Optic disc drusen could signify a patient at risk for nonarteritic AION. Photo: Ashley Kay Maglione, OD. Click image to enlarge.

A recent study found that patients with optic disc drusen–associated nonarteritic anterior ischemic optic neuropathy (AION) are younger at diagnosis and have fewer vascular risk factors when compared with individuals who have nonarteritic AION without optic disc drusen. This underscores the importance of distinguishing between these two groups and suggests optic disc drusen is an independent risk factor of the condition.

This case control study included 34 patients with optic disc drusen-associated nonarteritic AION and 34 nonarteritic AION patients without optic disc drusen. All patients had been systematically scanned with OCT using a standardized optic disc drusen scanning protocol.

Data showed that among patients with optic disc drusen-associated nonarteritic AION, the optic disc drusen were predominately deeply located (82%); however, there was no significant difference in size, according to the study authors.

When compared with nonarteritic AION patients who do not have optic disc drusen, optic disc drusen-associated nonarteritic AION patients were significantly younger at the time of diagnosis and had fewer vascular risk factors. Additionally, the study authors reported that these patients had significantly more peripapillary hyperreflective ovoid mass-like structures and prelaminar hyperreflective lines as well as smaller Bruch's membrane opening diameters vs. their counterparts without optic disc drusen.

In terms of visual acuity, the researchers observed no significant difference between the two groups. There were also no significant differences in lamina cribrosa position, ganglion cell layer volume or retinal nerve fiber layer thickness.

“In optic disc drusen AION, location of the optic disc drusen within the optic nerve head is important, while the size of the optic disc drusen is not,” the study authors concluded. “Optic disc drusen AION and non-optic disc drusen AION patients present with distinctly different vascular risk factors and anatomical characteristics, establishing optic disc drusen and potentially also peripapillary hyperreflective ovoid mass-like structures as independent risk factors for developing nonarteritic AION.”

Johannesen RG, Lykkebirk L, Jørgensen M, et al. Optic nerve head anatomy and vascular risk factors in patients with optic disc drusen associated anterior ischemic optic neuropathy. Am J Ophthalmol. June 24, 2022. [Epub ahead of print].