Optic disc drusen

Small deposits in the front of the optic nerve

Reviewed by Dr. James Deom, OD, MPH, FAAO, FSLS, Chief of Eye Care Services, Hazleton Eye Specialists Last reviewed: November 12, 2026 Audience: All (patient and clinician sections)

Same-day care

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For patients and families

What they are

Optic disc drusen are tiny, hardened (calcified) deposits that build up in the optic nerve head, usually in both eyes.¹ ² Many people with drusen have no symptoms and normal central vision.² They are often found at a routine eye exam, sometimes because the nerve looks swollen when it is not.

Why they matter

Drusen can slowly affect side vision, so visual field tests are part of follow-up.²
They can look like optic nerve swelling (papilledema). Special imaging can tell the difference and may spare you unnecessary tests.¹
In younger adults, drusen have been found in about half of eyes with NAION in two published studies, so they are one of the features eye doctors note when assessing a “disc at risk.”³ ⁴ Most people with drusen never have NAION.

How they are found

An eye exam with OCT (especially enhanced-depth imaging) and fundus autofluorescence photos, where drusen near the surface can glow, are common ways to find them. An ultrasound or CT scan is sometimes used.¹ ² See What to expect at an eye exam.

Treatment

There is no treatment that removes drusen. Care focuses on regular monitoring of vision, visual fields, and OCT, and on treating any related problem.²

Drusen and GLP-1 medicines

Because drusen are part of the “disc at risk” picture for NAION, they are one reason Dr. Deom recommends baseline imaging for people starting a GLP-1 medicine.

Dr. Deom’s recommendation (clinical opinion / practice recommendation)

Dr. James Deom recommends that everyone starting or taking a GLP-1 medication have a comprehensive dilated eye exam with OCT, OCT angiography (OCTA), and retinal photography (fundus photos with autofluorescence) as a baseline and for follow-up, and seek same-day care for sudden vision loss.

This is his clinical opinion, not a formal rule from every professional group. AAO and NANOS do not recommend an eye exam only to predict NAION, and no test can reliably predict or prevent it. Dr. Deom recommends the baseline so there is a record to compare against if anything changes, and so other eye problems can be found early.

Dr. James Deom’s personal clinical thought

This is his opinion, not established evidence. It is not a finding from the studies or a position of the FDA, EMA, AAO, NANOS, or AOA.

As people lose weight and get healthier on GLP-1 medicines, their blood pressure and cholesterol medicines are often not reviewed or adjusted. Blood pressure treatment that is no longer matched to a person’s needs may lead to low blood pressure (hypotension). Low blood pressure can be more pronounced at night and could reduce blood flow to the optic nerve during sleep. That possibility would fit the typical way NAION presents: vision loss noticed on waking.

Dr. Deom recommends that people taking a GLP-1 medicine also work on exercise and diet, and keep regular visits with their usual doctors — even if that doctor did not prescribe the GLP-1 — so the rest of their care, including blood pressure, is maintained. Do not start, stop, or change a blood pressure or cholesterol medicine on your own; talk with the clinician who prescribes it.

For clinicians

Diagnosis: the Optic Disc Drusen Studies (ODDS) Consortium recommends EDI-OCT, defining drusen as signal-poor cores often with a hyperreflective margin, located above the lamina cribrosa.¹ Distinguish drusen from peripapillary hyperreflective ovoid mass-like structures (PHOMS), which are not specific to drusen and occur in disc edema of other causes.¹ ⁵
Adjuncts: fundus autofluorescence (superficial drusen), B-scan ultrasonography, and CT. FAF and B-scan are less sensitive for buried drusen than EDI-OCT.¹ ²
Associations: visual field defects (often nasal or arcuate) that can progress slowly; NAION, particularly in younger patients;³ ⁴ peripapillary CNV and vascular occlusions are reported.²
Monitoring: periodic perimetry and OCT RNFL/GCL. Interpret RNFL with care, since drusen can thicken or distort measurements.²
GLP-1 RA context: document drusen and disc morphology at baseline and counsel on sudden monocular vision loss. Prior NAION or known drusen is a reason to coordinate any GLP-1 decision with the prescriber (see the monitoring framework).

Dr. Deom’s recommendation (clinical opinion / practice recommendation)

This is his clinical opinion and practice recommendation, not a society mandate. AAO and NANOS do not recommend routine examination solely to predict NAION, and no exam or imaging test reliably predicts or prevents an acute event. The baseline is intended to document disc anatomy and retinal status for later comparison and to detect other eye disease. See the study comparison for where professional positions agree and differ.

Dr. James Deom’s personal clinical thought

This is his opinion, not established evidence. It is not a finding from the studies or a position of the FDA, EMA, AAO, NANOS, or AOA.

As patients lose weight and their overall health improves on GLP-1 medicines, blood pressure and cholesterol medicines are often not re-addressed. Over-treatment of blood pressure may lead to hypotension, which can worsen at night and could cause nighttime hypoperfusion of the optic nerve. That sequence would fit the typical presentation of NAION (vision loss noticed on waking).

He recommends that people on GLP-1 medicines also improve exercise and diet, and keep regular visits with their usual doctors, even if that clinician did not prescribe the GLP-1, so the rest of their care, including blood pressure, is maintained.

For prescribers: consider reviewing antihypertensive dosing and timing (including bedtime dosing) as weight drops. Coordinate changes with the patient’s usual clinician when someone else wrote the GLP-1 prescription.

How to reach us

Same-day evaluation: providers can call the office at 570-453-2020 (fax 570-453-1020), or refer a patient or ask a question by email. Patients can schedule an exam online.

For privacy, please don’t include patient names or other identifying details in email. Our team will call to schedule and gather details securely.

General contact and referrals: Hazleton Eye Specialists, phone 570-453-2020, fax 570-453-1020. See Referral information for what to send.

References

Malmqvist L, et al. The Optic Disc Drusen Studies Consortium Recommendations for Diagnosis of Optic Disc Drusen Using Optical Coherence Tomography. J Neuroophthalmol. 2018;38(3):299-307. https://pubmed.ncbi.nlm.nih.gov/29095768/
EyeWiki (American Academy of Ophthalmology). Optic Disc Drusen. https://eyewiki.org/Optic_Disc_Drusen · AAO patient page: What Are Optic Nerve Drusen? https://www.aao.org/eye-health/diseases/what-is-optic-nerve-drusen
Young adults with anterior ischemic optic neuropathy: a multicenter optic disc drusen study. Am J Ophthalmol. 2020. https://doi.org/10.1016/j.ajo.2020.03.052
Prevalence of optic disc drusen in young patients with nonarteritic anterior ischemic optic neuropathy: a 10-year retrospective study. J Neuroophthalmol. 2020. https://doi.org/10.1097/wno.0000000000000974
Malmqvist L, et al. Peripapillary ovoid hyperreflectivity in optic disc edema and pseudopapilledema. Ophthalmology. 2018;125(10):1662-1664. https://pubmed.ncbi.nlm.nih.gov/29891127/

How to reach us

Hazleton Eye Specialists: phone 570-453-2020, fax 570-453-1020. Addresses for all five offices (Hazleton, Stroudsburg, Nanticoke, Pottsville, and Bangor) are on Find an Eye Doctor.

Sudden vision loss needs same-day care. Call an eye doctor right away. If you also have a new headache, jaw pain when chewing, scalp tenderness, fever, or you are over 50 and feel unwell, go to the emergency department.

Medical disclaimer. This page is for general education. The patient section is not medical advice, and the clinician section is not a clinical practice guideline; neither replaces an examination, clinical judgment, or specialty consultation. If you have sudden vision loss, seek same-day care from an eye doctor or an emergency department. Information is current as of the “last reviewed” date.