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Optic Nerve Head Drusen in Black Patients

Thurtell, Matthew J. MBBS, FRACP; Biousse, Valérie MD; Bruce, Beau B. MD; Newman, Nancy J. MD

Journal of Neuro-Ophthalmology: March 2012 - Volume 32 - Issue 1 - p 13–16
doi: 10.1097/WNO.0b013e3182268655
Original Contribution

Background: Several studies have suggested racial differences in the prevalence of optic nerve head drusen (ONHD). We aimed to determine the percentage of patients with ONHD who are black and to describe the clinical, ophthalmoscopic, and perimetric findings in these patients.

Methods: We conducted a retrospective chart review of all patients with ONHD seen at our institution between 1989 and 2010. Only black patients with ONHD confirmed on either funduscopy or B-scan ultrasonography were included. Demographic and clinical findings in these patients were recorded and analyzed.

Results: Of the 196 patients with confirmed ONHD, 10 (5.1%) were black. This included 7 females and 3 males with ages ranging from 8 to 61 years. Six of the 10 patients had bilateral ONHD. The ONHD were buried in 11 of 16 eyes and exposed in 5 of 16 eyes. Fifteen of 16 eyes with ONHD had small cupless optic nerve heads. Visual fields were normal in 4 of 16 eyes with ONHD. In the remainder, visual field defects included an enlarged blind spot (5 eyes), constricted field (5 eyes), nasal defect (2 eyes), central defect (1 eye), and generalized depression (1 eye). Visual field defects were present in 4 of 5 eyes (80%) with exposed ONHD and 8 of 11 eyes (72.7%) with buried ONHD. None of the patients were related, and none of their examined family members had exposed ONHD on funduscopic examination.

Conclusions: ONHD are rare in blacks, possibly due to the presence of a larger cup-to-disc ratio or a lack of predisposing genetic factors. Visual field defects are common in black patients with both exposed and buried ONHD.

Departments of Ophthalmology (MJT, VB, BBB, NJN), Neurology (VB, BBB, NJN), and Neurological Surgery (NJN), Emory University School of Medicine, Atlanta, Georgia.

Supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York; by core grant P30-EY06360 (Department of Ophthalmology); and by K23-EY019341 (Dr. Bruce). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award.

The authors report no conflicts of interest.

Address correspondence to Nancy J. Newman, MD, Neuro-Ophthalmology, 3600, Emory Eye Center, 1365-B Clifton Road NE, Atlanta, GA 30322; E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.