Advanced glaucoma without cupping in the setting of large optic disc drusen and high myopia

Fig. 1: Advanced glaucoma without cupping in the setting of large optic disc drusen and high myopia. Full size image A Fundus photograph of a 75-year-old male who presented with advanced glaucoma (dense inferior arcs, MD −18.6 dB), high myopia (−16 D), large disc area (2.04 mm 2 ), yellowish optic disc drusen (black asterisks), and prominent peripapillary atrophy (black arrows), OS. The intraocular pressure was 13 mmHg on latanoprost 0.005% qhs, OU. The patient also had prior selective laser trabeculoplasty, OU. B , C The autofluorescence imaging of the optic disc shows large hyper-autofluorescent deposits (≥500 μm) within the optic nerve (orange arrows) and hypo-reflective cores on SD-OCT (green asterisks). D The SD-OCTA scan shows marked circumpapillary capillary dropout (dark blue areas, white asterisks) with an average vessel density of 21% (normal of 46%). The average nerve fibre layer was 49 µm (normal of ≥95 µm). Thus, our case demonstrates a dual-mechanism (elevated IOP and large disc drusen) glaucomatous optic neuropathy. All images are taken from the left eye.