Neuro-Ophthalmology

Case 9

Patient Presentation: A 41-year-old man saw his optometrist for a routine examination. He was asymptomatic with a visual acuity of 20/20 OU; however, the optometrist was concerned for an abnormal appearing optic nerve in the right eye. Intraocular pressure and visual fields were normal. Optic disc photos were performed and are shown below.

Neuro-Ophthalmology 9-1.png

Question: What is the best OCT modality to further evaluate the optic nerves?

Neuro-Ophthalmology 9-2.png

Question: An EDI-OCT of the nerve was conducted and is shown above. What abnormality is seen in the EDI-OCT image of the optic nerves above?

Neuro-Ophthalmology 9-4.png

Fundus auto-fluorescence imaging was conducted as the findings on the OCT were not in line with the clinical findings on fundus examination. The fundus auto-fluorescence images are shown above:

Question: What is the diagnosis?

References:

1. Lee KM, Woo SJ. Fundus autofluorescence in the buried optic disc drusen: optical coherence tomography findings. Can J Ophthal 2016;52(2):E52-53.

2. Schmitz-Valckenberg S, Holz FG, Bird AC, et al. Fundus autofluorescence imaging: review and perspectives. Retina 2008;28:385-409.

Learning Objectives:

1. Understand what imaging modality is best to detect optic disc drusen

2. Learn the OCT appearance of optic disc drusen