What causes Optic Nerve Elevation?

About two years ago I went to the eye doctor because I was experiencing headaches, and eye pressure.  It was the first time I have ever had my eyes dilated (I have been wearing glasses since I was 6).  They immediately saw that my Optic Nerves were elevated in both eyes.  I did a field test (which was normal) and an OCT test which confirmed the elevated Optic Nerves.  I was immediately sent for blood work (which all came back normal) and an MRI (with and without contrast).  The MRI came back normal, but I had braces on and the radiologist said the metal artifact obscured the images but they saw what they needed to.  I then had a spinal tap which also came back normal.   I guess my question is, what exactly can be causing this Optic Nerve Elevation?  The dr. is asking me to go back to see her every 6 months and everytime it's the same old thing.  My vision is getting a tad worse each time but not drastically.  I had an appointment today and asked the doctor why is it still elevated? I mean there has to be a cause?  But they just don't know.  I guess i'm a little frustrated because I haven't gotten and answers... Should this Optic Nerve Elevation be something to worry about?  Thanks for any answers!

[John C Hagan III, MD, FACS, FAAO]

The thing that disturbs me is that you feel your vision is worse. I would suggest getting a second opinion from the best neuroophthalmologist you have access to.  There are not serious causes of optic nerve elevation (called pseudo-papilledema common causes is buried optic nerve drusen) but the vision should be stable.

You can even ask your present ophthalmologists to refer you to the neuroophthalmologist they respect most. In cases like yours a good physician will always welcome another opinion.

JCH MD

[jmburt87]

Thank you for responding!
My vision is slightly changing and they told me it would.  That is what is concerning me.  Last time is what -9.50, now it's -9.75.(within 6 months).  I don't know if that change should be anything to be worried about.  I had an ultra sound for drusen, and my Ophthalmologist said they saw some.  I then got a doctor at work to refer me to a neuroophthalmologist and she said that she didn't see any.  She couldn't find a cause for the Optic nerve elevation.  I'm thinking of getting a second opinion...
Thanks again.

[John C Hagan III, MD, FACS, FAAO]

Well you have a second opinion (the neuroophthalmologist). Note some times optic nerve drusen is ONLY visible with OCT.    Did the Neuro- look at the OCT.  ON drusen are easy to diagnose and both eye MDs should be able to tell you from the optic nerve OCT if drusen are there are not. If so it is the likely cause, if not you have had a full work up and all you may need is to be followed to see if things change. NOTE: just like some people have big noses, big ears, big.........you get the idea there are people with no eye disease that have somewhat elevated optic nerves.

Even if you had true papilledema it would not cause your glasses RX to change. a quarter diopter is not much in a half year (that's one click on the eye tester).

JCH MD

[jmburt87]

Yes the Neuro did look at the OCT.  She also sent me to another doctor who did an test with dye to look at the nerve and stuff in my eye.  That's when she said there was no drusen.... I guess I'll have to get used to the fact that I have big optic nerves.... Thank you very much for responding! :)

[John C Hagan III, MD, FACS, FAAO]

Yes, important to know and better your way than to find you have a brain tumor or pseudotumor cerebri

JCH MD

[jmburt87]

Once again I appreciate your responses.  But I feel like I should give up about the Optic Nerve Elevation.  I have had many tests (blood work, MRI, spinal tap) and all of it was normal.  I have been to specialists and they all see the ONE but don't know what is causing it.  I'm thinking since all the tests seem normal that like you said it's just something that is different about me.  I want to be ok with it, but there is still a part of me thinking, what if something really was missed?  Do you think I should just continue to go to the eye doctor once a year and not think anymore about it unless the doctors become concerned?  Thanks again Dr. Hagan.  

[John C Hagan III, MD, FACS, FAAO]

I would follow the recommendation of the neuroophthalmologist but since all the important relevant tests have been negative I would quit worrying about it between exams.

JCH MD