Risk stratification of visual field progression in optic disc drusen with and without glaucoma.

Abstract

Purpose: To investigate the visual field (VF) progression in patients with optic disc drusen (ODD) with or without glaucoma and identify factors associated with rapid deterioration.

Methods: In this single-center retrospective cohort, adult patients with ODD, ≥ 12 months of follow-up, and ≥ 3 reliable standard automated perimetry tests were included. VF progression was quantified as the VF mean deviation (MD) slope (dB/year) using linear mixed-effects modeling. Eyes were categorized as slow progression (MD slope > - 0.5 dB/year) or moderate-fast progression (MD ≤ - 0.5 dB/year). Baseline RNFL thickness and VF MD, Visual acuity, intraocular pressure (IOP), glaucoma diagnosis, and number of IOP-lowering medications (NOM) were extracted from the medical record. Associations with moderate-fast progression were evaluated using logistic regression.

Results: A total of 139 eyes from 84 patients were included (mean follow-up 57.4 ± 42.6 months; mean 4.9 perimetry tests/eye). Glaucoma was diagnosed in 83/139 eyes (59.7%). Overall, 91/139 eyes (65.5%) demonstrated VF deterioration (MD slope < 0 dB/year), more frequently in glaucoma-labeled eyes than no-glaucoma eyes (64/83 [77.1%] vs. 27/56 [48.2%]; p < 0.001). Moderate-fast progression occurred in 32/139 eyes (23.0%) and did not differ significantly by glaucoma status (28.9% vs. 14.3%, p = 0.064). In multivariable modeling, higher mean NOM was associated with higher odds of moderate-fast progression (adjusted odds ratio 2.41; 95% CI 1.06-5.45; p = 0.034), whereas glaucoma diagnosis and mean IOP were not independently associated. Severity-stratified analyses showed higher moderate-fast progression with baseline VF MD ≤ -6 dB (34.9% vs. 13.2%, p = 0.004) and RNFL < 80 µm (36.4% vs. 7.0%, p < 0.001).

Conclusions: In eyes with ODD, thinner RNFL and worse VF MD at baseline are associated with a higher risk of moderate-fast VF decline, supporting risk-stratified monitoring regardless of glaucoma label or IOP.