We diagnosed a white woman in her early 60s with giant optic disc drusen causing extensive visual field defects bilaterally. Her best-corrected visual acuity was 1.0 (approximate Snellen equivalent, 20/20) OU. Automated perimetric mean deviation was –19.5 dB in the right eye and –17.7 dB in the left eye. Optic disc drusen were defined as hyporeflective structures with a hyperreflective margin using optical coherence tomography (Figure, A). Optic disc drusen, inner limiting membrane, and Bruch membrane were segmented from the right optic nerve head using enhanced depth imaging optical coherence tomography scans and a specialized algorithm (Figure, B).1The total optic disc drusen volume was 1.9 mm3, comprising 66% of the optic nerve head volume of 2.9 mm3. The patient’s visual field loss warranted suspension of her driver’s license. This case demonstrates that optic disc drusen, even without concomitant disease such as anterior ischemic optic neuropathy, can be associated with substantial visual field loss.
