Optic Nerve Head Drusen: Imaging Using Optical Coherence Tomography Angiography

Flores-Reyes, Elsa María; Hoskens, Kirsten; Mansouri, Kaweh

doi:10.1097/ijg.0000000000000730

Cited by 25 publications

(12 citation statements)

References 10 publications

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“…A focal decrease in vessel density within the location of optic nerve head drusen in pseudopapilledema has been shown in one case report,21 and overall decreased vessel density in a cohort of 13 patients with optic disc drusen was recently described as well 22. Small, elevated, and crowded optic discs in pseudopapilledema might compress peripapillary nerve fiber layer, which then impair retinal blood flow to the peripapillary retina in pseudopapilledema including optic disc drusen 21. A similar peripapillary ischemic feature might happen in severe papilledema eyes, accounting for our finding no differences in any capillary values when we compared eyes with grade 3 papilledema with pseudopapilledema eyes.…”

Section: Discussionmentioning

confidence: 85%

“…Nasal PCD of <22.6% had 69% specificity and 63% sensitivity and the whole image capillary of irVD image of <22.8% had 74% specificity and 60% sensitivity for differentiating pseudopapilledema from papilledema. A focal decrease in vessel density within the location of optic nerve head drusen in pseudopapilledema has been shown in one case report,21 and overall decreased vessel density in a cohort of 13 patients with optic disc drusen was recently described as well 22. Small, elevated, and crowded optic discs in pseudopapilledema might compress peripapillary nerve fiber layer, which then impair retinal blood flow to the peripapillary retina in pseudopapilledema including optic disc drusen 21.…”

Section: Discussionmentioning

confidence: 91%

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Optical Coherence Tomography Angiography in Papilledema Compared With Pseudopapilledema

Fard

Sahraiyan

Jalili

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PurposeThe purpose of this study is to evaluate differences in optical coherence tomography angiography (OCT-A) findings between patients with papilledema and pseudopapilledema.MethodsIn this prospective, comparative study, 41 eyes of 21 subjects with papilledema, 27 eyes of 15 subjects with pseudopapilledema, and 44 eyes of 44 healthy normal subjects were included and were imaged using OCT-A. In addition to peripapillary total vasculature maps obtained with commercial vessel density mapping, major vessel removal using customized image analysis software was also used to measure whole image capillary density and peripapillary capillary density (PCD). Peripapiilary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were recorded.ResultsAverage RNFL thicknesses were greater in papilledema eyes than in pseudopapilledema and control subjects. GCC thickness was not different among three groups. Peripapillary vasculature values were significantly lower in papilledema (58.5 ± 6.1%) and pseudopapilledema (58.9 ± 4.7%) eyes compared with healthy eyes (63.2 ± 3.1%) using commercial machine software, without a difference between papilledema and pseudopapilledema eyes. However, using our customized software, peripapillary “capillary” density of papilledema eyes was 29.8 ± 9.4%, which was not significantly different from healthy subjects (31.8 ± 7.4%; P = 0.94). Pseudopapilledema eyes with peripapillary density of 25.5 ± 8.3% had significantly lower capillary values compared with control eyes (P = 0.01). There was a significantly lower whole image and nasal sector peripapillary capillary density of inner retina in pseudopapilledema eyes than papilledema eyes (P = 0.03 and P = 0.02, respectively).ConclusionsWhole image and nasal peripapillary sector capillary densities using OCT-A had diagnostic accuracy for differentiating true and pseudo-disc swelling.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 91%

Optical Coherence Tomography Angiography in Papilledema Compared With Pseudopapilledema

Fard

Sahraiyan

Jalili

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…More recently, OCT angiography (OCTA) has been used to detect microvascular changes in the peripapillary and macular areas in different optic neuropathies (19) including ODD (20). Previous studies found that eyes with ODD had focal microvascular attenuation corresponding to the drusen (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Topographic Quadrant Analysis of Peripapillary Superficial Microvasculature in Optic Disc Drusen

et al. 2021

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Background: Limited information is known about the topographic effect of optic disc drusen (ODD) on peripapillary retinal nerve fibers and microvasculature.Objective: This study aims to understand the structural and functional impact of ODD in different quadrants of the optic disc.Methods: We performed a retrospective case-control study of 22 ODD patients (34 eyes) and 26 controls (33 eyes) to compare optical coherence tomography (OCT) retinal nerve fiber layer (RNFL), OCT angiography (OCTA), and corresponding static perimetry mean deviation (MD) calculated using the modified Garway-Heath map in different quadrants of the optic disc. OCTA was analyzed using custom MATLAB script to measure six parameters in a peripapillary annulus with large vessel removal: vessel area density (VAD), vessel skeleton density (VSD), vessel perimeter index (VPI), vessel complexity index (VCI), flux, and vessel diameter index (VDI).Results: Quadrant analysis revealed that OCTA VAD and VCI were significantly decreased in superior, nasal, and inferior but not temporal quadrant. RNFL, VSD, and VPI were significantly impacted only in the superior and nasal quadrants. Corresponding visual field MDs in all ODD eyes were not different in the four quadrants, although eyes with MD equal or worse than −5 dB (32%) had worst visual field corresponding to the superior quadrant of the optic disc (inferior arcuate visual field). Structure-structure comparison of OCT and OCTA showed high correlation of RNFL with multiple OCTA measurements in the superior, nasal, and inferior quadrants but not temporal quadrant. Structure-function analysis revealed significant correlation of VAD and VCI and visual field MD in every quadrant, but RNFL was only significantly correlated in the superior and inferior quadrants.Conclusions: Peripapillary VAD and VCI are decreased in more quadrants than RNFL, supporting the clinical utility of performing OCTA in addition to OCT. Consistent with the most common locations of ODD, five OCT/OCTA measurements (VAD, VCI, RNFL, VSD, VPI) are decreased in the superior and nasal quadrants. OCT/OCTA measurements were significantly impacted in contrast to the relatively mild effect on corresponding visual field MD, consistent with the idea that a decrease in objective structural and vascular measurements occurs without parallel change in subjective visual function in ODD.

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“…Other studies have investigated the role of cerebrospinal fluid pressure on optic nerve head biomechanics, demonstrating that elevating cerebrospinal fluid pressure results in increased deformation of the lamina cribrosa and retrolaminar optic nerve, and that this deformation resolves within weeks following an intervention to lower cerebrospinal fluid pressure (14,15) . (12) argued that the study group in all the studies in favor of using OCT as a tool to differentiate between disc edema and pseudopapilledema had subjects with variable causes of disc swelling in the group with disc edema and could not be used to represent papilledema (16) . Though previous studies have found total retinal thickness to perform better than retinal nerve fiber layer thickness (17,18) .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Papilledema and Pseudopapilledema Using Optical Coherence Tomography

Elmenezaa¹,

Fawzy²,

Al-Nashar‎³

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Papilledema is a common clinical problem where the ophthalmologist plays an important role in its diagnosis . Optical coherence tomography (OCT) provides high resolution images of the retina and the retinal nerve fiber layer (RNFL). Objective: The aim of the work was early and non-invasive diagnosis of papilledema and differentiating it from pseudopapilledema using optical coherence tomography (OCT). Patients and methods: This observational case control study included a total of 45 eyes stratified into 3 equally groups, 15 each, (Group-1): eyes of healthy normal subjects, (Group-2) eyes with papilledema and (Group-3) eyes with pseudopapilledema. Patients presented at Ophthalmology Outpatient Clinic, Zagazig University Hospitals. Follow-up visits included an interview with the patient for assessing the presence of ocular symptoms, and for ophthalmologic examination to register all the clinical findings. Results: There is statistically significant difference between the studied groups regarding result of fundus examination. Normal control group had normal appearance of fundus. Concerning pseudo papilledema, 73.3% had crowded disc and 26.7% had dusen. Concerning papilledema, 40% had mild lesion, 20% had moderate and remaining 40% had severe lesion. There is statistically significant difference between the studied groups regarding morphological changes. Crowded disc and buried optic disc drusen occurred in 73.3% and 26.7% of pseudopapilledema group respectively). There is statistically significant difference between the studied groups regarding superior RNFL. On LSD comparison, the difference is significant between each individual groups. There is statistically significant difference between the studied groups regarding inferior RNFL. Conclusion: It could be concluded that spectral domain optical coherence tomography can differentiate between papilledema, pseudopapilledema, and a normal disc.

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Optic Nerve Head Drusen: Imaging Using Optical Coherence Tomography Angiography

Abstract: This is the first report in which peripapillary vessel density is analyzed using OCTA technology for this entity. OCTA could confirm the diagnosis and has the potential to assist with the diagnosis and evaluation of progression of ONHD.

Cited by 25 publications

References 10 publications

Optical Coherence Tomography Angiography in Papilledema Compared With Pseudopapilledema

Optical Coherence Tomography Angiography in Papilledema Compared With Pseudopapilledema

Topographic Quadrant Analysis of Peripapillary Superficial Microvasculature in Optic Disc Drusen

Diagnosis of Papilledema and Pseudopapilledema Using Optical Coherence Tomography

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