The diagnosis
It is important that you correctly diagnose optic disc drusen, and that this patient does NOT have ONH swelling.
How do you make this distinction? - it seems like - Looks lumpy and irregular - You don’t have hyperaemia like you would in ONH swelling - You don’t have vessel obscuration like you would in ONH swelling - Won’t have haemorrhages like ONH Swelling weill - OCT the ONH and make sure its high reflectivity with “acoustic shadowing” wtfever the fuck that means - Fundus autofluorescence -
What else do I need to do?
Assess the function of the optic nerve, namely: - RAPD - Ishihara - Visual acuity
Treatable and non treatable consequences
- Visual field loss - nothing we can do really
- Increased risk of NAAION
- sudden, painless vision loss
Sometimes random, sometimes have an autosomal dominant inheritance pattern Produces pseudo ONH swelling
Fx include lumpy disc, absent cup, anomalous vascular patterns including proximal branching, increased number of major vessels, tortuosity
no papilloedema features such as hyperaemia (Redness) or vessel obscuration
complications include: - juxtapipillary choroidal neovascularisation - vitreous haemorrhage - vascular occlusions, eg RVO or RAO - anterior ischaemic optic neuropathy
Testing - FAF