Multimodal Imaging Features of Optic Disc Drusen

center dot PURPOSE: To identify key en face multimodal imaging features of optic disc drusen (ODD). center dot DESIGN: Retrospective cross-sectional study. center dot METHODS: SETTING: a single academic center. PATIENT OR STUDY POPULATION: 786 patients (10-82 years of age) with diagnostic codes for optic disc drusen (ODD) in clinical notes extracted using natural language processing. INTERVENTION OR OBSERVATION PROCEDURES: color fundus imaging, green-light and blue-light fundus auto fluorescence (FAF), near-infrared reflectance (NIR), and enhanced-depth imaging optical coherence tomography (EDI-OCT). MAIN OUTCOME MEASUREMENTS: Ophthalmic imaging characteristics and sensitivity of en face imaging compared with EDI-OCT. center dot RESULTS: A total of 38 patients (61 eyes) had high quality EDI-OCT scans and en face multimodal imaging. Green-light FAF imaging had the highest diagnostic sensitivity (96.8%) for ODD and showed homogeneous hyperautofluorescence, whereas blue-light FAF imaging had heterogeneous brightness, which helped differentiate superficial from deep ODD. Blue-light FAF (93.5%) and NIR (91.8%) imaging were also sensitive tests and revealed papillary and peripapillary features that were not well seen on green-light FAF, including the size and depth of ODD, morphology of the optic disc, and common ODD-associated structures such as horizontal hyper reflective lines and peripapillary hyper-reflective ovoid mass-like structures (PHOMS). Color fundus imaging had the lowest sensitivity (82%). There was good inter rater reliability for all en face imaging modalities (P < .0001 for all). center dot CONCLUSIONS: In en face imaging, green-light FAF had the highest sensitivity for the diagnosis of ODD, whereas blue-light FAF and NIR images provided more information regarding the severity, location, depth, and size of ODD. In eyes that are negative on green-light FAF, EDI-OCT should be performed and provides the highest-resolution characterization of the entire optic disc to assess or rule out ODD. (Am J Ophthalmol 2021;225:18-26. (c) 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).) <comment>Superscript/Subscript Available</comment