Optic Nerve Head Drusen

Disc photos and fundus autofluorescence (right and left eye)

Funduscopy showed small optic nerves with irregular disc margins and pale refractile deposits on the surface (left moreso than right). The optic nerves exhibit a characteristic lumpy bumpy appearance. The drusenoid bodies within the optic nerve demonstrate hyper autofluorescence on fundus autofluorescence imaging.

Red free images (right and left eye)

Red-free imaging show reduced RNFL reflectivity in both eyes

Spectralis OCT line scans (right optic disc)

OCT line scans show hypo-reflective spheroidal spaces with hyper-reflective borders, typical of optic nerve head drusen.

Spectralis OCT line scans (left optic disc)

OCT line scans show hypo-reflective spheroidal spaces with hyper-reflective borders, typical of optic nerve head drusen. The drusen in this eye are larger, more numerous and superficial than in the right eye.

B-scan ultrasound (right and left eye)

B-scan ultrasound show a hyper-echoic signal at the optic nerve head with associated posterior shadowing.

Cirrus RNFL Analysis

OCT RNFL analysis shows widespread thinning of the RNFL in both eyes.

Cirrus Ganglion Cell Analysis

GCA shows thinning of the ganglion cell-inner plexiform layer in both eyes, more advanced in the left eye.

24-2 SITA Faster visual field

24-2 perimetry shows an early inferonasal step in the right eye and superior and inferonasal depressions in the left eye.

Disc photos and fundus autofluorescence images (right and left disc)

Funduscopy shows small elevated optic discs with white refractile deposits and irregular disc margins. Fundus autofluorescence reveals hyper autofluorescence mainly at nasal portion of the optic nerves

Red free images (right and left eye)

Red-free imaging showed reduced RNFL reflectivity superiorly and inferiorly in the right eye and inferiorly in the left eye.

B-scan ultrasound (right and left eye)

B-scan ultrasound shows hyper-echoic signals at the optic nerve head.

Spectralis OCT line scans - Right (1) and Left (2) optic disc

OCT shows the hypo-reflective spaces with hyper-reflective borders, characteristic of optic nerve head drusen.

Cirrus RNFL Analysis

OCT RNFL analysis shows RNFL thinning superiorly and nasally and to a lesser extent inferiorly

30-2 SITA Standard visual field

A 30-2 visual field test shows mild inferonasal depressions in the right eye and superonasal depressions in the left eye.

Fundus photograph and red-free image (right eye)

Fundus examination showed medium sized discs with blurred margins and extensive number of small coalesced creamy/yellow lesions at the surface of the optic nerve head. Red free viewing showed reduced RNFL reflectivity.

Fundus photograph and red-free image (left eye)

Fundus examination showed medium sized discs with blurred margins and extensive number of small coalesced creamy/yellow lesions at the surface of the optic nerve head. The individual disc drusen are easier to discern in this eye. Red free viewing showed reduced RNFL reflectivity.

Magnified view of the right and left optic nerve heads

A magnified view of both discs more clearly shows the presence of disc drusen with the individual drusen easier to discern on the left disc.

Fundus autofluorescence imaging

The creamy yellow lesions noted on examination correspond to areas of hyper-fluorescence on FAF imaging.

Spectralis OCT line scan through the right optic disc

OCT line scans show large number of discrete various size hyporeflective spaces within the RNFL.

Spectralis OCT line scan through the left optic disc

OCT line scans show large number of discrete various size hyporeflective spaces within the RNFL

Cirrus RNFL analysis

There is thinning of RNFL in both eyes compared to normative database however the pattern of thinning is similar between the two eyes.

Cirrus Ganglion Cell Analysis

There is thinning of the ganglion cell layers in both eyes compared to normative database however pattern is similar between the two eyes.

Disc photos and fundus autofluorescence images (right and left eye)

Funduscopy shows small optic nerves and cups with intact neuroretinal rims. The disc margins were distinct and there were no signs of vessel obscuration, choroidal folds or disc haemorrhages.

Fundus autofluorescence did not show any hyper-autofluorescent signal at the optic nerves.

Spectralis OCT volume and line scan (right optic disc)

OCT shows hyporeflective bodies with hyper reflective walls deep within the optic nerve in the right eye (blue arrow)

Spectralis OCT line scan (left optic disc)

OCT line scans show possible hyporeflective bodies with hyper reflective walls deep within the left optic nerve (blue arrow). Bergmeister papilla is seen as hyper reflective tissue above the inferonasal optic nerve in this eye (yellow arrow).

B-scan ultrasound (right and left eye)

B-scan ultrasound show a small hyper acoustic signals at the optic nerve with posterior shadowing (right more obvious than left).

Cirrus RNFL Analysis

OCT RNFL thickness was within the normative range limits although the thickness map shows a relatively thicker peripapillary RNFL in the right eye compared to left.

24-2 SITA Faster visual field

24-2 perimetry shows a clear field in the right eye and shallow nasal points of depression in the left eye, however this did not correspond with the structural findings.

Optic disc photos and fundus autofluorescence imaging (right and left eye)

Retinal photos show indistinct disc margins at initial presentation (more apparent in the left eye than in the right). FAF shows areas of hyper-autofluorescence in both eyes at initial presentation, again more noticeable in the left eye than in the right.

Flicker comparison of discs at initial and follow-up visits

Flicker comparison shows elevation of the optic nerves and increasingly indistinct disc margins.

Flicker comparison of fundus autofluorescence imaging (initial and follow up)

FAF flicker shows an increase in hyper-fluorescence at the optic disc.

Flicker comparison of red free images - initial and follow up (right and left eye)

Red-free flicker shows widening of the RNFL wedge defect superotemporally in the right eye, superotemporally and inferotemporally in the left eye.

Spectralis OCT line scans at initial and follow-up visits (right eye)

OCT line scans shows increased disc elevation and visibility of the disc drusen with more hyporeflective areas within the optic nerve.

Spectralis OCT line scans at initial and follow-up visits (left eye)

OCT line scans shows increased disc elevation and visibility of the disc drusen with more hyporeflective areas within the optic nerve.

Cirrus RNFL guided progression analysis (right eye)

RNFL GPA shows progressive loss of the superior RNFL in the right eye. There was also an inferior peripapillary elevation of the optic nerve due to surfacing of the disc drusen over time.

Cirrus RNFL Guided Progression Analysis (left eye)

RNFL GPA shows progressive loss of the superior and superonasal RNFL in the left eye. There was also an inferior peripapillary elevation of the optic nerve due to surfacing of the disc drusen over time.

Fundus photograph (right and left eye)

Retinal photography shows the left optic disc to have indistinct disc margins and relative pallor in comparison to the right disc.

Red-free images (right and left eye)

Red-free images show a widespread loss of the normal RNFL reflectivity in the left eye .

Stereophoto of the right optic disc

Stereophoto right optic disc shows a borderline small disc but is otherwise unremarkable apart from a heaped of the inferior rim with stereoviewing.

Stereophoto of the left optic disc

Note the uneven nature of the disc surface and notable elevation with stereoviewing.

Fundus autofluoresence (FAF) Imaging

FAF imaging shows hyper-AF of the right disc in the infero-nasal quadrant, and widespread AF of the disc in the left eye. These findings are consistent with surface disc drusen.

Cirrus Ganglion Cell Analysis (GCA)

Cirrus analysis shows marked thinning of the GC-IPL complex in the left eye, predominantly temporal to the fovea but also with a likely macular wedge.

Cirrus RNFL anlaysis

Cirrus RNFL analysis is relatively unremarkable in the right eye apart from a temporal shift of the superior vasculature. The left shows a marked global relative thinning both in comparison to the right eye and the normative database

Humphrey 30-2 threshold visual field

Humphrey 30-2 visual field test shows an inferior arcuate defect as well as a superior nasal step. The right shows isolated peripheral relative depressions likely related to lens artefacts.

Humphrey 20-2 threshold visual field

Humphrey 10-2 visual field test is essentially clear in the right and shows nasal central involvement of the superior and inferior defects

Cirrus OCT Angiography

OCTA shows reduced density of retinal capillaries in the left eye as compared to the right.

Cirrus Guided Progression Analysis - GCIPL

GPA shows stable structural findings over time in the left eye.

Cirrus Guided Progression Analysis - RNFL

GPA shows stable structural findings over time in the left eye however RNFL results are at the floor values and so should be interpreted with caution.

Humphrey Visual Field Guided Progression Analysis

Guided progression analysis shows notable variability but overall stable functional findings in the left eye over an almost 3 year period.