Differential Change in Retina Structure and Function in Children and Adolescents with Drusens of the Optic Nerve Disk

The first histological and clinical description of the optic nerve drusens was given in the 19th century. Then authors considered drusens as congenital pathologies, and a study of 1999 showed that drusen is not the primary pathology, but the dysplasia of the optic nerve disk and its circulation predisposes to the formation of drusen. Central vision in patients with drusens of the optic nerve disc is reduced rarely, and their diagnosis is reduced to ascertaining of the fact of having drusen without taking into account the structural and functional changes in the visual system.

Purpose of the work: to identify the pattern of changes in visual functions in children and adolescents with druses of the optic nerve disk, the development and addition of classification criteria.

Patients and methods. 45 children with drusens were examined, a comprehensive analysis of the visual system included a standard ophthalmological examination, a comprehensive study of visual system with ultrasound scanning, OCT and OCTA, standard automated and pulsarperimetry.

Based on the results of the cluster analysis, a graph of the distribution of patients into three groups (control group and two clinical groups) was constructed, and the structural and functional state of the visual system was analyzed. Drusens in children in the second group we marked as “peripheral”, and in the third — “central”. The carried out researches have shown, that the revealed disturbances are more expressed in the third clinical group. All this determines the need to complement the clinical classification of drusens and their separation depending on the location relative to the vessels of the optic nerve disk to the central and peripheral. The compression effect of drusen is accompanied with changes in the volume of the optic nerve disc, a violation of retinal hemodynamics, damage to the neuroglia and ganglion cells, which allows treating this pathology as a progressive neuroopticopathy, and the revealed dependence of changes on the localization of druses requires supplementing the existing classification. 

1. Tso M.O. Pathology and pathogenesis of drusen of the optic nerve head. Ophthalmology. 1981;88:1066–80.

2. Braun W. Ueber familiäres Vorkommen von Drusen der Papille. Klin. Monatsbl. Augenheilkd. 1935;94:734–8.

3. Lauber H. Klinische und anatomische untersuchungen ueber drusen im sehnervenkopf. Albrecht von Graefes Arch. Ophthalmol. 1921;105:567–89.

4. Leimgruber M. Erbforschungen ueber die Drusen der Sehnervenpapille. Archiv Ophthalmol. 1936;136:364–76.

5. Lorentzen S.E. Drusen of the optic disc. Acta Ophthalmol. 1966;90(Suppl.):1–180.

6. Singleton E.M., Kinsbourne M., Anderson W.B. Jr. Familial pseudopapilledema. Southern Med. J. 1973;66:796–802.

7. Lorentzen S.E. Drusen of the optic disk, an irregularly dominant hereditary affection. Acta Ophthalmol. 1961;39:626–43.

8. Antcliff R.J., Spalton D.J. Are optic disc drusen inherited? Ophthalmology. 1999;106(7):1278–81.

9. Golnik K. Congenital anomalies and acquired abnormalities of the optic nerve, (Version 14.3). UptoDate (On-Line Serial). Ophthalmology. 2006;88(10):1066–80.

10. Щуко А.Г., Самсонов Д.Ю., Жукова С.И., и др. Алгоритм диагностики друз диска зрительного нерва у детей. Практическая медицина. 2015;2(87):111– 115. [Shchuko A.G., Samsonov D.Yu., Zhukova S.I., Iureva T.N., Averianov D.A. Algoritm Diagnostiki druz diska zritelnogo nerva u detei [Algorithm for diagnosing drusen disc of the optic nerve in children]. Practical medicine=Prakticheskaya meditsina. 2015;2(87):111–115. (In Russ.)]

11. Савина Ю.Н., Юрьева Т.Н., Щуко А.Г., Короленко А.В. Роль метаболических нарушений в формировании друз диска зрительного нерва у детей с эссенциальной артериальной гипертензией. Современные технологии в офтальмологии. 2016;3:199–202. [Savina Ju.N., Iureva T.N., Shchuko A.G., Korolenko A.V. The role of metabolic disorders in the formation of the drusen of the optic nerve in children with essential arterial hypertension. Modern technologies in ophthalmology= Sovremennye tekhnologii v oftal’mologii. 2016;3:199–202. (In Russ.)]

12. Волкова Н.В., Щуко А.Г., Носкова Л.К. Роль гиперлипопероксидации и изменение гормональной регуляции в механизмах рубцовых изменений путей оттока внутриглазной жидкости после фистуляризирующих антиглаукоматозных операций. Сообщение 2. Национальный журнал глаукома. 2011;2:3–7. [Volkova N.V., Shchuko A.G., Noskova L.K. [Volkova N.V., Shchuko A.G., Noskova L.K. The role of hyperlipoperoxidation and the alteration of hormonal regulation in the mechanisms of scar changes in the pathways of intraocular fluid outflow after fistulazing antiglaucomatous operations. Report 2. National Journal glaucoma=Natsional’nyi zhurnal glaukoma. 2011;2:3–7. (In Russ.)]

13. Wakakura M., Ishikawa S. Neuro-ophthalmic aspects of vascular disease. Curr. Opin. Ophthalmol. 1994;5(6):18–22.

14. Rubinstein K., Ali M. Retinal complications of optic disc drusen. Br. J. Ophthalmol. 1982;66(2):83–95.

15. Sanders T.E., Gay A.J., Newman M. Drüsen of the optic disk-hemorrhagic complications. Trans. Am. Ophthalmol. Soc. 1970;68:186–218.

16. Zanella F.E., Kirchhof B. Calcification of optic disk drusen on CT. Medder U. Rofo. 1984;141(6):647–8.

17. Purvin V., King R., Kawasaki A. et al. Anterior ischemic optic neuropathy in eyes with optic disc drusen. Arch. Ophthalmol. 2004;122(1):48–53.