Buried optic disc drusen are most often confused with which condition?
The elevated disc with blurred margins mimics papilloedema, disc swelling caused by raised intracranial pressure, which makes the distinction challenging.
Which investigation confirmed optic disc drusen in the article's 15-year-old with elevated discs?
After dilated fundoscopy showed elevated discs with blurred margins in both eyes, a B-scan was done to confirm optic disc drusen.
What did fundus autofluorescence show in the article's case of optic disc drusen?
Fundus autofluorescence showed hyperautofluorescence of both optic discs.
What did OCT show of the retinal nerve fibre layer in the article's optic disc drusen case?
OCT confirmed retinal nerve fibre layer thinning together with disc elevation and blurred, irregular margins.
What happens to optic disc drusen with age?
With age the drusen become calcified and larger, compressing normal nerve structures and leading to visual field defects and vision loss.
When are IOP-lowering drugs given in optic disc drusen?
No treatment reverses the visual loss, but IOP-lowering drugs can be given to patients with borderline IOP and marked visual field defects.
Which complication carries an increased risk in optic disc drusen?
Patients with optic disc drusen have an increased risk of anterior ischaemic optic neuropathy (AION).