Abstract
Aim: To assess whether the detection rate of optic disc drusen (ODD) in children with swollen optic discs varies if the ultrasound scan (USS) is performed through the lens or avoiding the lens. Methods: Retrospective review of the ultrasound machine database for all patients who underwent USS for swollen discs in the department of pediatric ophthalmology, UPMC Children’s Hospital of Pittsburgh. Only patients who had both fundus pictures and USS performed (through and avoiding the lens) were included in the study. Results: A total of 31 patients (62 eyes) were included in the study. USS detected ODD in 44% of eyes (27 of 62 eyes, 15 patients). In 82% of these eyes (22 of 27 eyes), the ODD were not detected initially when scanning was done through the lens but were only detected when scanning was performed avoiding the lens. Ten out of sixteen patients with no ODD on USS had another identifiable cause for disc elevation, including raised intracranial pressure and sleep apnea. Conclusion: Ultrasound is a sensitive diagnostic tool for detecting ODD. The rate of detection of ODD is increased when USS is done avoiding the lens in children where the ODD are usually buried and not as calcified as those found in adults. Under such circumstances, the reduced echogenicity is absorbed by the absorbent pediatric lens, thus limiting the detection rates when scanning through the lens.
Highlights
It is vital to differentiate optic disc drusen (ODD) from papilledema to avoid unnecessary investigations in an otherwise asymptomatic patient [1]
On ocular coherence tomography (OCT), ODD is seen as a hypoechogenic subretinal structure with hyperreflective margins [3]
Thirty-one patients (62 eyes) who presented with bilateral disc edema and met the inclusion criteria were included in the study
Summary
It is vital to differentiate optic disc drusen (ODD) from papilledema to avoid unnecessary investigations in an otherwise asymptomatic patient [1]. On OCT, ODD is seen as a hypoechogenic subretinal structure with hyperreflective margins [3]. While some studies describe drusen as a hypo reflective subretinal structure, some studies report drusen as a hyperreflective mass. These findings are not specific to ODD. There are cases of optic disc edema described to have hyperreflective margins similar to ODD. Kulkarni et al [4] reported that the contour of elevation was smoother in optic disc edema compared to ODD. This test has low specificity and poor interobserver measurements [4]. TihthisbmuaryiendotObDe sDig[n6if]i,craendt uced calcifiincaatdiounltasnwdhionscereOaDseDd alerensroabbusostrlpytcioanlciafireedliaknedlyftoounpdreovnenttheensouurfgahcetroafntshmeiirssoipotnicodf irsecfls,ecbtuetdinwaves fromcthhieldorepnticwnitehrvbeurhieedadOtDoDthe[6t]r, arnesdduucecder.caTlchiuficsa, tiitoins danedsirianbcrleeatsoedsclaennsavabosidorinptgiotnhearleenlsikteolyimtoprove the repissroedlveuestniirtoaenbnleoouftogthhsectraiamnnsaamgvoeisisdsioionnngUotfhSreSefl[le3enc]s.teWtdowhimialveperssocfvarenomnthinethgreeposropoltuitcotincooenrlvsoefinhtheaaeddiumtlotastghueesstironangnsUldoSunScge[ir3t.u]T.dhWiunhsa,illi,etaxial, and tsrcaannsnvinegrsperpotoosciotilos nins oadf uthltes UusSinSgplroonbgeitsuhdoinualld, acxaipalt,uarnedsctarannssvaevroseidpinogsittihonesleonfst,hteoUthSeS bperostbeof our knowshleoduglde,ctahpetruerearsecannos satvuodidieinsginthtehleenlist,ertoattuhreebsepset coiffiocualrlykninowvelesdtiggea,ttihnegrethaereeffnoecsttuodf ineseginattihneg lens attenluitaetriaotunrbe yspseccaifnicnailnlyginwvhesilteigaatvinogidthinegeftfhecetloefnnsetgoatdinegtelecnt sOaDtteDn.uFautiortnhbeyrmscoanren,inwgewdheilsecarviboeidainsgimple two-sthteeplesncsantondinetgecptrOotDoDco. lFuthrtahteirsmeoarsei,ewr teoddesecprliobeyainsicmhpilde rtewno-tshtaepn stchaenpnirnogtopcrooltodceoslctrhiabteids eaabsoievre
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