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Steffen Hamann - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Optic Disc Drusen in young patients with nonarteritic anterior ischemic Optic neuropathy a 10 year retrospective study
Journal of Neuro-ophthalmology, 2021Co-Authors: Alexander J Fraser, Lasse Malmqvist, Lea Rueløkke, Steffen HamannAbstract:Background Nonarteritic anterior ischemic Optic neuropathy (NAION) in young patients (age ≤50) accounts for a minority of all cases of NAION and is more highly associated with crowding of the Optic nerves and bilateral involvement than NAION in older patients. Optic Disc Drusen (ODD) are likewise associated with crowded Optic nerves and are located in the prelaminar Optic nerve head where they could contribute to NAION pathogenesis. The purpose of this study was to determine the prevalence of ODD in the eyes of young NAION patients using modern imaging methods and to compare it to the baseline 1.8%-2.0% prevalence of ODD in the general population. Methods In this retrospective study, all young NAION patients (ages 18-50 years, inclusive) seen in 2 tertiary care neuro-ophthalmology clinics (in London, Canada and Copenhagen, Denmark) in the ten-year interval between April 1, 2009, and March 31, 2019, were identified and their medical charts reviewed. Patients were included in the study if ODD were diagnosed by any method (including ophthalmoscopy, ultrasound [US], fundus autofluorescence [FAF], computed tomography [CT], or any Optical coherence tomography [OCT] method), or if ODD were excluded by enhanced-depth imaging OCT (EDI-OCT) using the ODD Studies (ODDS) Consortium protocol. The presence or absence of ODD was recorded for each eye. Results There were 37 eligible patients (74 eyes). Mean age of NAION onset was 38.5 ± 10.0 years, and 23 patients (62%) were men. Patients had undergone the following methods of ODD detection: ophthalmoscopy (37 patients), EDI-OCT (36 patients), FAF (31 patients), US (9 patients), and CT orbits (8 patients). We found a prevalence of ODD of 56.7% in NAION-affected patients and 53.3% in NAION-affected eyes. Only 35.9% of ODD were visible on ophthalmoscopy. Twenty of 21 ODD patients (95.2%) had bilateral ODD. Age of onset and sex did not differ significantly between the ODD-positive group and the ODD-negative group. EDI-OCT outperformed any combination of ophthalmoscopy, US, FAF, and CT at detecting ODD. Conclusion ODD were found with much higher prevalence in young patients with NAION than in the general population and were usually bilateral and buried. ODD may contribute to NAION pathogenesis by exacerbating an underlying compartment syndrome in the crowded "Disc at risk." EDI-OCT may be the best imaging modality for ODD detection in future studies.
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Optic nerve head blood flow analysis in patients with Optic Disc Drusen using laser speckle flowgraphy
Neuro-Ophthalmology, 2021Co-Authors: Jakob Wagstrom, Lasse Malmqvist, Steffen HamannAbstract:Visual field defects are common in patients with Optic Disc Drusen (ODD). Our aim was to examine whether reduced Optic nerve head (ONH) microcirculation is related to visual field defects in ODD pa...
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diagnosing Optic Disc Drusen in the modern imaging era a practical approach
Neuro-Ophthalmology, 2021Co-Authors: Fiona Costello, Patrick A Sibony, S P Rothenbuehler, Steffen HamannAbstract:Optic Disc Drusen (ODD) are a well-recognised cause of an elevated Optic Disc appearance. When visible with ophthalmoscopy and fundus photography, ODD are readily identified. Yet, in more subtle cases of ODD, ancillary testing may be needed to render the diagnosis. Facilitating the diagnosis of ODD has clinical relevance, because affected individuals may otherwise undergo unnecessary costly and invasive investigations to rule out raised intracranial pressure and other causes of Optic Disc oedema. In this review, the role of established and emerging Optical coherence tomography (OCT) techniques in the diagnosis and management of ODD cases is reviewed. A practical approach is taken to explain how to optimise use of commercially available OCT technology in the clinical setting. Optical coherence tomography provides many advantages over other imaging modalities in the diagnosis of ODD, including the ability to correlate retinal measures of neuroaxonal structure with Drusen characteristics. Earlier spectral domain OCT techniques, however, were hindered by poor penetrance. In the modern imaging era, enhanced depth imaging OCT and swept source OCT enable higher resolution of ODD and other Optic nerve head structures that might otherwise be mistaken for Drusen. Ongoing studies featuring OCT angiography indicate that this technique may provide complementary information about microvascular supply that correlate with structural measures of Optic nerve injury. Advances in OCT will continue to improve diagnostic accuracy and inform clinical understanding regarding structure-function correlations germane to the longitudinal follow up of ODD patients.
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OCT Based Interpretation of the Optic Nerve Head Anatomy and Prevalence of Optic Disc Drusen in Patients with Idiopathic Intracranial Hypertension (IIH)
'MDPI AG', 2021Co-Authors: Elisabeth Arnberg Wibroe, Lasse Malmqvist, Steffen HamannAbstract:We aimed to systematically examine the Optic nerve head anatomy in patients with idiopathic intracranial hypertension (IIH) using a standardized Optical coherence tomography (OCT) protocol. The study retrospectively included 32 patients diagnosed from 2014 to 2021 with IIH. Using OCT, in accordance with a standardized scanning protocol for patients with Optic Disc Drusen, the presence of Optic Disc Drusen, prelaminar hyperreflective lines, peripapillary hyperreflective ovoid mass-like structures, the retinal nerve fiber layer thickness, and macular ganglion cell layer volume was obtained. Optic Disc Drusen were found in 3.1%, hyperreflective lines in 31.3%, and peripapillary hyperreflective ovoid mass-like structures in 81.3% of all IIH patients at least three months after the time of diagnosis. We found no significant differences in retinal nerve fiber layer thickness or macular ganglion cell layer volume in patients with hyperreflective lines or PHOMS respectively compared to patients without hyperreflective lines (p = 0.1285 and p = 0.1835). In conclusion, the prevalence of Optic Disc Drusen in IIH patients is similar to the reported prevalence in the general population. The high prevalence of hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures in IIH patients suggest these structures be a result of crowding in the Optic nerve head caused by papilledema
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determination of peripapillary vessel density in Optic Disc Drusen using edi oct and oct angiography
Experimental Eye Research, 2020Co-Authors: Annesofie Wessel Lindberg, Lasse Malmqvist, Lea Rueløkke, Isabelle Karlesand, Vedrana Andersen Dahl, Steffen HamannAbstract:Optical coherence tomography angiography (OCTA) is a rapidly developing technique which generates angiographic images non-invasively. This study proposes a method to determine the vessel density in OCTA scans in general and especially the local peripapillary vessel density. The method produces vessel density heatmaps that contain information about the local vessel density. We apply the method in a small study to demonstrate its applicability and its potential to investigate the influence of local conditions on the vessel density. In the study, we combine information from enhanced depth imaging Optical coherence tomography (EDI-OCT) about the location of Optic Disc Drusen (ODD) with information from OCTA about the vessel density. We see a reduction in local peripapillary vessel density in peripapillary sections with a large volume of ODD.
Lasse Malmqvist - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Optic Disc Drusen in young patients with nonarteritic anterior ischemic Optic neuropathy a 10 year retrospective study
Journal of Neuro-ophthalmology, 2021Co-Authors: Alexander J Fraser, Lasse Malmqvist, Lea Rueløkke, Steffen HamannAbstract:Background Nonarteritic anterior ischemic Optic neuropathy (NAION) in young patients (age ≤50) accounts for a minority of all cases of NAION and is more highly associated with crowding of the Optic nerves and bilateral involvement than NAION in older patients. Optic Disc Drusen (ODD) are likewise associated with crowded Optic nerves and are located in the prelaminar Optic nerve head where they could contribute to NAION pathogenesis. The purpose of this study was to determine the prevalence of ODD in the eyes of young NAION patients using modern imaging methods and to compare it to the baseline 1.8%-2.0% prevalence of ODD in the general population. Methods In this retrospective study, all young NAION patients (ages 18-50 years, inclusive) seen in 2 tertiary care neuro-ophthalmology clinics (in London, Canada and Copenhagen, Denmark) in the ten-year interval between April 1, 2009, and March 31, 2019, were identified and their medical charts reviewed. Patients were included in the study if ODD were diagnosed by any method (including ophthalmoscopy, ultrasound [US], fundus autofluorescence [FAF], computed tomography [CT], or any Optical coherence tomography [OCT] method), or if ODD were excluded by enhanced-depth imaging OCT (EDI-OCT) using the ODD Studies (ODDS) Consortium protocol. The presence or absence of ODD was recorded for each eye. Results There were 37 eligible patients (74 eyes). Mean age of NAION onset was 38.5 ± 10.0 years, and 23 patients (62%) were men. Patients had undergone the following methods of ODD detection: ophthalmoscopy (37 patients), EDI-OCT (36 patients), FAF (31 patients), US (9 patients), and CT orbits (8 patients). We found a prevalence of ODD of 56.7% in NAION-affected patients and 53.3% in NAION-affected eyes. Only 35.9% of ODD were visible on ophthalmoscopy. Twenty of 21 ODD patients (95.2%) had bilateral ODD. Age of onset and sex did not differ significantly between the ODD-positive group and the ODD-negative group. EDI-OCT outperformed any combination of ophthalmoscopy, US, FAF, and CT at detecting ODD. Conclusion ODD were found with much higher prevalence in young patients with NAION than in the general population and were usually bilateral and buried. ODD may contribute to NAION pathogenesis by exacerbating an underlying compartment syndrome in the crowded "Disc at risk." EDI-OCT may be the best imaging modality for ODD detection in future studies.
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Optic nerve head blood flow analysis in patients with Optic Disc Drusen using laser speckle flowgraphy
Neuro-Ophthalmology, 2021Co-Authors: Jakob Wagstrom, Lasse Malmqvist, Steffen HamannAbstract:Visual field defects are common in patients with Optic Disc Drusen (ODD). Our aim was to examine whether reduced Optic nerve head (ONH) microcirculation is related to visual field defects in ODD pa...
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OCT Based Interpretation of the Optic Nerve Head Anatomy and Prevalence of Optic Disc Drusen in Patients with Idiopathic Intracranial Hypertension (IIH)
'MDPI AG', 2021Co-Authors: Elisabeth Arnberg Wibroe, Lasse Malmqvist, Steffen HamannAbstract:We aimed to systematically examine the Optic nerve head anatomy in patients with idiopathic intracranial hypertension (IIH) using a standardized Optical coherence tomography (OCT) protocol. The study retrospectively included 32 patients diagnosed from 2014 to 2021 with IIH. Using OCT, in accordance with a standardized scanning protocol for patients with Optic Disc Drusen, the presence of Optic Disc Drusen, prelaminar hyperreflective lines, peripapillary hyperreflective ovoid mass-like structures, the retinal nerve fiber layer thickness, and macular ganglion cell layer volume was obtained. Optic Disc Drusen were found in 3.1%, hyperreflective lines in 31.3%, and peripapillary hyperreflective ovoid mass-like structures in 81.3% of all IIH patients at least three months after the time of diagnosis. We found no significant differences in retinal nerve fiber layer thickness or macular ganglion cell layer volume in patients with hyperreflective lines or PHOMS respectively compared to patients without hyperreflective lines (p = 0.1285 and p = 0.1835). In conclusion, the prevalence of Optic Disc Drusen in IIH patients is similar to the reported prevalence in the general population. The high prevalence of hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures in IIH patients suggest these structures be a result of crowding in the Optic nerve head caused by papilledema
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determination of peripapillary vessel density in Optic Disc Drusen using edi oct and oct angiography
Experimental Eye Research, 2020Co-Authors: Annesofie Wessel Lindberg, Lasse Malmqvist, Lea Rueløkke, Isabelle Karlesand, Vedrana Andersen Dahl, Steffen HamannAbstract:Optical coherence tomography angiography (OCTA) is a rapidly developing technique which generates angiographic images non-invasively. This study proposes a method to determine the vessel density in OCTA scans in general and especially the local peripapillary vessel density. The method produces vessel density heatmaps that contain information about the local vessel density. We apply the method in a small study to demonstrate its applicability and its potential to investigate the influence of local conditions on the vessel density. In the study, we combine information from enhanced depth imaging Optical coherence tomography (EDI-OCT) about the location of Optic Disc Drusen (ODD) with information from OCTA about the vessel density. We see a reduction in local peripapillary vessel density in peripapillary sections with a large volume of ODD.
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young adults with anterior ischemic Optic neuropathy a multicenter Optic Disc Drusen study
American Journal of Ophthalmology, 2020Co-Authors: Steffen Hamann, Lasse Malmqvist, Lulu L. C. D. Bursztyn, Fiona Costello, Marianne Wegener, Masoud Aghsaei Fard, Valerie Biousse, Gulsenay Citirak, Alison V Crum, Kathleen B. DigreAbstract:Purpose Optic Disc Drusen (ODD), present in 2% of the general population, have occasionally been reported in patients with nonarteritic anterior ischemic Optic neuropathy (NA-AION). The purpose of this study was to examine the prevalence of ODD in young patients with NA-AION. Design Retrospective, cross-sectional multicenter study. Methods All patients with NA-AION 50 years old or younger, seen in neuro-ophthalmology clinics of the international ODDS (Optic Disc Drusen Studies) Consortium between April 1, 2017, and March 31, 2019, were identified. Patients were included if ODD were diagnosed by any method, or if ODD were excluded by enhanced-depth imaging Optical coherence tomography (EDI-OCT) using ODDS Consortium guidelines. NA-AION eyes with ODD were termed “ODD-AION”; those without were termed “NODD-AION”. Results A total of 65 patients (127 eyes) with NA-AION were included (mean 41 years old). Of the 74 eyes with NA-AION, 51% had ODD-AION, whereas 43% of fellow eyes without NA-AION had ODD (P = .36). No significant differences were found between ODD-AION and NODD-AION eyes in terms of Snellen best-corrected VA or perimetric mean deviation. According to EDI-OCT results, 28% of eyes with NODD-AION had peripapillary hyperreflective ovoid mass-like structures (PHOMS); 7% had hyperreflective lines, whereas 54% with ODD-AION had PHOMS; and 66% had hyperreflective lines (P = .006 and P Conclusions Most of these young NA-AION patients had ODD. This indicates that ODD may be an independent risk factor for the development of NA-AION, at least in younger patients. This study suggests ODD-AION be recognized as a novel diagnosis.
Jeong-min Hwang - One of the best experts on this subject based on the ideXlab platform.
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morphologic features of buried Optic Disc Drusen on en face Optical coherence tomography and Optical coherence tomography angiography
American Journal of Ophthalmology, 2020Co-Authors: Min Seok Kim, Jeong-min Hwang, Kyoung Min Lee, Hee Kyung Yang, Se Joon WooAbstract:Purpose To evaluate and compare the morphologic characteristics of buried Optic Disc Drusen (ODD) and Optic Disc edema (ODE) by using en face Optical coherence tomography (OCT) and OCT angiography (OCTA). Design Retrospective, cross-sectional study. Methods We reviewed the medical records of 61 patients (92 eyes) with buried ODD, 45 patients (62 eyes) with ODE, and 42 normal-appearing fellow eyes examined at 1 referral center between November 1, 2017 and April 30, 2019. Characteristic en face OCT and OCTA findings of buried ODD compared to those of ODE and normal Optic Discs were investigated. Results On en face OCT, all buried ODD were visualized as hyperreflective kidney-shaped masses well demarcated from the Optic nerve axons, whereas ODE was visualized as ill-defined boundaries confluent with the retinal nerve fibers. On OCTA, 25.0% of the eyes with buried ODD showed a C-shaped vessel density decrease in the nasal radial peripapillary capillary layer, while 40.3% of the eyes with ODE had nonspecific focal vessel density decrease around the Optic nerve head. Larger ODD were significantly associated with a vessel density decrease on OCTA (P = .009). The Disc diameter positively correlated with the ODD area (r = 0.245; P = .018) and negatively correlated with the ODD height (r = −0.237; P = .023). Conclusions En face OCT showed the characteristic features of buried ODD compared to those of ODE or normal Optic Discs. The demarcation of buried ODD from the Optic nerve axons on en face OCT and the poor vascular perfusion of buried ODD on OCTA suggest that buried ODD are materials deposited around the Optic Disc rather than the herniated Optic nerve axon fibers.
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factors associated with visual field defects of Optic Disc Drusen
PLOS ONE, 2018Co-Authors: Kyoung Min Lee, Se Joon Woo, Jeong-min HwangAbstract:Purpose To investigate the prevalence and risk factors for visual field defect in patients with Optic Disc Drusen (ODD). Methods We assessed the visual field status of patients with ODD whose diagnosis were confirmed by spectral-domain Optical coherence tomography (SD-OCT). Visual field defects were classified as normal, enlarged blind spot, or other defects. ODD were classified into either type 1 (without hyperreflective border and heterogenic internal reflectance) or type 2 (with hyperreflective border and lower internal reflectance). The prevalence and risk factors for each visual field defect was analyzed using logistic regression analysis and classification and regression tree (CART) modeling. Results Of the 40 eyes with ODD, 33 (83%) eyes were categorized as type 1 and 7 (17%) eyes were categorized as type 2 ODD. Regarding the visual field defects, 19 (48%) eyes showed normal visual field, 11 (28%) eyes showed enlarged blind spot, and 9 (24%) eyes showed other defects. The latter was more frequent in type 2 ODD (P = 0.001). Logistic regression analysis revealed that the factor associated with other defects was the thinning of the average retinal nerve fiber layer (RNFL) (per 10 μm decrease, OR = 3.436, P = 0.004), and the factor associated with enlarged blind spot was the height of ODD (per 100 μm increase, OR = 3.956, P = 0.023). CART modeling revealed that the average RNFL thickness lesser than 85.5 μm, and then the ODD height larger than 348 μm were the best split-up factors for predicting the type of visual field defects. Conclusions In this study, one-quarter of ODD patients showed abnormal visual field defect other than enlarged blind spot. These other visual field defects appeared to be associated with the axonal loss in the eyes with type 2 ODD.
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Patients’ characteristics by the types of Optic Disc Drusen and visual field defects.
2018Co-Authors: Kyoung Min Lee, Se Joon Woo, Jeong-min HwangAbstract:Patients’ characteristics by the types of Optic Disc Drusen and visual field defects.
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differentiation between Optic Disc Drusen and Optic Disc oedema using fundus photography
Acta Ophthalmologica, 2017Co-Authors: Jeong-min Hwang, Kyoung Min Lee, Se Joon WooAbstract:Purpose To describe a funduscopic sign that can be used to differentiate between Optic Disc Drusen (ODD) and Optic Disc oedema (ODE). Methods A total of 73 eyes from 73 consecutive subjects with Disc margin blurring who had been evaluated using spectral-domain Optical coherence tomography (SD-OCT) were included. Final diagnosis was made by SD-OCT; ODD was defined by direct visualization of ODD, while ODE was defined by documentation of retinal nerve fibre layer oedema (nasal retinal nerve fibre layer thickness >78.0 μm). Peripapillary retina was selected as a two-Disc-diameter-sized square image from the fundus photograph. Using MATLAB software, colour photographs were converted to indexed image of eight colours. Presence of a smooth contour strip between the nasal Disc margin and juxtapapillary retina was defined as a halo. Whether the halo could predict the ODD was analysed retrospectively. Results The halo sign was detected in 45 eyes (100%) with ODD including one eye with both ODD and ODE. No eyes with ODE alone showed the halo sign. The halo sign implied the presence of ODD (Cohen's kappa = 1.000, p < 0.001) and the absence of ODE (Cohen's kappa = 0.971, p < 0.001). The halo sign showed a good interobserver reliability [ICC (2, 1) = 0.944, 95% confidence interval 0.912–0.964]. SD-OCT images showed that halos represented retinal elevations above ODD. Conclusions In the patients with blurred Disc margin, the presence of a halo strongly suggested underlying ODD rather than ODE.
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Optic Disc Drusen associated with Optic nerve tumors.
Optometry and Vision Science, 2015Co-Authors: Jeong-min HwangAbstract:PURPOSE: To propose a theory based on clinical observation, namely, whether axonal distress induced by Optic nerve tumors could be a triggering factor for Optic Disc Drusen (ODD) formation. CASE REPORTS: A 28-year-old woman with ODD and Optic Disc melanocytoma, a 53-year-old woman with ODD and Optic nerve meningioma, and a 29-year-old woman with ODD and Optic nerve glioma underwent comprehensive ophthalmologic examinations including spectral-domain Optical coherence tomography, swept-source Optical coherence tomography, visual field tests, color vision tests, and complete neurologic examinations including brain magnetic resonance imaging. In two cases, unilateral ODD existed on the same side of Optic nerve tumors. In the bilateral case, the nerve that contained the tumor had ODD that were located more deeply and on both nasal and temporal sides of the Optic nerve compared with the contralateral eye. In two cases, Optic Disc edema (ODE) was also present, and ODD persisted after ODE resolved. CONCLUSIONS: Optic nerve tumors can trigger the formation of ODD, which suggests that ODD pathogenesis involves axonal flow distress in the Optic nerve. The presence of asymmetric ODD and ODE may indicate the presence of an Optic nerve tumor.
Fiona Costello - One of the best experts on this subject based on the ideXlab platform.
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diagnosing Optic Disc Drusen in the modern imaging era a practical approach
Neuro-Ophthalmology, 2021Co-Authors: Fiona Costello, Patrick A Sibony, S P Rothenbuehler, Steffen HamannAbstract:Optic Disc Drusen (ODD) are a well-recognised cause of an elevated Optic Disc appearance. When visible with ophthalmoscopy and fundus photography, ODD are readily identified. Yet, in more subtle cases of ODD, ancillary testing may be needed to render the diagnosis. Facilitating the diagnosis of ODD has clinical relevance, because affected individuals may otherwise undergo unnecessary costly and invasive investigations to rule out raised intracranial pressure and other causes of Optic Disc oedema. In this review, the role of established and emerging Optical coherence tomography (OCT) techniques in the diagnosis and management of ODD cases is reviewed. A practical approach is taken to explain how to optimise use of commercially available OCT technology in the clinical setting. Optical coherence tomography provides many advantages over other imaging modalities in the diagnosis of ODD, including the ability to correlate retinal measures of neuroaxonal structure with Drusen characteristics. Earlier spectral domain OCT techniques, however, were hindered by poor penetrance. In the modern imaging era, enhanced depth imaging OCT and swept source OCT enable higher resolution of ODD and other Optic nerve head structures that might otherwise be mistaken for Drusen. Ongoing studies featuring OCT angiography indicate that this technique may provide complementary information about microvascular supply that correlate with structural measures of Optic nerve injury. Advances in OCT will continue to improve diagnostic accuracy and inform clinical understanding regarding structure-function correlations germane to the longitudinal follow up of ODD patients.
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young adults with anterior ischemic Optic neuropathy a multicenter Optic Disc Drusen study
American Journal of Ophthalmology, 2020Co-Authors: Steffen Hamann, Lasse Malmqvist, Lulu L. C. D. Bursztyn, Fiona Costello, Marianne Wegener, Masoud Aghsaei Fard, Valerie Biousse, Gulsenay Citirak, Alison V Crum, Kathleen B. DigreAbstract:Purpose Optic Disc Drusen (ODD), present in 2% of the general population, have occasionally been reported in patients with nonarteritic anterior ischemic Optic neuropathy (NA-AION). The purpose of this study was to examine the prevalence of ODD in young patients with NA-AION. Design Retrospective, cross-sectional multicenter study. Methods All patients with NA-AION 50 years old or younger, seen in neuro-ophthalmology clinics of the international ODDS (Optic Disc Drusen Studies) Consortium between April 1, 2017, and March 31, 2019, were identified. Patients were included if ODD were diagnosed by any method, or if ODD were excluded by enhanced-depth imaging Optical coherence tomography (EDI-OCT) using ODDS Consortium guidelines. NA-AION eyes with ODD were termed “ODD-AION”; those without were termed “NODD-AION”. Results A total of 65 patients (127 eyes) with NA-AION were included (mean 41 years old). Of the 74 eyes with NA-AION, 51% had ODD-AION, whereas 43% of fellow eyes without NA-AION had ODD (P = .36). No significant differences were found between ODD-AION and NODD-AION eyes in terms of Snellen best-corrected VA or perimetric mean deviation. According to EDI-OCT results, 28% of eyes with NODD-AION had peripapillary hyperreflective ovoid mass-like structures (PHOMS); 7% had hyperreflective lines, whereas 54% with ODD-AION had PHOMS; and 66% had hyperreflective lines (P = .006 and P Conclusions Most of these young NA-AION patients had ODD. This indicates that ODD may be an independent risk factor for the development of NA-AION, at least in younger patients. This study suggests ODD-AION be recognized as a novel diagnosis.
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Optic Disc Drusen understanding an old problem from a new perspective
Acta Ophthalmologica, 2018Co-Authors: Steffen Hamann, Lasse Malmqvist, Fiona CostelloAbstract:: Optic Disc Drusen (ODD) are acellular deposits located in the Optic nerve head of up to 2.4% of the population. They may develop as by-products of impaired axonal metabolism in genetically predisposed individuals, in whom a narrow scleral canal is hypothesized to play a role. Although ODD are often considered as benign innocent bystanders, recognized as part of a routine ophthalmological examination, the vast majority of patients with ODD have visual field defects. Optic Disc Drusen (ODD)-associated complications with severe visual loss, most often due to anterior ischaemic Optic neuropathy, are also known to occur. There are no treatments available to prevent or ameliorate the vision loss caused by ODD. In children, the ODD are usually uncalcified and buried within the Optic nerve head tissue. In these cases, the condition can be difficult to diagnose, as it often resembles a papilloedema with Optic nerve head swelling caused by raised intracranial pressure. During the teenage years, the ODD progressively become more calcified and probably also larger, which allow them to be visible on ophthalmoscopy. With the advent and proper utilization of high-resolution modalities of Optical coherence tomography (OCT), it has now become possible to detect even the smallest and most deeply located ODD. This allows for ODD detection at a much earlier developmental stage than has previously been possible and enhances the possibilities of research in underlying mechanisms. A review of the literature on ODD was conducted using the PUBMED database. The review focuses on the current knowledge regarding pathogenesis, diagnostics, clinical disease-tracking methodologies, structure-function relationships and treatment strategies of ODD.
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the role of Optical coherence tomography in differentiating Optic Disc Drusen from Optic Disc edema
Asia-Pacific journal of ophthalmology, 2018Co-Authors: Fiona Costello, Lasse Malmqvist, Steffen HamannAbstract:An elevated Optic nerve head can be an ominous sign, sometimes signifying an underlying basis for raised intracranial pressure. Alternatively, patients may harbor a different mechanism for this Optic nerve head appearance, including Optic Disc Drusen (ODD), which does not confer any life-threatening implications. It is important to refine the approach to distinguishing ODD from papilledema because this is a relatively common, and important, conundrum encountered in clinical practice. Optical coherence tomography (OCT) is a noninvasive, readily accessible, and cost-effective ocular imaging technique that can improve the diagnostic accuracy for detecting ODD; or, instead, increase the index of suspicion for papilledema, thus prompting additional investigations needed to identify (or exclude) potential causes of raised intracranial pressure. In this review, we will Discuss the value of OCT in the diagnostic approach to cases of mild Optic Disc elevation, with acknowledgment of the potential pearls and pitfalls of this imaging technology. In particular, we will emphasize the helpful role OCT can play in differentiating cases of ODD from mild papilledema in the context of idiopathic intracranial hypertension (IIH).
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the Optic Disc Drusen studies consortium recommendations for diagnosis of Optic Disc Drusen using Optical coherence tomography
Journal of Neuro-ophthalmology, 2017Co-Authors: Lasse Malmqvist, Alexander J Fraser, Mitchell Lawlor, Bradley J Katz, Lulu L. C. D. Bursztyn, Kathleen B. Digre, Clare L Fraser, Fiona Costello, Axel Petzold, Patrick A SibonyAbstract:Background:Making an accurate diagnosis of Optic Disc Drusen (ODD) is important as part of the work-up for possible life-threatening Optic Disc edema. It also is important to follow the slowly progressive visual field defects many patients with ODD experience. The introduction of enhanced depth imag
Kyoung Min Lee - One of the best experts on this subject based on the ideXlab platform.
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morphologic features of buried Optic Disc Drusen on en face Optical coherence tomography and Optical coherence tomography angiography
American Journal of Ophthalmology, 2020Co-Authors: Min Seok Kim, Jeong-min Hwang, Kyoung Min Lee, Hee Kyung Yang, Se Joon WooAbstract:Purpose To evaluate and compare the morphologic characteristics of buried Optic Disc Drusen (ODD) and Optic Disc edema (ODE) by using en face Optical coherence tomography (OCT) and OCT angiography (OCTA). Design Retrospective, cross-sectional study. Methods We reviewed the medical records of 61 patients (92 eyes) with buried ODD, 45 patients (62 eyes) with ODE, and 42 normal-appearing fellow eyes examined at 1 referral center between November 1, 2017 and April 30, 2019. Characteristic en face OCT and OCTA findings of buried ODD compared to those of ODE and normal Optic Discs were investigated. Results On en face OCT, all buried ODD were visualized as hyperreflective kidney-shaped masses well demarcated from the Optic nerve axons, whereas ODE was visualized as ill-defined boundaries confluent with the retinal nerve fibers. On OCTA, 25.0% of the eyes with buried ODD showed a C-shaped vessel density decrease in the nasal radial peripapillary capillary layer, while 40.3% of the eyes with ODE had nonspecific focal vessel density decrease around the Optic nerve head. Larger ODD were significantly associated with a vessel density decrease on OCTA (P = .009). The Disc diameter positively correlated with the ODD area (r = 0.245; P = .018) and negatively correlated with the ODD height (r = −0.237; P = .023). Conclusions En face OCT showed the characteristic features of buried ODD compared to those of ODE or normal Optic Discs. The demarcation of buried ODD from the Optic nerve axons on en face OCT and the poor vascular perfusion of buried ODD on OCTA suggest that buried ODD are materials deposited around the Optic Disc rather than the herniated Optic nerve axon fibers.
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factors associated with visual field defects of Optic Disc Drusen
PLOS ONE, 2018Co-Authors: Kyoung Min Lee, Se Joon Woo, Jeong-min HwangAbstract:Purpose To investigate the prevalence and risk factors for visual field defect in patients with Optic Disc Drusen (ODD). Methods We assessed the visual field status of patients with ODD whose diagnosis were confirmed by spectral-domain Optical coherence tomography (SD-OCT). Visual field defects were classified as normal, enlarged blind spot, or other defects. ODD were classified into either type 1 (without hyperreflective border and heterogenic internal reflectance) or type 2 (with hyperreflective border and lower internal reflectance). The prevalence and risk factors for each visual field defect was analyzed using logistic regression analysis and classification and regression tree (CART) modeling. Results Of the 40 eyes with ODD, 33 (83%) eyes were categorized as type 1 and 7 (17%) eyes were categorized as type 2 ODD. Regarding the visual field defects, 19 (48%) eyes showed normal visual field, 11 (28%) eyes showed enlarged blind spot, and 9 (24%) eyes showed other defects. The latter was more frequent in type 2 ODD (P = 0.001). Logistic regression analysis revealed that the factor associated with other defects was the thinning of the average retinal nerve fiber layer (RNFL) (per 10 μm decrease, OR = 3.436, P = 0.004), and the factor associated with enlarged blind spot was the height of ODD (per 100 μm increase, OR = 3.956, P = 0.023). CART modeling revealed that the average RNFL thickness lesser than 85.5 μm, and then the ODD height larger than 348 μm were the best split-up factors for predicting the type of visual field defects. Conclusions In this study, one-quarter of ODD patients showed abnormal visual field defect other than enlarged blind spot. These other visual field defects appeared to be associated with the axonal loss in the eyes with type 2 ODD.
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Patients’ characteristics by the types of Optic Disc Drusen and visual field defects.
2018Co-Authors: Kyoung Min Lee, Se Joon Woo, Jeong-min HwangAbstract:Patients’ characteristics by the types of Optic Disc Drusen and visual field defects.
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differentiation between Optic Disc Drusen and Optic Disc oedema using fundus photography
Acta Ophthalmologica, 2017Co-Authors: Jeong-min Hwang, Kyoung Min Lee, Se Joon WooAbstract:Purpose To describe a funduscopic sign that can be used to differentiate between Optic Disc Drusen (ODD) and Optic Disc oedema (ODE). Methods A total of 73 eyes from 73 consecutive subjects with Disc margin blurring who had been evaluated using spectral-domain Optical coherence tomography (SD-OCT) were included. Final diagnosis was made by SD-OCT; ODD was defined by direct visualization of ODD, while ODE was defined by documentation of retinal nerve fibre layer oedema (nasal retinal nerve fibre layer thickness >78.0 μm). Peripapillary retina was selected as a two-Disc-diameter-sized square image from the fundus photograph. Using MATLAB software, colour photographs were converted to indexed image of eight colours. Presence of a smooth contour strip between the nasal Disc margin and juxtapapillary retina was defined as a halo. Whether the halo could predict the ODD was analysed retrospectively. Results The halo sign was detected in 45 eyes (100%) with ODD including one eye with both ODD and ODE. No eyes with ODE alone showed the halo sign. The halo sign implied the presence of ODD (Cohen's kappa = 1.000, p < 0.001) and the absence of ODE (Cohen's kappa = 0.971, p < 0.001). The halo sign showed a good interobserver reliability [ICC (2, 1) = 0.944, 95% confidence interval 0.912–0.964]. SD-OCT images showed that halos represented retinal elevations above ODD. Conclusions In the patients with blurred Disc margin, the presence of a halo strongly suggested underlying ODD rather than ODE.