Optic Disc Drusen
Calcified deposits within the optic nerve head that are not glaucoma, but matter greatly in a glaucoma practice because they can mimic optic nerve swelling, produce glaucoma-like visual field defects, and sometimes coexist with true glaucoma in the same eye.
Overview
Optic disc drusen are deposits of calcified protein and mucopolysaccharide material that form within the optic nerve head, the point where the optic nerve exits the eye. They are not a form of glaucoma and, on their own, are usually a benign, incidental finding. They matter to a glaucoma practice for a very practical reason: they can make the optic nerve look swollen when it isn't (pseudopapilledema), they can cause visual field defects that closely resemble glaucomatous field loss, and they can occasionally be present in the same eye as true glaucoma, which makes distinguishing the two, or recognizing both, an important diagnostic skill.
Symptoms
- Usually no symptoms at all — most people with optic disc drusen are unaware they have them
- Occasionally brief, transient graying-out or dimming of vision lasting seconds (transient visual obscurations)
- In a minority of patients, mild peripheral visual field defects noticed only on formal testing, not by the patient
- Rarely, more significant vision loss from an uncommon complication such as a choroidal neovascular membrane or a blood vessel occlusion near the disc
How Common Is It?
Optic disc drusen are relatively common, with population studies estimating they affect roughly 0.3–2% of people, and they are bilateral (present in both eyes) in about two-thirds to three-quarters of cases.
They tend to become more visible with age: in children and young adults the drusen are often 'buried' beneath the surface of the disc and invisible on a standard exam, while over time they tend to migrate closer to the surface and calcify further, becoming more clearly visible as small, round, yellowish bodies later in life.
Genetics & Risk Factors
Optic disc drusen often run in families, with an autosomal dominant inheritance pattern reported in some pedigrees, and they are more common in people with smaller, more crowded optic discs, which is thought to predispose to their formation.
They are also reported more often in certain associated conditions, including retinitis pigmentosa, Usher syndrome, and, less commonly, angioid streaks (seen in pseudoxanthoma elasticum), so a broader eye and family history is sometimes relevant.
Ocular Findings on Exam
In younger patients, drusen are often 'buried' — not visible on the disc surface — and the optic nerve may simply look mildly elevated or blurred at the margins, which is exactly why they're so easily mistaken for true optic disc swelling (papilledema) from elevated pressure around the brain.
As patients age, drusen more often become 'exposed,' appearing as yellowish, refractile, lumpy nodules on the surface of the disc that are usually straightforward to recognize on a dilated exam.
Testing & Diagnosis
- B-scan ultrasound, the gold-standard test, showing drusen as a highly reflective structure with a characteristic acoustic shadow even at low settings
- Fundus autofluorescence, which takes advantage of the fact that calcified drusen naturally autofluoresce, making even buried drusen easy to spot
- Enhanced-depth imaging OCT, showing drusen as round, signal-poor bodies within the optic nerve head, and useful for following them over time alongside standard glaucoma OCT scans
- Automated visual field testing, both to detect any drusen-related field loss and to distinguish its pattern from true glaucomatous loss when possible
- Careful serial optic nerve photography, since distinguishing stable drusen-related field loss from progressive glaucoma often depends on comparison over time rather than a single visit
Treatment Options
No Specific Treatment for the Drusen Themselves
In the large majority of cases, optic disc drusen require no direct treatment — the focus is on monitoring, not intervention.
Periodic Optic Nerve Function Monitoring
Regular visual field testing and OCT imaging are used to watch for any slow, drusen-related change in optic nerve function over time, since a minority of patients do experience gradual peripheral field loss independent of eye pressure.
Identifying and Treating Any True Coexisting Glaucoma
Because optic disc drusen can occur in the same eye as true glaucoma, and can also make it harder to interpret optic nerve appearance and OCT scans, a careful, individualized assessment of eye pressure, the drainage angle, and field testing patterns is used to determine whether separate glaucoma treatment is also needed.
Management of Rare Complications
In the uncommon event of a complication such as a choroidal neovascular membrane near the disc, treatment (such as an anti-VEGF injection) is directed at that specific complication.
How This Differs From Other Glaucomas
Optic disc drusen are not glaucoma at all, but they matter enormously in a glaucoma practice because they can convincingly mimic true optic nerve swelling and can produce visual field defects that closely resemble glaucomatous loss — an incorrect diagnosis in either direction can lead to unnecessary neurological workup, or to missing a true, treatable glaucoma.
Monitoring also requires different tools than standard glaucoma follow-up: B-scan ultrasound and fundus autofluorescence, in addition to the OCT and visual field testing used for glaucoma, are central to confirming the diagnosis and following it accurately, especially when a patient has both optic disc drusen and true glaucoma at the same time.
Frequently Asked Questions
Are optic disc drusen the same as glaucoma?
No. Optic disc drusen are calcified deposits within the optic nerve head, not a form of glaucoma. However, they matter to glaucoma specialists because they can visually mimic optic nerve swelling, can cause visual field defects that resemble glaucomatous field loss, and can occasionally occur in the same eye as true glaucoma, which requires careful testing to sort out.
Can optic disc drusen cause vision loss?
Most people with optic disc drusen have normal or near-normal vision throughout life. A minority develop mild, usually stable peripheral visual field defects, and rare complications (such as a choroidal neovascular membrane or blood vessel occlusion near the disc) can cause more significant vision loss.
How are optic disc drusen diagnosed?
The gold-standard test is B-scan ultrasound, which shows the calcified drusen as a highly reflective spot with a characteristic acoustic shadow. Fundus autofluorescence and enhanced-depth OCT imaging are also very useful, especially for drusen that are buried and not visible on a standard eye exam.
Do I need treatment?
There is no specific treatment for the drusen themselves in most cases. We focus on periodic monitoring of optic nerve function with visual fields and OCT, and on making sure any separate, true glaucoma is identified and treated on its own if present.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for Optic Disc Drusen at Inland Glaucoma Center in Upland, CA.