Radial Optic Neurotomy for Progressive Visual Field Loss Associated with Optic Disc Head Drusen: A Case Report

Introduction: To report the use of radial optic neurotomy (RON) as an experimental surgical approach for progressive visual field loss associated with extensive bilateral optic disc head drusen (ONHD). Case Presentation: A 27-year-old female with extensive bilateral ONHD presented with rapidly progressive and severe concentric visual field loss, more severe in the left eye, despite normal intraocular pressure and topical hypotensive therapy. Multimodal imaging confirmed ONHD with significant retinal nerve fiber layer thinning and severe concentric visual field loss sparing central vision in the left eye. RON was performed at the nasal edge of the optic disc without complications. Conclusion: RON may represent a potential therapeutic option in carefully selected young patients with ONHD and progressive, severe visual field loss. Further studies are required to establish optimal timing, appropriate indications, and long-term outcomes.