Peripapillary Hyperreflective Ovoid Mass-like Structures Research Articles

Peripapillary Hyperreflective Ovoid Mass-Like Structures as a Finding in Pseudopapilledema in Children.

Peripapillary Hyperreflective Ovoid Mass-Like Structures as a Finding in Pseudopapilledema in Children.

Peripapillary hyperreflective ovoid mass-like structures: multimodal imaging and associated diseases.

Growing evidence has demonstrated that peripapillary hyperreflective ovoid mass-like structures (PHOMS) are novel structures rather than a subtype of optic disc drusen. They correspond to the laterally bulging herniation of optic nerve fibers and are believed to be the marker of axoplasmic stasis. PHOMS present in a broad spectrum of diseases, including optic disc drusen, tilted disc syndrome, papilloedema, multiple sclerosis, non-arteritic anterior ischemic optic neuropathy, optic neuritis, Leber hereditary optic neuropathy, and so on. We focus on the multimodal imaging features, pathophysiological mechanisms of PHOMS, and their association with multiple diseases and healthy people in this review to deepen the ophthalmologists' understanding of PHOMS. Additionally, we provide some new directions for future research.

Features of Peripapillary Hyperreflective Ovoid Mass-Like Structures in Nonarteritic Anterior Ischemic Optic Neuropathy Patients and Normal Controls.

To determine the characteristics of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and in normal adults. A total of 406 included eyes were divided into four groups: acute NAION group, chronic NAION group, unaffected group, and normal eyes group. PHOMS were detected on optical coherence tomography slices from optical coherence tomography angiography scans centered on the optic nerve head (ONH). The differences in age, sex, and ONH parameters were investigated between eyes with PHOMS and eyes without PHOMS among groups. The prevalence of PHOMS in acute eyes (43.48%) and fellow eyes (28.20%) was significantly higher than that in normal eyes (11.76%) (acute vs. normal, P < 0.001; fellow vs. normal, P = 0.014). In the acute group, the PHOMS score of size was negatively correlated with age in acute eyes (r = -0.486, P = 0.03). The size of PHOMS was negatively correlated with age and cup/disc ratio and positively correlated with retinal nerve fiber layer thickness in the nasal and inferior sectors in the normal groups. No differences in age, sex, ONH parameters, or visual field defects were found between eyes with PHOMS and eyes without PHOMS. The prevalence of PHOMS increased significantly in acute nonoptic disc drusen (NODD)-NAION eyes and fellow eyes. PHOMS could also be found among normal adults. PHOMS may be a nonspecific sign secondary to ONH edema and axoplasmic stasis. The high prevalence of PHOMS in acute NODD-NAION eyes may indicate axoplasmic stasis secondary to tissue edema.

Optical coherence tomography in papilledema: A probe into the intracranial pressure correlation.

To study the optic nerve head characteristics on optical coherence tomography (OCT) in patients with papilledema and correlate them with intracranial pressure (ICP). A retrospective hospital-based study of 46 eyes of 23 patients with bilateral optic disc edema secondary to increased ICP. The clinical profile and the OCT features in terms of retinal nerve fiber layer thickness (RNFL), ganglion cell inner plexiform layer (GCIPL) thickness, and enhanced depth imaging (EDI) B scan images of the optic nerve head were studied and correlated with the ICP. Papilledema was secondary to idiopathic intracranial hypertension (IIH) (n = 20), obstructive hydrocephalus (n = 2), and communicating hydrocephalus (n = 1). The mean ICP in 20 IIH patients was 347 mmH2O. The ICP and RNFL thickness in all four quadrants were found to be weakly positively correlated: superior RNFL r (38) = 0.17, P = 0.30, and nasal RNFL r (38) = 0.30, P = 0.05, inferior RNFL r (38) = 0.29, P = 0.07, and temporal RNFL, r (38) = -0.001, P = 0.99. The GCIPL layer thickness and the ICP were weakly negatively correlated in all sectors: superior (38) = -0.23, P = 0.16, superonasal, r (38) = -0.07, P = 0.67, inferonasal r (38) = -0.08, P = 0.64, inferior r (38) = -0.21, P = 0.19, inferotemporal r (38) = -0.23, P = 0.17, superotemporal, r (38) -0.21, P = 0.20. Descriptive features on the B scan, such as peripapillary hyperreflective ovoid mass-like structures and microcystic spaces, were observed most commonly with an ICP of 251-350 mmH2O, and the hyperreflective dots in the RNFL layer and Bruch's membrane inward denting were observed more commonly with an ICP of 351-450 mmH2O. The RNFL thickness in all four quadrants had a weak positive correlation, and the GCIPL layer had a weak negative correlation with the ICP. The EDI descriptive features on OCT may vary with ICP.

Peripapillary hyperreflective ovoid mass-like structures and the retinal nerve fiber layer thinning.

We describe a report of three cases of bilateral Peripapillary Hyperreflective Ovoid Mass-Like Structures (PHOMS), their respective multimodal imaging, and retinal nerve fiber layer (RNFL) analysis over time. We performed an elaborated multimodal imaging of three pediatric patients with PHOMS. We performed a visual acuity testing, followed by a biomicroscopic and fundus examination, an additional Optical Coherence Tomography (OCT), fundus autofluorescence (FAF), infra-red (IR), fluorescein angiography (FA), Scanning laser Ophtalmoscopy (SLO), and retro-mode imaging. Furthermore, we analyzed RNFL thickness over several consecutive visits. The multimodal approach exhibited similar characteristics of PHOMS in all eyes, namely a torus-like shaped that was particularly demarcated and well visualized using SLO and retro-mode tool. In all the eyes, we found a downward trend of the RNFL over time. In both the right and left eye, RNFL at presentation averaged at 152.33 ± 25.42 and 130 ± 18.33 microns, respectively. Several weeks after, it averaged at 142 ± 30.34 and 125.67 ± 14.84 microns, respectively. Our report shows a thinning trend of the RNFL thickness over time in patients with PHOMS.

Understanding pseudopapilledema on spectral domain optical coherence tomography.

Optic nerve head drusen (ONHD), peripapillary hyperreflective ovoid mass-like structures (PHOMS), and horizontal hyperreflective lines (HHL) are commonly seen in eyes with pseudopapilledema on enhanced depth imaging (EDI) spectral domain optical coherence tomography (SDOCT). The objective of this study is to assess the frequency of ONHD, PHOMS, and HHL on spectral domain OCT in the eyes diagnosed to have pseudopapilledema. A retrospective case-control study included patients diagnosed as pseudopapilledema and had EDI SD OCT imaging of the optic nerve head (n = 48 eyes) and controls (n = 20 eyes). OCT scans through the optic nerve head were studied to diagnose ONHD, HHL, and PHOMS. One proportion z test was used to find the difference in proportions. Forty eight eyes of 27 subjects were studied. ONHD as described by the optic disc drusen Studies consortium was noted in 19 eyes (39.48%), P value-0.032, PHOMS in 31 eyes (64.6%), P value 0.043, HL in 19 eyes (39.48%), P value 0.032, and none of the normals had ONHD, PHOMS, and HHL. PHOMS are more frequently seen than ONHD and HHL in eyes with pseudopapilledema.

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) in patients with acute Leber's hereditary optic neuropathy.

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) represent an optical coherence tomography (OCT) finding that has been characterized in different forms of pseudopapilledema. The aim of this study was to investigate the prevalence of PHOMS in patients affected by acute LHON using structural OCT, and to provide a detailed description of these findings. Patients with a clinical and molecularly confirmed diagnosis of acute LHON (visual loss having occurred less than 6months) were enrolled from the neuro-ophthalmology clinic at San Raffaele Scientific Institute. Patients had a complete ophthalmologic evaluation, including imaging with structural OCT. Our analysis included 16 patients (21 eyes-8 males and 8 females) with acute LHON. Structural OCT exhibited PHOMS in 12 eyes from 9 patients with a prevalence rate of 57.1%. In a subsequent topographical assessment in the peripapillary area, the most common location of PHOMS was the temporal region (12 out of 12 eyes), while the nasal region was affected in 2 eyes (16.7%). Considering the 12 eyes with PHOMS, mean ± SD temporal peripapillary RNFL thickness was 87.5 ± 28.4 microns. The temporal peripapillary RNFL thickness was significantly lower in eyes without PHOMS (63.7 ± 32.2 microns; P = 0.40). At the 12-month follow-up visit, PHOMS disappeared in 10 out of 12 eyes. Acute LHON eyes have PHOMS which are mainly confined to the temporal peripapillary sector. PHOMS may represent swelled retinal fibers that have herniated or are in stasis.

Peripapillary hyper-reflective ovoid mass-like structures (PHOMS): clinical significance, associations, and prognostic implications in ophthalmic conditions.

Pioneering advancements in optical coherence tomography (OCT) have facilitated the discernment of peripapillary hyper-reflective ovoid mass-like structures (PHOMS), prevalent neuro-ophthalmological findings associated with an array of ophthalmic conditions, such as optic disc drusen (ODD), papilledema, myopic/tilted optic discs, non-arteritic anterior ischemic optic neuropathy (NA-AION), and optic neuritis. Despite an expanding corpus of research, numerous inquiries persist concerning their clinical significance, correlations with ocular afflictions, and prognostic implications. This comprehensive review endeavors to impart an in-depth comprehension of PHOMS, encompassing facets like conceptualization, detection, pathogenesis, and associations with diverse ophthalmic conditions. Furthermore, we underscore several unresolved quandaries and suggest prospective avenues for future exploration.

Prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in suspected papilloedema in children.

Suspected papilloedema is a frequent cause of referral to paediatric ophthalmology clinics. Recent publications have described a new finding called peripapillary hyperreflective ovoid mass-like structures (PHOMS) that may cause pseudopapilloedema. We evaluated the optical coherence tomography (OCT) scans of the optic nerve in all children referred with suspected papilloedema for the presence of PHOMS and report their frequency. The optic nerve OCT scans from children seen in our suspected papilloedema virtual clinic between August 2016 and March 2021 were evaluated for the presence of PHOMS by three assessors. A Fleiss' kappa statistic was calculated to test the agreement between the assessors for the presence of PHOMS. A total of 220 scans from 110 patients were evaluated during the study period. The mean patient age was 11.2 SD ± 3.4, (range 4.1-16.8). PHOMS were identified in at least one eye in 74 (67.3%) patients. Of these, 42 (56.8%) patients had bilateral and 32 (43.2%) had unilateral PHOMS. Excellent agreement between assessors for the presence of PHOMS (Fleiss' kappa 0.9865) was observed. PHOMS were common in association with other identified causes of pseudopapilloedema (81.25%) but were also common in papilloedema (66.67%) and otherwise normal discs (55.36%). Misdiagnosis of papilloedema can lead to unnecessary and invasive tests. PHOMS are found frequently within the paediatric population referred for suspected disc swelling. They appear to be an independent cause of pseudopapilloedema but are often seen in conjunction with true papilloedema and other causes ofpseudopapilloedema.

Tilted Optic Disc and Peripapillary Hyper-reflective Ovoid Mass-Like Structure

An 11-year-old healthy girl was seen for a routine examination. Visual acuity was 20/20 both eyes. Refraction was –2.25 in the right eye and –0.50 in the left eye. Fundus examination was notable for an indistinct nasal optic disc margin with elevation in the right eye only (Fig A-B). OCT demonstrated a hyper-reflective signal in the nasal portion of the right optic disc (Fig C, arrow). Peripapillary hyper-reflective ovoid mass-like structures (PHOMS) is believed to represent axoplasmic stasis. Aside from being associated with a tilted optic disc, PHOMS can be observed in papilledema, anterior ischemic optic neuropathy, optic neuritis, and central retinal vein occlusion (Magnified version of Fig A-C is available online at www.aaojournal.org).

Peripapillary hyperreflective ovoid mass-like structures: Multimodal imaging-A review.

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a laterally bulging herniation of distended axons into the peripapillary region above the level of Bruch's membrane opening. Increased use of enhanced depth imaging-optical coherence tomography (EDI-OCT) in our evaluation of the optic nerve head (ONH) and greater recognition of the vast range of optic nerve pathologies with which PHOMS is associated provides convincing evidence that PHOMS is not just buried optic disc drusen (ODD) as previously described. The frequent coexistence of PHOMS with ODD, papilloedema, anterior ischaemic optic neuropathy, tilted optic disc syndrome, inflammatory demyelinating disorders and other diseases associated with axoplasmic stasis provides insight into its underlying pathophysiology. The present review will discuss the role of key imaging modalities in the differential diagnosis of PHOMS, explore the current literature on the relationship between PHOMS and common neuro-ophthalmic conditions, and highlight the gaps in our knowledge, with respect to disease classification and prognosis, to pave the way for future directions of research.

Peripapillary hyperreflective ovoid masslike structures in a pediatric population referred for suspected papilledema

BackgroundPeripapillary hyperreflective ovoid masslike structures (PHOMS) are now considered a common cause of pseudopapilledema in the pediatric population. MethodsThe 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. ResultsA 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). ConclusionsPediatric 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.

Peripapillary Hyperreflective Ovoid Mass–like Structures (PHOMS) in Children: The Copenhagen Child Cohort 2000 Eye Study

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.

An overview of peripapillary hyperreflective ovoid mass-like structures.

The purpose of this review is to provide an overview of the ophthalmic findings associated with peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both adult and pediatric patients. PHOMS have recently been identified in a number of different ophthalmic disease entities ranging from nonpathologic to pathologic, including but not limited to anatomic abnormalities (tilting in myopia), optic nerve head drusen, optic disc edema from inflammation (optic neuritis, white dot syndromes), vascular insults (ischemic optic neuropathy, retinal vascular occlusion), and papilledema. The mechanism underlying the formation of PHOMS has not been fully elucidated although it has been hypothesized that PHOMS occur secondary to axoplasmic stasis from crowding at the optic nerve head. Although the clinical significance of the presence of PHOMS remains unclear, PHOMS are associated with several disease processes. Understanding the mechanism behind their formation and their impact on optic nerve head structure and visual function may be relevant in patients with optic nerve head pathology. The presence of PHOMS may also correlate with disease severity and duration. Future studies to evaluate whether the formation of PHOMS may be useful as an early indicator of disease or a prognostic tool are warranted.

Peripapillary hyperreflective ovoid masslike structures (PHOMS) in a pediatric population referred for suspected papilledema

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a new, benign entity identified in evaluation of the optic nerve, best described on enhanced depth imaging optical coherence tomography (EDI-OCT). PHOMS are now being considered the most common cause for pseudopapilledema in children. We chose to investigate pediatric patients with PHOMS referred for suspected papilledema.

Optic Nerve Head Anatomy and Vascular Risk Factors in Patients With Optic Disc Drusen Associated Anterior Ischemic Optic Neuropathy

Optic disc drusen (ODD) is an anatomical risk factor for nonarteritic anterior ischemic optic neuropathy (NA-AION). This study aimed to investigate the anatomical and vascular risk factors of patients with ODD-AION (ODD-associated NA-AION) and compare them with similar data from patients with nODD-AION (NA-AION without ODD). Case-control study. Thirty-four ODD-AION and 34 nODD-AION patients who had all been systematically optical coherence tomography scanned using a standardized ODD scanning protocol were retrospectively analyzed and compared regarding demographics, vascular risk factors, clinical characteristics, and specific optic nerve head anatomical characteristics. In patients with ODD-AION, the ODD were predominantly deeply located (82%) but with no significant difference in size (52% large, 48% small). When compared with nODD-AION patients, ODD-AION patients were significantly younger at the time of diagnosis (P=.012) and had fewer vascular risk factors (P=.015). The ODD-AION patients had significantly more peripapillary hyperreflective ovoid mass-like structures (PHOMS) (P < .001) and prelaminar hyperreflective lines (P < .001) as well as smaller Bruch's membrane opening diameters (P=.017) compared with nODD-AION patients. No significant differences were found between ODD-AION and nODD-AION patients regarding visual acuity, refraction, lamina cribrosa position, ganglion cell layer volume, or retinal nerve fiber layer thickness. In ODD-AION, location of the ODD within the optic nerve head is important, while the size of the ODD is not. The ODD-AION and nODD-AION patients presented with distinctly different vascular risk factors and anatomical characteristics, establishing ODD and potentially also PHOMS as independent risk factors for developing NA-AION.

Features of peripapillary hyperreflective ovoid mass‐like structures (PHOMS) according to their etiology

AbstractPurposeTo compare clinical and multimodal imaging findings in patients with PHOMS and correlate them with the etiology.MethodsA prospective descriptive comparative study carried out at the Ophthalmology Department of Habib Thameur University Hospital of Tunis between March 1st 2020 and March 30th 2021. Inclusion criteria were presence of blurred optic disc margins. Patients with optic disc drusen were excluded. All patients underwent complete ophthalmic examination, 24.2 Humphrey visual field (VF), fluorescein angiography (FA) and Swept‐Source Optical Coherence Tomography (SS‐OCT). Comparative Mann Whitney and chi‐squared tests were performed.ResultsSixteen eyes of 8 patients were eligible for the study. Mean age was 41.63 years +/‐ 10.49 years. Mean Best Corrected Visual Acuity was 0.23+‐0.27 log MAR. Main etiologies were sequelae of idiopathic intracranial hypertension (IIH) in 8 eyes (50%) and tilted disc syndrome (TDS) in 6 eyes (37.5%). VF defects were found in 12 eyes (75%). They included non‐specific scotomas (35.7%), blind spot enlargement (21.4%) and peripheral arcuate defect (12.5%). Peripapillary Retinal Nerve Fiber Layer (pRNFL) were thickened in 62.5% of eyes, altered in 31.3% and preserved in 6.3%. Inferior and nasal pRNFL showed no alterations in all eyes. SS‐OCT revealed hyperreflective lesions in all eyes, associated to posterior shadowing in 12 eyes (75%), hyperreflective dots in 10 eyes (62.5%) and peripapillary pigment epithelium detachment in 9 eyes (56.3%). There were no statistically significant differences in VF alterations between TDS and IIH group. Patients with IIH presented thicker pRNFL (p = 0.023) and were more likely to present annular leakage in FA (p = 0.012).ConclusionsPHOMS is a recently described entity that can be related to several etiologies such as IIH, TDS or ischemic optic nerve neuropathy. Both TDS and IIH can lead to visual field defects. IIH is more likely to give annular retention in FA and thickening of pRNFL.

Volumetric Measurement of Peripapillary Hyperreflective Ovoid Masslike Structures in Patients with Optic Disc Drusen

PurposeTo develop a method to determine the volume of peripapillary hyperreflective ovoid masslike structures (PHOMS) and to examine the correlation between PHOMS and anatomic optic nerve head characteristics in a large cohort of patients with optic disc drusen (ODD).DesignRetrospective, observational study of patients with ODD.ParticipantsPatients with ODD seen in a 3-year period.MethodsWe determined the prevalence of PHOMS. We then developed a method to calculate the volume of PHOMS and measured this in all patients where radial scans on OCT were available. We analyzed the correlation between PHOMS volume and patient age, size of Bruch’s membrane opening (BMO), ODD visibility, and anatomic location of ODD in the optic nerve.Main Outcome MeasuresPrevalence and characteristics of PHOMS in patients with ODD.ResultsIn 247 (77%) eyes with ODD, PHOMS were found. Among these, 80% were in the first decade of life, 87% were in the second decade, 89% were in the third decade, 85% were in the fourth decade, 74% were in the fifth decade, 73% were in the sixth decade, 58% were in the seventh decade, 40% were in the eighth decade, and 0% were in the ninth decade. The ophthalmoscopic visibility of ODD increased with age. The volume of PHOMS decreased with age, but with no correlation to the size of BMO. The median volume of PHOMS was 0.27 mm3 (interquartile range [IQR], 0.13–0.49 mm3). Predominantly, PHOMS were observed in the nasal peripapillary area (87.5% nasal, 78.5% superior, 67% inferior, and 63.5% temporal).ConclusionsIn patients with ODD, PHOMS are seen frequently, with the highest prevalence in younger individuals. The volume of PHOMS decreases with age, and PHOMS are seen more frequently in patients with superficial ODD.

Association of peripapillary hyper-reflective ovoid masslike structures and disease duration in primary progressive multiple sclerosis.

Peripapillary hyper-reflective ovoid masslike structures (PHOMS) are a novel finding during retinal optical coherence tomography in patients with multiple sclerosis (MS). To date, there are no data on the occurrence of PHOMS in early MS. The aim of this study was to investigate the frequency of PHOMS in patients with first diagnosed early relapsing-remitting MS (RRMS) and to search for associations of PHOMS with disease patterns in different MS subtypes. This was a cross-sectional analysis in two different cohorts: cohort 1, consisting of early RRMS patients (n=349); cohort 2, consisting of patients with primary progressive MS (PPMS) (n=66) and RRMS (n=65). Peripapillary hyper-reflective ovoid masslike structures were detected in 18.3% of patients with early RRMS. The occurrence of PHOMS was not associated with age, disease duration and disability. Investigating clinical patterns and the occurrence of PHOMS (cohort 2), an association of PHOMS with higher Expanded Disability Status Scale measures (PHOMS 4.9, 3.7-6.1; no PHOMS 3.5, 3.0-5.3; p=0.03) and longer disease durations (PHOMS 6.5years, 1.9-11.0; no PHOMS 1.0years, 0.0-4.0, p=0.0007) was found in patients with PPMS but not RRMS. After p value adjustment, the disease duration appeared to be more relevant (β=0.16, p=0.06). Peripapillary hyper-reflective ovoid masslike structures were found in 18% of patients with early MS. The presence of PHOMS might be associated with disease progression only in PPMS but not RRMS, suggesting that PHOMS might be embedded in neurodegenerative processes.

OCT Based Interpretation of the Optic Nerve Head Anatomy and Prevalence of Optic Disc Drusen in Patients with Idiopathic Intracranial Hypertension (IIH).

We aimed to systematically examine the optic nerve head anatomy in patients with idiopathic intracranial hypertension (IIH) using a standardized optical coherence tomography (OCT) protocol. The study retrospectively included 32 patients diagnosed from 2014 to 2021 with IIH. Using OCT, in accordance with a standardized scanning protocol for patients with optic disc drusen, the presence of optic disc drusen, prelaminar hyperreflective lines, peripapillary hyperreflective ovoid mass-like structures, the retinal nerve fiber layer thickness, and macular ganglion cell layer volume was obtained. Optic disc drusen were found in 3.1%, hyperreflective lines in 31.3%, and peripapillary hyperreflective ovoid mass-like structures in 81.3% of all IIH patients at least three months after the time of diagnosis. We found no significant differences in retinal nerve fiber layer thickness or macular ganglion cell layer volume in patients with hyperreflective lines or PHOMS respectively compared to patients without hyperreflective lines (p = 0.1285 and p = 0.1835). In conclusion, the prevalence of optic disc drusen in IIH patients is similar to the reported prevalence in the general population. The high prevalence of hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures in IIH patients suggest these structures be a result of crowding in the optic nerve head caused by papilledema.