Multimodal OCT/OCT-A Risk Stratification in Optic Disc Drusen: Drusen Height, Peripapillary Perfusion, and Visual...

Area of Science:

• Ophthalmology
• Neuro-ophthalmology

Background:

• Optic disc drusen (ODD) are optic nerve head deposits that can mimic swelling and lead to progressive optic nerve damage and visual field loss.
• Identifying patients with ODD at risk for rapid visual field decline is crucial for timely intervention.

Purpose of the Study:

• To determine predictors of progressive visual field loss in patients with optic disc drusen.
• To evaluate the utility of optical coherence tomography (OCT) and OCT-angiography in assessing ODD progression.

Main Methods:

• A cohort of 131 adults with OCT-confirmed ODD underwent OCT-angiography and serial visual field testing over at least 18 months.
• Key measurements included drusen size (maximum height), peripapillary and intra-optic nerve blood vessel density, and visual field change rate.
• Fast progression was defined as visual field worsening of ≥0.5 dB per year.

Main Results:

• Superficial ODD eyes exhibited larger drusen and more frequent visual field defects compared to buried ODD.
• Low peripapillary blood vessel density was strongly associated with fast visual field progression (52.3%).
• Superficial ODD (OR 6.3), larger drusen (OR 2.0 per 100 µm), and lower vessel density were significant predictors of fast progression.

Conclusions:

• Combining drusen size and peripapillary vessel density measurements significantly enhances the prediction of visual field loss in ODD patients.
• These combined metrics improve diagnostic accuracy (AUC 0.8 to 0.9) and can guide closer monitoring for high-risk individuals.