CIBA - Digital Grand Rounds - Answer/Discussion

CIBA Vision Ophthalmics - Digital Grand Rounds

Digital Grand Rounds Program - Answer/Discussion

Optic disc drusen or hyaline bodies of the optic nerve are acellular laminated concretions of unknown source. They are partially calicified and possibly related to accumulation of axoplasmic derivitieves of degenerating retinal nerve fibers. Disc drusen slowly become more visible and as they enlarge toward the disc surface and margins. Disc drusen usually become visible in the early teenage years. The condition is inherited as an autosomal irregular dominant trait. Examination of other family members my reveal elevated discs or disc drusen. The condition is bilateral 67-73% of the time, although asymetry is common. Retinitis pigmentosa is rarely associated with disc drusen.
Disc drusen may compress the nerve fibers causing visual field loss. Visual field loss progresses very slowly and affects the inferior nasal field most commonly. Central field loss could rarely occur secondary to hemorrhages from sub-macular fibrovascular membrane, ischemic disc infarction, arterial occlusions.
Diagnosis is aided by observation of autofluoresnce of the disc. This can be observed by viewing the disc through the fundus camera with the fluorescein angiography exciter and barrier filters in place. Dye injection is not necessary.
Ophthalmolgoy consultation recommended follow-up every 6 months.
References:
Glaser JS. Topical Diagnosis: Prechiasmal Visual Pathways. In: Duane's Clinical Ophthalmology : 1989 Vol 2, Chap 5, p 21-2.
Nanjiani M. Fluorescein Angiography Technique, Interpretation, and Application. Oxford University Press 1991 p. 31
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