A Comparison of Diagnostic Accuracy of Imaging Modalities to Detect Optic Disc Drusen: The Age of Enhanced Depth Imaging Optical Coherence Tomography

Saerom Youn; Brandon Loshusan; James J Armstrong; J Alexander Fraser; Steffen Hamann; Lulu L C D Bursztyn

doi:10.1016/j.ajo.2022.12.004

A Comparison of Diagnostic Accuracy of Imaging Modalities to Detect Optic Disc Drusen: The Age of Enhanced Depth Imaging Optical Coherence Tomography

Am J Ophthalmol. 2023 Apr:248:137-144. doi: 10.1016/j.ajo.2022.12.004. Epub 2022 Dec 11.

Authors

Saerom Youn¹, Brandon Loshusan¹, James J Armstrong², J Alexander Fraser³, Steffen Hamann⁴, Lulu L C D Bursztyn⁵

Affiliations

¹ From Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (S.Y., B.L., J.A.F., L.B.).
² From Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (S.Y., B.L., J.A.F., L.B.); Department of Ophthalmology, Western University, London, ON, Canada (J.J.A., J.A.F., L.B.).
³ Department of Ophthalmology, Western University, London, ON, Canada (J.J.A., J.A.F., L.B.); Department of Clinical Neurological Sciences, Western University, London, ON, Canada (J.A.F., L.B.).
⁴ Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark (S.H.).
⁵ From Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (S.Y., B.L., J.A.F., L.B.); Department of Ophthalmology, Western University, London, ON, Canada (J.J.A., J.A.F., L.B.); Department of Clinical Neurological Sciences, Western University, London, ON, Canada (J.A.F., L.B.). Electronic address: lulu.bursztyn@sjhc.london.on.ca.

PMID: 36516916
DOI: 10.1016/j.ajo.2022.12.004

Abstract

Purpose: To identify the most accurate diagnostic imaging modality to detect optic disc drusen (ODD) between B-scan ultrasonography (US), fundus photography, fundus autofluorescence (FAF), and enhanced depth imaging optical coherence tomography (EDI-OCT).

Design: Comparative diagnostic analysis.

Methods: Two hundred five eyes of 105 patients referred to 2 tertiary care neuro-ophthalmology clinics for suspected ODD were recruited: 108 eyes had ODD and 97 did not have ODD. All eyes received a full in-person ophthalmic exam with 3D view of the optic nerve and all 4 imaging modalities. Images were independently reviewed by 3 masked neuro-ophthalmologists to determine the presence or absence of ODD. Final interpretation was made through consensus. The reference standard was defined as the attending ophthalmologist's clinical judgement based on open chart review, with access to all image modalities and clinical information, including disease course. Main outcome measures were sensitivity, specificity, accuracy, and precision for each imaging modality. Examiner confidence was quantified as the proportion of eyes in which the reviewers were certain of their decision.

Results: The EDI-OCT had the highest sensitivity and accuracy (95%, 97%) to detect ODD, compared with FAF (84%, 92%), US (74%, 86%), and fundus photography (38%, 66%), respectively. All image modalities had high specificity (> 97%) and precision (> 93%). The EDI-OCT also had highest examiner confidence (96%) compared with all others (88%).

Conclusions: Among all modalities, EDI-OCT was the imaging modality with the highest diagnostic utility for the detection of ODD and should be considered as the preferred initial diagnostic modality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Fundus Oculi
Humans
Optic Disk Drusen* / diagnostic imaging
Optic Disk* / diagnostic imaging
Tomography, Optical Coherence / methods
Ultrasonography