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The Rates of Retinal Nerve Fiber Layer Change in Children With Optic Disc Drusen
Tais Estrela1, Jacqueline Jeon-Chapman1,2, Jia Jia Zhang1
1Departments of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Purpose:
Optic disc drusen (ODD) are calcified deposits in the prelaminar portion of the optic nerve head. Although often asymptomatic, it can damage optic nerve fibers, resulting in irreversible vision loss. This study evaluates rates of structural changes in children with ODD and risk factors associated with faster rates of retinal nerve fiber layer (RNFL) thinning.
Design:
Retrospective cohort study.
Subjects:
Forty eyes of 22 children with ODD and 40 eyes of 20 age-, gender-, and race-matched glaucoma-suspect children.
Methods:
Children were required to have ≥3 OCT RNFL tests and a minimum of 18 months between the first and last OCT. Linear mixed models estimated RNFL changes over time. Univariable and multivariable models assessed the effect of clinical variables on rates of change.
Main Outcome Measures:
The primary outcome was the rates of RNFL change over time, which was compared to the glaucoma-suspect group. The secondary outcome was to investigate the clinical factors associated with faster RNFL thinning.
Results:
Children with ODD were followed for an average of 4.1 ± 2.5 years (median 3.2). Eyes with ODD had rates of RNFL change significantly faster than the glaucoma-suspect group (-2.01 ± 1.53 μm/year versus -0.07 ± 0.47 μm/year; P < 0.001). The multivariable model revealed older age and higher RNFL at baseline were significantly associated with faster rates of RNFL thinning, with 0.37 μm/year faster loss for each year older (P = 0.040) and 0.07 μm/year faster loss for each μm higher RNFL at baseline (P = 0.030).
Conclusions:
Children with ODD demonstrate significant rates of RNFL thinning over time. Knowing the distribution of RNFL change attributable to ODD in children will enable clinicians to identify rapid progressors and alternative etiologies of optic nerve injury.
Financial Disclosures:
The authors have no proprietary or commercial interest in any materials discussed in this article.
