Differentiation of Optic Nerve Head Drusen and Optic Disc Edema with Spectral-Domain Optical Coherence Tomography

Purpose: To evaluate the efficacy of spectral-domain optical coherence tomography (SD-OCT) in differentiating optic disc edema (ODE) and optic nerve head drusen (ONHD) and to reveal the differential points. Design: Comparative case series. Participants: Forty-five patients with ONHD, 15 patients with ODE, and 32 normal controls. Methods: Spectral-domain optical coherence tomography was performed with scans on the optic nerve head and measurements of retinal nerve fiber layer thickness. Main Outcome Measures: Qualitative findings of optic nerve head scans and retinal nerve fiber layer thickness profiles on SD-OCT. Results: Optic nerve head drusen was visualized as a focal, hyperreflective, subretinal mass with a discrete margin on SD-OCT. The retinal nerve fiber layer was deformed and showed pseudoedema and high reflectance. The outer nuclear layer smoothly covered the drusen, which led to a hyporeflective, boot-shaped area adjacent to the drusen. In ODE, peripapillary retinal nerve fiber layers were significantly thicker in all sections than ONHD (average thickness of ODE: 174.1 +/- 53.5 mu m vs ONHD: 119.2 +/- 20.2 mu m vs control: 103.4 +/- 19.1 mu m, P < 0.001). Retinal nerve fiber thickness in the nasal section provides a good differential marker for ODE from ONHD (area under receiver operating characteristic curve = 0.866). Conclusions: With the use of SD-OCT, noninvasive and accurate differentiation of ONHD and ODE is possible. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011; 118: 971-977 (C) 2011 by the American Academy of Ophthalmology.