Optic disc drusen-associated neovascularization: A systematic review

We have integrated current evidence of visual outcomes in optic disc drusen-associated choroidal neovascularization (ODD-CNV). We systematically reviewed all published ODD-CNV cases from 1974 to 2024 using three databases (PubMed, EMBASE, and Web of Science). Only studies reporting baseline visual acuity, follow-up visual acuity, and an intervention were included. Methodological quality was assessed using a standardized tool for case reports. Seventy-four eyes (65 patients) were identified from 48 eligible articles. The median age of the subjects was 13 years (range: 3-75), and 63.5 % were females. CNVs were mainly peripapillary, with 45.7 % of them progressing into the macula. On average, the eyes had a follow-up period of 21.5 months. Overall, treatment (of any type) showed better outcomes (0.53 LogMAR improvement, > 3 lines on Snellen chart) compared to observation only (0.09 LogMAR improvement). Anti-vascular endotheial growth factor (VEGF) injections and laser photocoagulation, the most frequently used interventions, showed 0.62 and 0.19 LogMAR improvement, respectively; however, the difference was not statistically significant (p = 0.05398). Among 24 pediatric eyes, anti-VEGF showed 0.71 LogMAR improvement with minimal side effects and recurrence in one eye only. When stratified by age, pediatric patients experienced a greater LogMAR improvement compared to adults, even when adjusting for anti-VEGF treatment (p = 0.0279). Our findings highlight the importance of intervention in ODD-CNV patients, particularly in the younger population, as they are more responsive to treatment. Anti-VEGF demonstrates great efficacy and safety profile in the pediatric population.