Retinal peripapillary nerve fiber and retinal ganglion cell layer thickening preceed atrophy in children and teenagers with optic disc drusen

In adults, optic disc drusen (ODD) are linked to thinning of the retinal ganglion cell layer (rGCL) and peripapillary retinal nerve fibre layer (pRNFL), but stage-specific pediatric changes remain unclear. This prospective cross-sectional study included 31 patients (61 eyes) with ODD and 21 age-matched controls (42 eyes), aged 6–18 years. pRNFL thickness was measured with Spectralis SD-OCT at 3.5 mm and 4.7 mm peripapillary rings; rGCL was assessed at the posterior pole. ODD were graded A–D (deep–superficial). At 3.5 mm, stage D showed pRNFL thinning in TS (p = 0.024) and NS (p = 0.004), while stage C showed thickening globally (p = 0.003), TS (p = 0.024), NS (p = 0.026), TI (p < 0.001). At 4.7 mm, stage D had thinning in all sectors, most in TS (p = 0.001), NS (p < 0.001), TI (p < 0.001); the temporal sector was most preserved. Stage C did not differ from controls here. rGCL thickening occurred in stage B in S (p = 0.036), NS (p = 0.015; p = 0.036), globally (p = 0.040), and in stage C in all but TI. Stage D showed marked global thinning (p < 0.001), most temporal, least nasal.Thus, rGCL thickening preceded pRNFL changes; 3.5 mm detected early congestion, 4.7 mm revealed atrophy; the papillomacular bundle was relatively preserved. In pediatric patients deep drusen and those advancing toward the optic nerve head surface first cause sector-specific swelling of both pRNFL and rGCL followed by atrophy in the very same sectors.