Optic Nerve Head Anatomy and Vascular Risk Factors in Patients With Optic Disc Drusen Associated Anterior Ischemic Optic Neuropathy

PURPOSE: Optic disc drusen (ODD) is an anatomical risk factor for nonarteritic anterior ischemic optic neuropathy (NA-AION). This study aimed to in-vestigate the anatomical and vascular risk factors of pa-tients with ODD-AION (ODD-associated NA-AION) and compare them with similar data from patients with nODD-AION (NA-AION without ODD).center dot DESIGN: : Case-control study.center dot METHODS: Thirty-four ODD-AION and 34 nODD-AION patients who had all been systematically optical co-herence tomography scanned using a standardized ODD scanning protocol were retrospectively analyzed and com-pared regarding demographics, vascular risk factors, clin-ical characteristics, and specific optic nerve head anatom-ical characteristics.center dot RESULTS: In patients with ODD-AION, the ODD were predominantly deeply located (82%) but with no signif-icant difference in size (52% large, 48% small). When compared with nODD-AION patients, ODD-AION pa-tients were significantly younger at the time of diag-nosis ( P = .012) and had fewer vascular risk factors ( P = .015). The ODD-AION patients had significantly more peripapillary hyperreflective ovoid mass-like struc-tures (PHOMS) ( P < .001) and prelaminar hyperreflec-tive lines ( P < .001) as well as smaller Bruch's membrane opening diameters ( P = .017) compared with nODD-AION patients. No significant differences were found be-tween ODD-AION and nODD-AION patients regarding visual acuity, refraction, lamina cribrosa position, gan-glion cell layer volume, or retinal nerve fiber layer thick-ness.center dot CONCLUSION: In ODD-AION, location of the ODD within the optic nerve head is important, while the size of the ODD is not. The ODD-AION and nODD-AION patients presented with dis-tinctly different vascular risk factors and anatomical characteristics, establishing ODD and potentially also PHOMS as independent risk factors for developing NA-AION. (Am J Ophthalmol 2022;242: 156-164.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ))

Automated summary

In ODD-AION, the location of the ODD within the optic nerve head is important, while the size of the ODD is not. ODD-AION and nODD-AION patients have different vascular risk factors and anatomical characteristics, establishing ODD and potentially PHOMS as independent risk factors for developing NA-AION.