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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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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.
Question: What is the best OCT modality to further evaluate the optic nerves?
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?
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
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