Optical Coherence Tomography Findings of Optic Nerve Head Drusen in Children and Adolescents

Du Ri Seo; Song Hee Park

doi:10.3341/jkos.2015.56.9.1446

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Seo and Park: Optical Coherence Tomography Findings of Optic Nerve Head Drusen in Children and Adolescents

Original Article

J Korean Ophthalmol Soc 2015;56(9):1446-1453.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1446

Optical Coherence Tomography Findings of Optic Nerve Head Drusen in Children and Adolescents

Du Ri Seo, M.D., Song Hee Park, M.D., PhD

Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Song Hee Park, MD, PhD Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: 82-2-709-9354, Fax: 82-2-710-3196 E-mail: scheye@schmc.ac.kr

Received 12 February 201529 May 2015 Accepted 21 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the features of optic nerve head drusen (ONHD) observed on the optical coherence tomography (OCT) of pediatric and adolescent patients and to compare the characteristics of diagnosed ONHD pediatric and adolescent patients with the control group.

Methods

We performed a retrospective chart review of pediatric and adolescent patients with nasal elevation or marginal blur-ring of the optic nerve head on either direct ophthalmoscopic examination or fundus photography. Patients were compared with a control group of the same age who had normal optic nerve heads and no abnormal findings except refractive errors under oph-thalmic examination including OCT.

Results

There were 29 eyes (n = 16) with ONHD as a subretinal mass-like lesion on OCT among 84 eyes with nasal elevation or marginal blurring of the optic nerve head on OCT. Thirteen patients (18.8%) were diagnosed with ONHD in both eyes. The fol-lowing 3 groups were compared: group 1, showing nasal elevation or marginal blurring of the optic nerve head on OCT and diag-nosed with ONHD; group 2, without ONHD; group 3, normal controls. The spherical equivalent was significantly different among the groups ( p < 0.001). Compared with group 3, group 1 showed peripapillary retinal nerve fiber layer thickening of the temporal area; however, there was no difference between groups 1 and 2.

Conclusions

Buried ONHD in children and adolescents may be asymptomatic and the diagnosis can be made when a subretinal mass-like lesion is detected on OCT.

Keywords: Buried optic nerve head drusen, Optical coherence tomography

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Figure 1

. Case of rapidly progressing buried optic nerve head drusen. (A) Right fundus photograph of 10 year-old male 2 years earlier. (B) Present fundus photograph presenting with nasal marginal blurring of the optic disc. (C-1) Infrared image shows a nasal elevation of the optic disc border. (C-2) A hyperreflective subretinal mass-like lesion (white arrow) is observed posterior to the outer plexiform and outer nuclear layers on the present spectral domain optical coherence tomography (SD-OCT).

Figure 2.

Images showing the optic nerve head drusen of the right eye (A, C, E) and normal optic nerve head of the left eye (B, D, F). (A) Right fundus photograph presenting with optic disc swelling. (C) A focal hyper-reflective mass-like lesion (white arrow) is observed posterior to the outer plexiform and outer nuclear layers on SD-OCT. (E, F) The peripapillary RNFL thickness in each eye. SD-OCT = spectral domain optical coherence tomography; RNFL = retinal nerve fiber layer; TS = superotemporal; NS = superonasal; T = temporal; G = general; N = nasal; TI = inferotemporal; NI = inferonasal.

Figure 3.

Images showing optic nerve head drusen of both eyes. (A, B) Fundus photographs presenting with optic disc swelling. (C, D) A focal hyperreflective mass-like lesion (white arrow) is seen posterior to the outer plexiform and outer nuclear layer on SD-OCT. (E, F) The peripapillary RNFL thickness in each eye. SD-OCT = spectral domain optical coherence tomography; RNFL = retinal nerve fiber layer; TS = superotemporal; NS = superonasal; T = temporal; G = general; N = nasal; TI = in-ferotemporal; NI = inferonasal.

Table 1.

Summary of 16 patients with optic nerve head drusen

Patient	Sex	Age (years)	Eye	BCVA (log MAR)	Spherical equivarent (D)	Cylinder power (D)	RNFL th(μ m)
Patient	Sex	Age (years)	Eye	BCVA (log MAR)	Spherical equivarent (D)	Cylinder power (D)	Average	N	SN	ST	T	IT	IN
1	Female	12	OD	0	-1.25	-1.25	110	45	54	137	146	216	89
			OS	0	-1	-1	121	85	136	143	99	199	120
2	Female	9	OD	0	-5.5	-1	112	52	112	207	97	190	87
			OS	0	-5.5	-0.75	103	27	154	203	89	160	73
3	Male	10	OD	0	-1.75	0	99	67	110	132	75	146	116
			OS	0	-1.5	0	100	70	129	142	76	133	101
4	Female	12	OD	0	-2.5	0	100	51	134	111	103	152	93
5	Male	11	OD	0	-5.25	0	97	36	71	109	130	182	79
			OS	0	-4.5	-0.75	115	87	161	157	82	145	123
6	Male	9	OD	0.1	-5	0	106	65	150	151	77	151	112
			OS	0.1	-6	0	89	63	83	103	68	144	118
7	Male	11	OD	0	-6.5	-1.25	99	68	83	134	99	155	84
			OS	0	-6.5	-1.5	142	98	177	226	129	173	106
8	Male	11	OD	0	-2	0	94	55	82	119	88	171	93
9	Male	11	OD	0	-3	-3.5	88	62	86	122	77	129	85
			OS	0	-4.5	-3	87	57	120	109	74	122	80
10	Male	12	OD	0	-5.75	-0.5	83	42	80	132	85	135	64
			OS	0	-4.5	-2	86	37	85	136	89	138	76
11	Female	3	OD	0	-2	-1	99	55	89	143	85	157	120
			OS	0	-3	-2	85	36	57	124	91	157	81
12	Male	12	OD	0	-2.5	0	109	55	135	148	125	138	92
			OS	0	-2.75	0	107	58	123	164	102	158	88
13	Female	13	OD	0	-2	-1	108	55	126	155	116	171	68
			OS	0	-1.75	-0.5	108	65	126	162	105	165	75
14	Female	8	OS	0	-4.75	-1.75	106	61	119	154	96	178	85
15	Female	11	OD	0	-4.5	-0.75	132	43	82	160	181	258	96
			OS	0	-3	-1.5	125	51	131	178	120	237	105
16	Male	9	OD	0	-3	0	116	110	106	150	93	158	111
			OS	0	-3	-0.5	110	98	98	160	76	163	107

BCVA = best-corrected visual acuity; log MAR = the logarithm of the minimum angle of resolution; RNFL = retinal nerve fiber layer; N = na-sal; SN = superonasal; ST = superotemporal; T = temporal; IT = inferotemporal; IN = inferonasal; OD = oculus dexter; OS = oculus sinister.

Table 2.

Clinical features of patients according to each group

	Group 1^∗ (n = 29)	Group 2^† (n = 23)	Group 3^‡ (n = 33)	p-value
Age (average)	10.24 ± 2.4	9.52 ± 1.93	9.43 ± 2.55	0.091^§
Male:female	17:12	5:18	21:12	0.005^∏
BCVA (log MAR)	0.01 ± 0.03	0.00	0.00	0.132^§
Spherical equivalent (D)	-3.61 ± 1.69	-1.77 ± 2.14	-0.17 ± 1.47	<0.001^§
Cylinder power (D)	-0.88 ± 0.92	-0.32 ± 0.52	-0.82 ± 1.08	0.054^§

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best-corrected visual acuity; log MAR = the logarithm of the minimum angle of resolution.

^∗ Patients who have optic nerve head drusen;

^† Patients who have blurred or tilted optic disc but no optic nerve head drusen;

^‡ Normal control;

^§ Kruskal-Wallis test;

^∏ Chi-square test.

Table 3.

Comparison of the retinal nerve fiber layer of the three groups

	Nasal	Superonasal	Superotemporal	Temporal	Inferotemporal	Inferonasal
	β p-value^§(95% CI, μ m)	β p-value^§(95% CI, μ m)	β p-value^§(95% CI, μ m)	β p-value^§(95% CI, μ m)	β p-value^§(95% CI, μ m)	β (95% CI, μ m) p-value^§
Group 1^∗ Reference (n = 29)	Reference	Reference	Reference	Reference	Reference
Group 2^†(n = 23)	-2.87	0.555	-14.46	0.103	-7.84	0.278	-8.69	0.131	-14.48	0.076	3.53	0.584
(n = 23)	(-12.52~6.77)	(-31.92~2.98)	(-22.11~6.43)	(-20.02~2.65)	(-30.54~1.57)	(-30.54~1.57)	(-9.25~16.30)
	1.82	0.772	2.69	0.772	1.772	1.17	0.877
Group 3^‡	1.82	2.69	0.772	1.17	0.877	-20.83	0.001	-21.98	0.012	9.07	0.184
(n=33)	(-8.35~11.99)	(-15.71~21.09)	(-13.88~-16.22)	(-32.78~-8.87)	(-38.91~-5.05)	(-4.40~22.54)

CI = confidence interval.

^∗ Patients who have optic nerve head drusen;

^† Patients who have blurred or tilted optic disc but no optic nerve head drusen;

^‡ Normal control;

^§ Multiple linear regression analysis adjusted by sex and spherical equivalent.

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