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—We agree with Dr Hepler that on extremely rare occasions "there are patients whose drusen alone appear to generate progressive vision loss." There are also patients who lose vision from acquired optic nerve diseases who happen to have drusen in the nerve head. That the patient described by Kamin et al now has a counting fingers level of vision and that the hyaline bodies are more prominent does not categorically infer cause and effect. With both demyelinative optic neuritis and Leber's hereditary optic atrophy, vision may improve, fluctuate, or worsen.Fortunately, with the advent of modern neuroradiologic techniques, including polytomography of bones and computerized axial tomography of bones and soft tissues, the clinical dilemma of whether nerve head drusen are the cause of central visual loss may usually be resolved. Given the nearly inviolate rule that optic nerve drusen do not cause loss of acuity (without macular hemorrhage),
Rosenberg M, Savino P, Glaser J. Pseudopapilledema-Reply. Arch Ophthalmol. 1979;97(8):1543. doi:10.1001/archopht.1979.01020020193026