Diagnosis Of Optic Nerve Head Drusen Research Articles

Optic Nerve Head Drusen and Visual Field Loss in Normotensive and Hypertensive Eyes

To compare visual field loss (VFL) in eyes with optic nerve head drusen (ONHD) with or without ocular hypertension (OHT). The records of all patients aged 45 years or older with a diagnosis of ONHD at 2 centers were reviewed. OHT was defined as intraocular pressure >or=22 mm Hg. We categorized ONHD into 3 grades based on visibility on disc photographs. We identified 22 eyes (13 patients) with both ONHD and OHT and 81 normotensive eyes (47 patients) with ONHD. VFL was present in 20/22 (90.9%) of hypertensive eyes compared with 54/81 (66.7%) of normotensive eyes (P=0.03, Fisher exact test). Drusen grade III and OHT were both independently and significantly associated with greater incidence of VFL (logistic regression analysis). VFL occurs more frequently in eyes with ONHD that also have OHT. Eyes with grade III ONHD are at increased risk for VFL compared to eyes with grade I drusen with the same intraocular pressure status. Patients with OHT and ONHD should undergo close surveillance for disease progression and be treated appropriately to prevent additional VFL.

The Rate of Visual Field Loss in Optic Nerve Head Drusen

To define the rate of visual field loss in patients with optic nerve head drusen (ONHD). Retrospective chart review. Goldmann visual field (GVF) testing from initial visit and last follow-up examination were quantified using the modified Esterman grid technique. The rate of visual field loss was calculated by comparing the initial GVF to the last follow-up GVF. A comparative analysis of GVF and age at initial evaluation was performed on all patients with an initial GVF only. Tertiary academic care center. Inclusion criteria for the rate analysis: (1) diagnosis of ONHD and (2) at least 36 months of follow-up with serial GVF testing. (1) patients with glaucoma or glaucoma-suspect; (2) history or examination evidence for other ocular disease; and (3) drusen-related macular causes of visual loss. Thirty-two of 292 charts were included in the rate analysis. The rate of visual field loss was 1.58%. There was no statistically significant difference between men and women (P = .74). One hundred eighty patients were included in the initial visual field analysis. There was a significant negative correlation between age and GVF, with older patients having lower GVF scores with a Spearman correlation of -0.42 (P < 0.0001); 73% of these 180 patients had mild, minimal, or no visual field loss. The rate of visual field loss for ONHD over a 36-month interval of time was 1.6% per year. Patients with minimal or no visual field loss were younger, and patients with moderate or severe visual loss were older.