Two differing presentations of optic nerve head drusen

Optic nerve head drusen was recognized histologically in 1858 by Heinrich Muller The majority of optic nerve head drusen cases have been benign in nature. However, optic nerve head drusen can be visually devastating.

Two patients were diagnosed with optic nerve head drusen. They were similar in age and each had a best-corrected visual acuity of 20/20 OU. Although the diagnosis was the same, the disease affected each person very differently. One is currently asymptomatic; the other is legally blind secondary to severely constricted visual fields. These cases demonstrate the diversity of visual effects produced by optic nerve head drusen. Appropriate ocular workup, including visual fields, B-scan ultrasonography, computed tomography, and other tests, are presented.

There is no existing treatment for optic nerve head drusen. Proper diagnosis and patient education is the best-available modality of care. Patients need to be aware of potential complications which, while rare, can affect vision. Visual-field testing can aid in monitoring for subtle changes in vision.