Pediatric Ophthalmology

158 8 Congenital Abnormalities of the Optic Nerve

● MRI of the brain in any patient with associ ated progressive visual loss Treatment ● Drusen alone need no medical therapy. ● CNVMs may require laser photocoagula tion or intravitreal anti-vascular endothelial growth factor (VEGF). ● Ischemic complications (NAION and retinal vascular occlusions) managed in the absence of drusen. NAION is the most com mon cause of acute vision loss in patients with optic nerve drusen. Prognosis ● Usually very good but complications may occur ● VF defects are identified in up to 51% of children and become more common with increasing age.

● Hemorrhagic complications—peripapillary or disc hemorrhage

● CNVM ● NAION ● Retinal artery or vein occlusion

REFERENCES Dutton GN. Congenital disorders of the optic nerve: excavations and hypoplasia. Eye (Lond) . 2004;18(11):1038-1048. Levin AV, Zanolli C, Capasso JE. The Wills Eye Handbook of Ocular Genetics . Thieme Medical Publishers, Inc; 2018. Maguire JI, Murchison AP, Jaeger EA. Wills Eye Hospital 5-Minute Ophthalmology Consult . Lippincott Williams & Wilkins; 2012. Taylor DS. Congenital anomalies of the optic discs. Taylor and Hoyt's Pediatric Ophthalmology and Stra bismus , 5th ed. Elsevier Saunders; 2017:562-580.

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