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34-year-old woman . Her vision is okay. She has optic nerve swelling, which is impressive and suggested she come here for an evaluation to distinguish between possible optic nerve drusen or optic nerve edema. Her brain scan was okay. Her vision is fine too. She is not getting headaches. VISUAL ACUITY: OD 20/15, OS 20/20. IOP: OD 19, OS 21. SLIT EXAMINATION: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Shows 1+ optic nerve thickening. I didn’t see any clear cut drusen. OS: There is 3+ optic nerve thickening. Neither eye has any flame hemorrhages or at the edge of the optic nerve. SPECTRALIS-SD-OCT SCAN: I did a spectral domain OCT over the optic nerve in both eyes, which shows what is consistent with optic nerve drusen. The outer nuclear layer is displaced and the outer plexiform layer is not swollen in either eye. I did nerve fiber layer scans in the right eye. The average nerve fiber layer thickness is 126 microns, which is well below the cut off you would expect with optic nerve edema, based on recently published reports. In the left eye it is a little trickier, because the optic nerve scan doesn’t properly trace the nerve fiber layer. There are a few artifacts, but temporally at least where it does trace the nerve fiber layer, she is within normal limits. When you get to the superior pole, it is a little bit edematous and then on the inferior pole, unfortunately the optic nerve edge is lost and doesn’t trace the optic nerve fiber properly. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The images show no hyper auto fluorescencent drusen in either eye. IMPRESSION: 1. PROBABLE OPTIC NERVE DRUSEN DISCUSSION: I explained to the patient based on the spectral domain OCT scans over the optic nerve, I would say there is a 99 percent chance that these are optic nerve drusen. Because of the difficulties with the tracings in the left eye and also because the left nerve is so elevated, the nerve fiber layer thickness isn’t very reliable. I suggested she return for a check here in three to six months. I asked her to see you back regularly. Based on the findings at the moment, I don’t think a spinal tap is necessary.

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Optic Nerve (Disc) Drusen - Infrared Reflectance160 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Infrared Reflectance208 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Fundus Autofluorescence250 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Fundus Autofluorescence269 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan261 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan173 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan135 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan150 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan95 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan120 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan118 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - Spectral Domain Optical Coherence Tomography Line Scan131 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen - RNFL Scan140 views34 Year Old woman no headaches normal vision00000
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Optic Nerve (Disc) Drusen vs. Disc Edema Vs. AION - Spectral Domain Optical Coherence Tomography Line Scan160 views00000
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34-year-old woman . Her vision is okay. She has optic nerve swelling, which is impressive and suggested she come here for an evaluation to distinguish between possible optic nerve drusen or optic nerve edema. Her brain scan was okay. Her vision is fine too. She is not getting headaches. VISUAL ACUITY: OD 20/15, OS 20/20. IOP: OD 19, OS 21. SLIT EXAMINATION: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Shows 1+ optic nerve thickening. I didn’t see any clear cut drusen. OS: There is 3+ optic nerve thickening. Neither eye has any flame hemorrhages or at the edge of the optic nerve. SPECTRALIS-SD-OCT SCAN: I did a spectral domain OCT over the optic nerve in both eyes, which shows what is consistent with optic nerve drusen. The outer nuclear layer is displaced and the outer plexiform layer is not swollen in either eye. I did nerve fiber layer scans in the right eye. The average nerve fiber layer thickness is 126 microns, which is well below the cut off you would expect with optic nerve edema, based on recently published reports. In the left eye it is a little trickier, because the optic nerve scan doesn’t properly trace the nerve fiber layer. There are a few artifacts, but temporally at least where it does trace the nerve fiber layer, she is within normal limits. When you get to the superior pole, it is a little bit edematous and then on the inferior pole, unfortunately the optic nerve edge is lost and doesn’t trace the optic nerve fiber properly. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The images show no hyper auto fluorescencent drusen in either eye. IMPRESSION: 1. PROBABLE OPTIC NERVE DRUSEN DISCUSSION: I explained to the patient based on the spectral domain OCT scans over the optic nerve, I would say there is a 99 percent chance that these are optic nerve drusen. Because of the difficulties with the tracings in the left eye and also because the left nerve is so elevated, the nerve fiber layer thickness isn’t very reliable. I suggested she return for a check here in three to six months. I asked her to see you back regularly. Based on the findings at the moment, I don’t think a spinal tap is necessary.