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To the Editor.
—In their article in the May Archives, Bec et al1 reported on the identification of optic nerve drusen with computed tomography (CT). This capability is well known.Using this method to detect drusen is not cost-effective (a CT scan costs $300 to $400) and exposes the patient to unnecessary radiation. Even when they are "buried," the diagnosis of drusen is usually not difficult with ophthalmoscopy. Should an ophthalmologist have difficulty determining whether disc elevation represents drusen or papilledema, it would be in the patient's best interest to have this determination made clinically by a neuro-ophthalmologist rather than by a radiologist. In general, CT scanning in a patient with drusen should be reserved for the evaluation of unexplained reduced visual acuity, in which case a compressive lesion must be ruled out.
Beck RW. Optic Nerve Head Drusen. Arch Ophthalmol. 1984;102(10):1424. doi:10.1001/archopht.1984.01040031154001