Sy. Roh et al., EVALUATION OF COEXISTING OPTIC-NERVE HEAD DRUSEN AND GLAUCOMA WITH OPTICAL COHERENCE TOMOGRAPHY, Ophthalmology, 104(7), 1997, pp. 1138-1144
Objective: Optic nerve head drusen often make evaluation of the nerve
head difficult to interpret, In addition, visual field defects are kno
wn to occur in patients with optic disk drusen, resembling glaucomatou
s damage. The authors report two cases of coincident optic nerve head
drusen and glaucoma, in which the use of optical coherence tomography
(OCT) in evaluating the nerve fiber layer was beneficial. Participants
: Two patients with both optic nerve head drusen and glaucoma, one wit
h primary open angle glaucoma, the other with pseudoexfoliation glauco
ma were evaluated, Both patients had asymmetric optic disk drusen, wit
h clinically visible drusen only in one eye. Intervention: Ophthalmolo
gic examination, color and red-free photography, automated Humphrey vi
sual field testing and OCT were performed, Results: Nerve fiber layer
loss as measured by OCT was found to be greater than expected by the a
ppearance of the optic nerve head and red-free photography, with visua
l fields consistent with findings in case 1. In case 2, visual fields
were full, despite nerve fiber layer thinning seen by OCT and red-free
photography. Conclusions: There can be significant nerve fiber layer
thinning in patients with both glaucoma and optic disk drusen, despite
the appearance of the optic nerve head in these patients. The cup mar
gin may be obscured by the drusen, giving rise to a falsely full-appea
ring disk. In such cases, OCT may provide a useful means to quantitati
vely measure the nerve fiber layer thickness and to aid in the managem
ent of these patients by detecting nerve fiber layer thinning earlier
than would otherwise be possible.