Multicolor Imaging of Optic Disc Drusen

Abstract

Optic disc drusen (ODD) are calcified deposits at the anterior optic nerve that are often detectable by ophthalmic imaging, including optical coherence tomography and fundus autofluorescence imaging. Multicolor (MC) imaging is a novel modality that captures reflectance of blue, green, and near-infrared laser lights with confocal scanning laser ophthalmoscopy to rapidly acquire high-resolution reflectance images of the optic disc and retina. Here, we show an eye with 3 MC imaging features of ODD, including prominent green hyperreflectance of the optic disc, green sheathing of the papillary and peripapillary vasculature (arterioles > venules), and presence of orange superficial ODD. MC imaging can provide rapid high-resolution assessment of eyes with optic nerve head elevation to help distinguish pseudopapilledema vs papilledema in children and adults without dilation, and future large studies incorporating MC imaging will help determine its contribution in the diagnosis and monitoring of ODD and assessment of other causes of optic nerve head elevation.

FIG. 1.

Multimodal ophthalmic imaging of optic disc drusen (right eye) with MultiColor (MC) reflectance imaging, color fundus imaging (Color), blue-light fundus autofluorescence (FAF) imaging, and optical coherence tomography (OCT). The MC image (pseudocolored composite of the blue, green, near-infrared images in the middle row), there is green hyperreflectance of the entire optic disc. There is prominent green reflectance of the papillary and peripapillary arteriolar sheaths, which corresponds to the subtle white sheathing around the narrowed vessels seen on color fundus imaging. A cluster of small ODD at 9 o’clock position of the optic disc is most distinct on near-infrared reflectance image (red arrows) but also visible on blue and green reflectance images. There is also a ring of peripapillary hyperreflectance due to loss of retinal pigment epithelium on OCT (yellow arrows). This ring appears dark on blue-light FAF.