The literature on the appearance of buried optic nerve head drusen (ONHD) on spectral domain optical coherence tomography (SD-OCT) is conflicting. Some authors have described a focal subretinal hyperreflective mass posterior to the outer plexiform and outer nuclear layers [1]; whereas others described ONHD as a hyporeflective round or ovoid structure containing hyperreflective foci, located anterior to the lamina cribrosa [2,3,4]. In this study, we aimed to clarify this controversy with multimodal imaging. We attempted to correlate our findings with published histological findings.

This retrospective, observational study assessed five consecutive patients referred by optometrists to an acute ophthalmology service with suspected swollen optic discs. The mean age was 28 years (range: 13–49 years). The presence of buried ONHD was diagnosed clinically with history and dilated fundoscopy and confirmed with ultrasonography. None of the patients had exposed or visible ONHD. All patients underwent imaging with colour fundus photography, fundus autofluorescence and SD-OCT (Spectralis, Heidelberg Engineering, Germany). We obtained 49 horizontal enhanced depth imaging SD-OCT scans in a square raster pattern centred on the optic nerve head of each eye. Each horizontal scan consisted of at least 12 OCT B-scans, which were averaged using active retinal tracking. This scan protocol enabled high-resolution visualisation of deeper structures within and around the optic nerve head.

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