Anterior ischemic optic neuropathy in association with optic nervehead drusen

Visual field defects due to optic nerve drusen in Afro-Caribbean patients: A case series of 16 eyes

INTRODUCTION

Optic Nerve Head Drusen (ONHD) are very rare among black patients but may cause more severe visual defects in these patients. The goal of our study was to describe the frequency of visual field defects secondary to OND in Afro-Caribbean patients and study the characteristics of their physical examination, color vision and contrast sensitivity.

METHODS

We carried out a prospective study at the Martinique university medical center on patients of African descent with ONHD diagnosed on fundus examination and B-scan ultrasonography. All patients received a complete neuro-ophthalmological examination. The primary study endpoint was the frequency of visual field defects. Secondary study endpoints were the results of ETDRS visual acuity, Pelli-Robson contrast sensitivity chart, and 15 hue color vision test.

RESULTS

Sixteen eyes of 10 patients from 11 to 68 years of age were included. Forteen eyes (87%) had exposed ONHD. Eleven eyes (69%) showed a visual field defect: 9 eyes (69%) had an enlarged blind spot, and 9 eyes (69%) had an arcuate scotoma. 3 eyes (19%) had loss of ETDRS visual acuity, and 12 eyes (75%) showed loss of Pelli-Robson contrast sensitivity. Five eyes (31%) had an abnormal color vision test.

CONCLUSION

This is one of the largest case series of ONHD in Black patients. The frequency of visual field defects was high but comparable to that of studies in other ethnic groups. Larger comparative studies are necessary to confirm these results.

Optic Nerve Head Drusen: An Update

Optic nerve head drusen are benign acellular calcium concretions that usually form early in life, just anterior to the lamina cribrosa. Improving imaging using optical coherence tomography suggests they are common and may be present in many clinically normal discs. These drusen may change in appearance in early life, but are generally stable in adulthood, and may be associated with visual field defects, anterior ischaemic optic neuropathy, or rarer complications. Based on long-term clinical data and optical coherence tomography, we propose a refined hypothesis as to the cause of optic disc drusen. Here we summarise recent findings and suggest future studies to better understand the forces involved.

Acute Unilateral Anterior Ischemic Optic Neuropathy Secondary to Optic Nerve Head Drusen: Report of a Rare Coexistence

A 45-year-old white male noticed on awakening the painless loss of inferior vision in the left eye 2 days ago. He was otherwise well and his medical history was unremarkable. Visual acuity was 20/20 in OD and 20/32 in OS with a left inferior altitudinal defect and right blind spot enlargement demonstrable on visual field test. On fundus examination, both disc margins were blurred and the left disc was diffusely oedematous, with linear haemorrhages in the adjacent nerve fibre layer. Radiologic imaging and laboratory tests were unremarkable. Bilateral optic nerve head drusen (ONHD) was demonstrated by optical coherence tomography and fundus autofluorescence imaging. Unilateral acute non-arteritic anterior ischemic optic neuropathy (NAION) and concomitant bilateral ONHD were diagnosed. NAION may develop secondary to ONHD. Therefore, clinicians should be aware of this rare association and inform the patients about this risk. Patients with ONHD should be followed-up periodically in terms of possible ischemic complications.

Bilateral optic nerve head drusen with chorioretinal coloboma in the right eye

Chorioretinal coloboma is a congenital defect of the eye caused by improper closure of the embryonic fissure. Optic nerve head drusen (ONHD) are white calcareous deposits that are generally asymptomatic. We report a very rare association of both in a healthy patient with no any systemic syndrome. A 16-year-old man was referred to our clinic from suffering blurred vision. Best corrected visual acuity of the right eye was 6/10 and 10/10 in the left one. External ocular and slit lamp examination were normal. Dilated ophthalmoscopy showed marked swelling in both optic nerves and chorioretinal coloboma in the right eye inferiorly. Ultrasonography showed an echodense structure with acoustic shadowing in both eyes consistent with buried ONHD. Visual field testing showed normal field in the left eye and moderate superior field depression in the right eye corresponding to inferior coloboma in funduscopy. Results of general medical and neurologic, cardiologic, and other examinations were normal. To the best our knowledge combination of bilateral ONHD and unilateral chorioretinal coloboma in a healthy patient with no any systemic syndrome has not been published in the literature. We reported this very rare association and recommended examine eyes and other body organs. In such cases that coloboma is associated with ONHD, we should keep in mind Noonan syndrome. The diagnosis of Noonan syndrome is clinical and confirm by the consultant pediatricians and clinical geneticists.

Unilateral Acute Anterior Ischemic Optic Neuropathy in a Patient with an Already Established Diagnosis of Bilateral Optic Disc Drusen

Optic disc drusen (ODD) are calcific deposits that form in the optic nerve head secondary to abnormalities in axonal metabolism and degeneration. Anterior ischemic optic neuropathy, central retinal artery, and vein occlusion are among the rare vascular complications of disc drusen. We reported the clinical course of a 51-year-old patient with a unilateral acute nonarteritic anterior ischemic optic neuropathy (NAION) who received the diagnosis of bilateral optic disc drusen five years earlier and thereby reiterated the association of ODD and acute NAION.