A Comparison of Diagnostic Accuracy of Imaging Modalities to Detect Optic Disc Drusen: The Age of Enhanced Depth Imaging Optical Coherence Tomography

center dot PURPOSE: To identify the most accurate diagnostic imaging modality to detect optic disc drusen (ODD) be-tween B-scan ultrasonography (US), fundus photogra-phy, fundus autofluorescence (FAF), and enhanced depth imaging optical coherence tomography (EDI-OCT).center dot DESIGN: Comparative diagnostic analysis.center dot METHODS: Two hundred five eyes of 105 patients re-ferred to 2 tertiary care neuro-ophthalmology clinics for suspected ODD were recruited: 108 eyes had ODD and 97 did not have ODD. All eyes received a full in-person ophthalmic exam with 3D view of the optic nerve and all 4 imaging modalities. Images were independently re-viewed by 3 masked neuro-ophthalmologists to determine the presence or absence of ODD. Final interpretation was made through consensus. The reference standard was de-fined as the attending ophthalmologist's clinical judge-ment based on open chart review, with access to all im-age modalities and clinical information, including disease course. Main outcome measures were sensitivity, speci-ficity, accuracy, and precision for each imaging modality. Examiner confidence was quantified as the proportion of eyes in which the reviewers were certain of their decision.center dot RESULTS: The EDI-OCT had the highest sensitivity and accuracy (95%, 97%) to detect ODD, compared with FAF (84%, 92%), US (74%, 86%), and fundus photog-raphy (38%, 66%), respectively. All image modalities had high specificity (> 97%) and precision (> 93%). The EDI-OCT also had highest examiner confidence (96%) compared with all others (88%).center dot CONCLUSIONS: Among all modalities, EDI-OCT was the imaging modality with the highest diagnostic utility for the detection of ODD and should be considered as the preferred initial diagnostic modality. (Am J Oph-thalmol 2023;248: 137-144. (c) 2022 Elsevier Inc. All rights reserved.)

Automated summary

The study aimed to identify the most accurate diagnostic imaging modality for detecting optic disc drusen (ODD), comparing B-scan ultrasonography (US), fundus photography, fundus autofluorescence (FAF), and enhanced depth imaging optical coherence tomography (EDI-OCT). Among all modalities, EDI-OCT demonstrated the highest sensitivity, accuracy, and examiner confidence in detecting ODD, making it the preferred initial diagnostic modality.