Optic disk drusen

Optic disk drusen occur in 3.4 to 24 per 1,000 population and are bilateral in approximately 75%. Disturbance in the axonal metabolism in the presence of a small scleral canal—regardless of eyelength—is considered responsible for the development. The drusen increase in size, becoming more visible with age due to continuing calcium apposition, and they are associated with visual field defects in a considerable number of patients. Patients do not usually notice these defects, despite their progressive nature over the years, and this indicates an insidious course. A correct diagnosis of optic disk drusen is mandatory, although effective treatment is not yet available. It is most important to differentiate optic disk drusen from papilledema in order to avoid unnecessary neurological examinations, but also to avoid overlooking genuine neurologic disorders. Because optic disk drusen can cause severe visual field defects, patients require individual consultation regarding work issues and whether or not to drive. Optic disk drusen can be accompanied by vascular complications as well. In some cases these vascular changes—for example, choroidal neovascularization—are treatable. Patients with optic disk drusen should undergo regular visual field, IOP, and nerve fiber layer examinations. In patients with deteriorating visual field and borderline IOP, we recommend antiglaucomatous therapy.     

Optic disk drusen

Optic disk drusen (ODD) is a much more prevalent condition than it is usually considered. It is important to recognize ODD in order to escape serious neurosurgical interventions and rule out the development of optic neuropathy leading to grave visual dysfunction. Three cases with ODD are described. The authors conclude that it is an acquired disease, which can be bi- and unilateral. Initial diagnosis "suspected congestive optic disk of both eyes" was erroneous in all cases and it was replaced by "pseudocongestion" because of ODD. A characteristic symptom of ODD is narrowing of visual field borders and presence of scotomas in the lower half of central visual field. Since ODD are a manifestation of progressive optic neuropathy leading to disorders in the central visual field, dedystrophic and (if necessary) ophthalmo-hypotensive therapy is to be carried out.     

Optic disk pits and optic disk pit maculopathy: A review

Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The origin of the macular fluid and the mechanism of transition to the subretinal space in optic disk pit maculopathy pathophysiology are not yet fully understood. With the evolution of imaging modalities, especially optic coherence tomography, our knowledge of this disorder continues to increase. Although many different treatments have been tried, there is no consensus on the most effective.     

Optic disk cupping and pallor measurements of patients with a disk hemorrhage

We evaluated whether the rate of occurrence of glaucomatous disk damage in eyes with an optic disk hemorrhage differed from the rate of occurrence in control eyes. We compared 24 patients with a disk hemorrhage to 24 control patients, who had been matched for diagnosis, disk appearance, and visual fields. Cup volume and cup-to-disk area ratio of the optic disk were measured using the stereophotogrammetric technique, and area of pallor was measured using computerized image analysis. We found that diabetes increased the probability that a patient would have a disk hemorrhage, and that a hemorrhage was associated with progression of glaucomatous disk changes in half of the cases during the mean 3.1-year follow-up period. However, the mean rate of glaucomatous disk damage in patients with a hemorrhage was not different from matched control patients. A disk hemorrhage is a sign of later disk damage, but it does not alter the rate of glaucomatous disk progression.     

The disk edema dilemma

A 33-year-old diabetic woman experienced visual loss OS and disk edema OU. Extensive evaluation led to the diagnosis of diabetic papillopathy. Appropriate evaluation and management of diabetic papillopathy is discussed.     

Morphometric characteristics of optic disk with disk hemorrhage in normal-tension glaucoma.

PURPOSE: To evaluate the morphometric characteristics of the optic disk in eyes with and without disk hemorrhage in normal-tension glaucoma. METHODS: This was a prospective study conducted at Gifu University Hospital of 50 eyes of 50 patients with normal-tension glaucoma (12 men, 38 women; age, 56.5 +/- 14.1 years) who had developed new disk hemorrhage at the time of enrollment and 58 eyes of 58 patients with normal-tension glaucoma (20 men, 38 women; age, 56.7 +/- 12.4 years) with no history of disk hemorrhage during the follow-up period of more than 2 years. Age and global indexes of the visual field were matched. We morphometrically compared the optic disk with and without hemorrhage using a scanning laser tomograph. Global and sector analyses were made of the optic disk structural parameters. RESULTS: There was no significant difference in the global values of the disk parameters between the disk hemorrhage and the nonhemorrhage groups. However, the inferotemporal values for the rim area, rim volume, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-section area in the disk hemorrhage group were significantly smaller than those in the nonhemorrhage group (P <.05). In the disk hemorrhage group, moreover, the values for the rim area, rim volume, and retinal nerve fiber layer cross-section area in the inferotemporal sector with hemorrhage were significantly smaller than those in the same sector without hemorrhage (P <.05). CONCLUSION: Localized damage of the disk rim and retinal nerve fiber layer at the inferotemporal sector was prominent in eyes with disk hemorrhage.     

Optic disk characteristics before the occurrence of disk hemorrhage in glaucoma patients

PURPOSE: To evaluate qualitatively the structural characteristics and the associated features that antedate the occurrence of a disk hemorrhage in patients with glaucoma. METHODS: Retrospective observational case series. A total of 4018 pairs of stereoscopic optic disk images obtained over 15 years were reviewed. All eyes with optic disk images before the occurrence of a disk hemorrhage were enrolled. The disk images were evaluated in a masked fashion with respect to the general neural rim and peripapillary appearance. RESULTS: The optic disk characteristics and associated features that most antedate the disk hemorrhage in 33 eyes of 26 patients that had previous optic disk images for evaluation are focal neural rim notch (36%), thin sloping rim (42%), peripapillary atrophy (79%), and superior-inferior rim asymmetry (73%). In eyes with preexisting focal rim notches, all subsequent disk hemorrhages were identified at or adjacent to the notches. CONCLUSIONS: Focal rim notching may precede the occurrence of a disk hemorrhage.     

Melanocytomas of the optic disk

PURPOSE: To evaluate the various forms of clinical presentation, the potential of growth, the risk of functional loss and the possibility of malignant transformation of optic disk melanocytomas in European patients. DESIGN: Retrospective observational case control study. METHODS: Evaluation of 37 cases of optic disk melanocytomas identified in the computer files of the ocular oncology unit of Jules Gonin Hospital to determine the clinical presentation of these tumors and the risk of complications. RESULTS: The tumor was asymptomatic in 28 cases. Visual acuity was normal in 26 cases, subnormal in 10 cases, and in one case it was reduced to 0.1. Visual field defects were observed in 19 cases; the size and extent of the tumor and the degree of papilledema appeared to influence the severity of the visual field defect. Tumor growth was demonstrated in 6 of the 9 cases in which follow-up was for at least six years. In two cases there was presumed malignant transformation that was treated by accelerated proton beam radiotherapy. CONCLUSIONS: Melanocytomas in white Europeans and those of European derivation are rarely symptomatic, have only a moderate effect on visual function and show a low rate of progression over long observation. The risk of tumor progression, although sometimes occurring as much as several years after the initial diagnosis, justifies a cautious approach with long-term regular surveillance of these patients.     

Optic disk and choroidal coloboma

Most of the optic nerve head abnormalities are clinically innocuous, but sometimes they can cause significant symptoms and lead to visual disturbance, or even to visual loss; optic pists can cause defects in the visual fields, not necessarily explicable by the serous maculopathy, that is the most important complication associated with optic pits. Our purpose is to present a case of an optic pit with sensory macular detachment associated with a choroidal coloboma located at a distance of two optic disc diameters from the optic nervehead. This finding to our knowledge has not been previously reported.     

Oprelvekin-associated bilateral optic disk edema

PURPOSE: To report a case of bilateral optic disk edema in a patient taking oprelvekin for radioimmunotherapy-induced thrombocytopenia. DESIGN: Observational case report. METHODS: A 38-year-old man with a history of relapsed non-Hodgkins follicular lymphoma complained of bilateral loss of vision following oprelvekin therapy for thrombocytopenia. RESULTS: Funduscopic examination demonstrated bilateral optic disk edema with exudates inferotemporal to the right nerve. The results of magnetic resonance imaging of the brain and orbits and lumbar puncture were normal. The disk edema resolved with discontinuation of oprelvekin therapy. CONCLUSIONS: Oprelvekin therapy may be associated with bilateral optic disk edema. This has been shown to be reversible in a primate model.