Risk stratification of visual field progression in optic disc drusen with and without glaucoma

To investigate the visual field (VF) progression in patients with optic disc drusen (ODD) with or without glaucoma and identify factors associated with rapid deterioration.

In this single-center retrospective cohort, adult patients with ODD, ≥ 12 months of follow-up, and ≥ 3 reliable standard automated perimetry tests were included. VF progression was quantified as the VF mean deviation (MD) slope (dB/year) using linear mixed-effects modeling. Eyes were categorized as slow progression (MD slope > - 0.5 dB/year) or moderate-fast progression (MD ≤ - 0.5 dB/year). Baseline RNFL thickness and VF MD, Visual acuity, intraocular pressure (IOP), glaucoma diagnosis, and number of IOP-lowering medications (NOM) were extracted from the medical record. Associations with moderate-fast progression were evaluated using logistic regression.

A total of 139 eyes from 84 patients were included (mean follow-up 57.4 ± 42.6 months; mean 4.9 perimetry tests/eye). Glaucoma was diagnosed in 83/139 eyes (59.7%). Overall, 91/139 eyes (65.5%) demonstrated VF deterioration (MD slope < 0 dB/year), more frequently in glaucoma-labeled eyes than no-glaucoma eyes (64/83 [77.1%] vs. 27/56 [48.2%]; p < 0.001). Moderate-fast progression occurred in 32/139 eyes (23.0%) and did not differ significantly by glaucoma status (28.9% vs. 14.3%, p = 0.064). In multivariable modeling, higher mean NOM was associated with higher odds of moderate-fast progression (adjusted odds ratio 2.41; 95% CI 1.06-5.45; p = 0.034), whereas glaucoma diagnosis and mean IOP were not independently associated. Severity-stratified analyses showed higher moderate-fast progression with baseline VF MD ≤ -6 dB (34.9% vs. 13.2%, p = 0.004) and RNFL < 80 µm (36.4% vs. 7.0%, p < 0.001).

In eyes with ODD, thinner RNFL and worse VF MD at baseline are associated with a higher risk of moderate-fast VF decline, supporting risk-stratified monitoring regardless of glaucoma label or IOP.