Atlas of Ophthalmology

Decreased Retinal Nerve Fiber Thickness in Optic Disc Drusen (Colour Photography, SD-OCT, VEP, Visual Field, Ocular Ultrasonography)

Optic Nerve -> Congenital Anomalies (Abnormalities)
Patient: 50 years old of age, male, BCVA +0.5-1.25/162°=1.0 at OD, +0.75-2.0/173°=0.9 at OS, IOP 13/13 mmHg. Ocular Medical History: unclear visual field defects at both eyes. General Medical History: empty. Main Complaint: unclear optic nerve alterations. Purpose: to demonstrate thinning of retinal nerve fiber thickness in raised and blurred optic discs. Methods: Colour Photography, SD-OCT Heidelberg Engineering, VEP, Octopus G1 Visual Fields, Visual Evoked Potentials, Ocular Ultrasonography. Findings: Colour Photography: raised and blurred optic discs. SD-OCT Circular Scan: thinning of peripapillary retinal nerve fiber layer at both eyes. SD-OCT: raised optic discs with highly reflective lesions at both eyes . Visual field: arcuate scotomas at both eyes. Visual Evoked Potentials: decreased amplitude, regular latency at both eyes. Ocular Ultrasonography: calcification at the optic nerve at both eyes. Discussion: Calcification at the optic nerve is diagnostic of optic disc drusen, causing changes in visual fields and thinning of the peripapillary retinal nerve fiber layer. Optic disc drusen arise from alteration in axoplasmic flow of ganglion cells. Optic disc drusen are calcified hyaline-like deposits resulting from calcific degeneration and occur in 0.5–20% of the population. Sarac O (1) suggested, that examining peripapillary retinal nerve fiber layer helped in differentiating optic disc edema from optic nerve head drusen. Literature: 1) Sarac O, Tasci YY, Gurdal C, Can I.Differentiation of optic disc edema from optic nerve head drusen with spectral-domain optical coherence tomography. J Neuroophthalmol. 2012 Sep;32(3):207-11.

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