Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function

Nolan, Kaitlyn, W., MD; Lee, Michael, S., MD; Jalalizadeh, Rohan, A., MD; Firl, Kevin, C., MS; Van Stavern, Gregory, P., MD; McClelland, Collin, M., MD

Journal of Neuro-Ophthalmology: June 2018 - Volume 38 - Issue 2 - p 147–150
doi: 10.1097/WNO.0000000000000587
Original Contribution

Objective: To determine whether at the time of diagnosis, the intraocular pressure (IOP) in patients with optic nerve head drusen (ONHD) correlates with the perimetric mean deviation (PMD) and the mean retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT).

Methods: This retrospective chart review included adults with ONHD from 2 academic medical centers. Inclusion criteria were age older than 18 years, definitive diagnosis of ONHD, measurement of IOP, and an automated visual field (VF) within 3 months of diagnosis. Exclusion criteria were unreliable VFs, use of IOP-lowering therapy, and visually significant ocular comorbidities. Data were collected from the initial visit. Age, IOP, method of diagnosis of ONHD, mean RNFL thickness, and PMD were recorded. Multiple and logistic regression models were used to control for potential confounders in statistical analyses.

Results: Chart review identified 623 patients, of which 146 patients met inclusion criteria. Mean age was 44.2 years (range: 19–82 years). Average PMD of 236 eyes was −5.22 dB (range, −31.2 to +1.21 dB). Mean IOP was 15.7 mm Hg (range: 6–24 mm Hg). Forty eyes (16.9%) underwent RNFL measurement using OCT; mean RNFL thickness was 79.9 μm (range: 43–117 μm). There was no statistically significant association between IOP and PMD (P = 0.13) or RNFL thickness (P = 0.65). Eyes with ocular hypertension tended to have less depressed PMD than those without (P= 0.031). Stratified analyses of visible and buried subgroups yielded similar results.

Conclusions: Lowering IOP in patients with ONHD has been proposed as a means to prevent progression of optic neuropathy. Our study demonstrated that among predominately normotensive eyes, higher IOP was not associated with greater VF loss or thinner RNFL at the time of presentation. This suggests that lowering IOP may not be beneficial in preventing visual loss in normotensive eyes with ONHD.

Department of Ophthalmology and Visual Neurosciences (KWN, MSL, KCF, CMM), University of Minnesota School of Medicine, Minneapolis, Minnesota; and Department of Ophthalmology and Visual Sciences (RAJ, GPVS), Washington University School of Medicine, St. Louis, Missouri.

Address correspondence to Collin M. McClelland, MD, Department of Ophthalmology and Visual Neurosciences, 420 Delaware Street, SE/MMC 493, Minneapolis, MN 55455; E-mail: cmc@umn.edu

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (www.jneuro-ophthalmology.com).

© 2018 by North American Neuro-Ophthalmology Society