Purpose: To evaluate the ophthalmoscopic manifestations of patients with visible and hidden optic disc drusen (ODD). Method: We studied 55 patients (100 eyes) with ODD that were confirmed using B-scan ultrasonography and a control group of 60 patients (100 eyes) for differential diagnosis. We analysed the optic nerve features with stereoscopic photography and compared the characteristics between visible and hidden ODD and between hidden ODD and papilloedema. Results: The patients with ODD presented the following ophthalmoscopic features: visible drusen (52%), blurred edges (84%), raised optic disc (74%), absence of optic disc cupping (69%), absence of venous pulse (54%), abnormal vascular branching (81%), presence of cilioretinal vessels (42%), peripapillary atrophy (56%) and haemorrhages (2%). Comparison of the qualitative characteristics of the papillae of the eyes with visible and hidden ODD showed statistically significant differences in all parameters studied, except for morphological alterations (p = 0.851) and haemorrhage (p = 0.954). Comparison of hidden ODD with papilloedema showed statistically significant differences in blurred edges, disc elevation, absence of optic disc cupping, altered colour, anomalous vascular branching and optic disc haemorrhages (p < 0.005). Conclusions: Ophthalmologic features associated with ODD can help us to diagnose their presence and avoid confusing them with papilloedema.

Keywords:
Echography, Optic disc drusen, Optic nerve, Ocular fundus photography
1.
Auw-Haedrich C, Staubach F, Witschel H: Optic disk drusen. Surv Ophthalmol 2002;47:515–532.
2.
Roh S, Noecker RJ, Schuman JS, Hedges TR, 3rd, Weiter, JJ, Mattox C: Effect of optic nerve head drusen on nerve fiber layer thickness. Ophthalmology 1998;105:878–885.
3.
Gili Manzanaro P, Yanguela Rodilla J, Rodriguez Caravaca G, Carrasco Font C, Martin Rodrigo JC, Arias Puente A: Decreased visual acuity from optic disc drusen (in Spanish). Arch Soc Esp Oftalmol 2010;85:64–69.
4.
Savino PJ, Glaser JS, Rosenberg MA: A clinical analysis of pseudopapilledema. II. Visual field defects. Arch Ophthalmol 1979;97:71–75.
5.
Grover S, Fishman GA, Brown J Jr: Frequency of optic disc or parapapillary nerve fiber layer drusen in retinitis pigmentosa. Ophthalmology 1997;104:295–298.
6.
Pierro L, Brancato R, Minicucci M, Pece A: Echographic diagnosis of drusen of the optic nerve head in patients with angioid streaks. Ophthalmologica 1994;208:239–242.
7.
Nischal KK, Hingorani M, Bentley CR, Vivian AJ, Bird AC, Baker AJ: Ocular ultrasound in Alagille syndrome: a new sign. Ophthalmology 1997;104:79–85.
8.
Lam BL, Morais CG Jr, Pasol J: Drusen of the optic disc. Curr Neurol Neurosci Rep 2008;8:404–408.
9.
Nieto Uresandi MI, Corcóstegui Guraya B, González Sanjuán R: Drusas de papila. Oftalmoscopia como elemento diagnóstico de mayor valor. Arch Soc Esp Oftalmol 1985;49:297–300.
10.
Kelley JS: Autofluorescence of drusen of the optic nerve head. Arch Ophthalmol 1974;92:263–264.
11.
Mustonen E, Nieminen H: Optic disc drusen – a photographic study. I. Autofluorescence pictures and fluorescein angiography. Acta Ophthalmol (Copenh) 1982;60:849–858.
12.
Atta HR: Imaging of the optic nerve with standardised echography. Eye (Lond) 1988;2:358–366.
13.
Bec P, Adam P, Mathis A, Alberge Y, Roulleau J, Arne, JL: Optic nerve head drusen. High-resolution computed tomographic approach. Arch Ophthalmol 1984;102:680–682.
14.
Chen J, Lee L: Clinical applications and new developments of optical coherence tomography: an evidence-based review. Clin Exp Optom 2007;90:317–335.
15.
Wester ST, Fantes FE, Lam BL, Anderson DR, McSoley JJ, Knighton RW: Characteristics of optic nerve head drusen on optical coherence tomography images. Ophthalmic Surg Lasers Imaging 2010;41:83–90.
16.
Boldt HC, Byrne SF, DiBernardo C: Echographic evaluation of optic disc drusen. J Clin Neuroophthalmol 1991;11:85–91.
17.
Kurz-Levin MM, Landau K: A comparison of imaging techniques for diagnosing drusen of the optic nerve head. Arch Ophthalmol 1999;117:1045–1049.
18.
Lee KM, Woo SJ, Hwang JM: Differentiation of optic nerve head drusen and optic disc edema with spectral-domain optical coherence tomography. Ophthalmology 2011;118:971–977.
19.
Gutteridge IF, Cockburn DM: Optic nerve head drusen: a correlation of clinical signs. Austr J Optom 1981;64:252–255.
20.
Mustonen E: Pseudopapilloedema with and without verified optic disc drusen. A clinical analysis I. Acta Ophthalmol (Copenh) 1983;61:1037–1056.
21.
Erkkila H: Optic disc drusen in children. Acta Ophthalmol 1977;129(suppl):3–44.
22.
Wilkins JM, Pomeranz HD: Visual manifestations of visible and buried optic disc drusen. J Neuroophthalmol 2004;24:125–129.
23.
Rosenberg MA, Savino PJ, Glaser JS: A clinical analysis of pseudopapilledema. I. Population, laterality, acuity, refractive error, ophthalmoscopic characteristics, and coincident disease. Arch Ophthalmol 1979;97:65–70.
24.
Bronner A, Payeur G. Papillary drusen with a tumoral aspect (in French). Bull Soc Ophtalmol Fr 1970; 70: 136–140.
25.
Lorentzen SE: Drusen of the optic disk, an irregularly dominant hereditary affection. Acta Ophthalmol (Copenh) 1961;39:626–643.
26.
Lichter PR: Variability of expert observers in evaluating the optic disc. Trans Am Ophthalmol Soc 1976;74:532–572.
27.
Levinson JB: Pseudopapilledema secondary to optic nerve drusen: ophthalmoscopic differentiation. J Am Optom Assoc 1986;57:373–375.
28.
Erkkila H: The central vascular pattern of the eyeground in children with drusen of the optic disk. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976;199:1–10.
29.
Sacks JG, O’Grady RB, Choromokos E, Leestma J: The pathogenesis of optic nerve drusen. A hypothesis. Arch Ophthalmol 1977;95:425–428.
30.
Borruat FX, Sanders MD: Vascular anomalies and complications of optic nerve drusen (in French). Klin Monbl Augenheilkd 1996;208:294–296.
31.
Erkkila H: Clinical appearance of optic disc drusen in childhood. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1975;193:1–18.
32.
Dejean C, Leplat G, Hervouet F: L’embryologie de l’oeil et sa tératologie. Paris, Masson, 1958.
33.
Harris MJ, Fine SL, Owens SL: Hemorrhagic complications of optic nerve drusen. Am J Ophthalmol 1981;92:70–76.
34.
Sanders TE, Gay AJ, Newman M: Hemorrhagic complications of drusen of the optic disk. Am J Ophthalmol 1971;71:204–217.
35.
Aumiller MS: Optic disc drusen: complications and management. Optometry 2007;78:10–16.
36.
Davis PL, Jay WM: Optic nerve head drusen. Semin Ophthalmol 2003;18:222–242.
37.
Wilson GA, Lloyd C, Moore AT: Optic disc drusen and peripapillary subretinal neovascular membranes in children. J Pediatr Ophthalmol Strabismus 2002;39:351–354.
38.
Diduszyn JM, Quillen DA, Cantore WA, Gardner TW: Optic disk drusen, peripapillary choroidal neovascularization, and POEMS syndrome. Am J Ophthalmol 2002;133:275–276.
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2012
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