Microvascular changes detected by optical coherence tomography angiography (OCTA) associated with peripapillary retinal nerve fibre layer loss and visual field impairment in a paediatric with optic disc drusen

Author: Esther Casado-López (Spain)

Co-authors: Bachar Kudsieh, Maria Alarcón Tomas, Jose María Ruiz-Moreno

Purpose

To report a case of a 12-year-old boy who was diagnosed of bilateral optic disc drusen (ODD). ODD are acellular deposits discovered incidentally during routine eye exams that in some cases could lead into vascular compression at the optic nerve head. Studies about vascular changes in children with ODD are very limited.

Setting/Venue

Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Methods

Prospective case report of a 12-year-old boy who was diagnosed of bilateral ODD being referred to ophthalmology unit to exclude papilledema. He presented with 20/20 best corrected visual acuity (BCVA) and occasional myodesopsias.

Results

Initial optical coherence tomography (OCT) revealed a superficial and deep location of the deposits and a loss of retinal nerve fibre layer (RNFL), OCT angiography (OCTA) revealed no notable vascular changes in the papillary region, while a visual field (VF) test indicated moderate scotoma. During follow up, the change of the ODD location intro more superficial position was associated with progressive RNFL loss along with peripapillary microvascular changes and VF loss.

Conlusions

ODD is a rare, typically buried and benign, condition in children that should be ruled out in cases of papilledema and requires close follow-up to detect changes in ODD location and progressive VF and RNFL loss. OCT is useful for detecting ODD and measuring RNFL in general follow-up, while OCTA is a non-invasive method that can detect ODD-associated microvascular changes.

Financial Disclosure

Dr. Ruiz-Moreno receives research support from Topcon, Co.