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 and five eyes of 105 patients referred to two tertiary care neuro-ophthalmology clinics for suspected ODD were recruited. Of these eyes, 108 had ODD, and 97 did not. All eyes received a full in-person ophthalmic exam with 3D view of the optic nerve and all four imaging modalities. Images were independently reviewed by three 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: EDI-OCT had the highest sensitivity and accuracy (95%, 97%) to detect ODD, compared to FAF (84%, 92%), US (74%, 86%), and fundus photography (38%, 66%). All image modalities had high specificity (>97%) and precision (>93%). EDI-OCT also had highest examiner confidence (96%) compared to all others (88%).
Conclusion: Among all modalities, EDI-OCT is the imaging modality with the highest diagnostic utility for the detection of ODD and should be considered as the preferred initial diagnostic modality.