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Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function.

Kaitlyn W Nolan1, Michael S Lee, Rohan A Jalalizadeh

  • 1Department of Ophthalmology and Visual Neurosciences (KWN, MSL, KCF, CMM), University of Minnesota School of Medicine, Minneapolis, Minnesota; and Department of Ophthalmology and Visual Sciences (RAJ, GPVS), Washington University School of Medicine, St. Louis, Missouri.

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Summary

Higher intraocular pressure (IOP) did not correlate with visual field loss or thinner retinal nerve fiber layer (RNFL) in optic nerve head drusen (ONHD) patients. This suggests IOP lowering may not prevent vision loss in normotensive ONHD cases.

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Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology

Background:

  • Optic nerve head drusen (ONHD) are calcifications within the optic nerve head.
  • Management strategies for ONHD often consider intraocular pressure (IOP) due to potential optic neuropathy.
  • The relationship between IOP and visual function in ONHD is not fully understood.

Purpose of the Study:

  • To investigate the correlation between intraocular pressure (IOP) and visual field defects (perimetric mean deviation, PMD) and retinal nerve fiber layer (RNFL) thickness in patients diagnosed with optic nerve head drusen (ONHD).

Main Methods:

  • A retrospective chart review was conducted on adult patients diagnosed with ONHD.
  • Data included IOP, PMD from visual field testing, and RNFL thickness from optical coherence tomography (OCT).
  • Statistical analyses, including regression models, were used to assess associations, controlling for confounders.

Main Results:

  • No statistically significant association was found between IOP and PMD (P=0.13) or RNFL thickness (P=0.65) in 146 patients with ONHD.
  • A trend suggested ocular hypertension was associated with less depressed PMD (P=0.031).
  • Subgroup analyses for visible and buried ONHD showed similar non-significant findings.

Conclusions:

  • In patients with ONHD, higher IOP at diagnosis was not associated with greater visual field loss or thinner RNFL, particularly in predominantly normotensive eyes.
  • These findings suggest that interventions aimed at lowering IOP may not be effective in preventing visual impairment in normotensive ONHD patients.