An overview of peripapillary hyperreflective ovoid mass-like structures

Abstract

Purpose of reviewThe purpose of this review is to provide an overview of the ophthalmic findings associated with peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both adult and pediatric patients.Recent findingsPHOMS have recently been identified in a number of different ophthalmic disease entities ranging from nonpathologic to pathologic, including but not limited to anatomic abnormalities (tilting in myopia), optic nerve head drusen, optic disc edema from inflammation (optic neuritis, white dot syndromes), vascular insults (ischemic optic neuropathy, retinal vascular occlusion), and papilledema. The mechanism underlying the formation of PHOMS has not been fully elucidated although it has been hypothesized that PHOMS occur secondary to axoplasmic stasis from crowding at the optic nerve head.SummaryAlthough the clinical significance of the presence of PHOMS remains unclear, PHOMS are associated with several disease processes. Understanding the mechanism behind their formation and their impact on optic nerve head structure and visual function may be relevant in patients with optic nerve head pathology. The presence of PHOMS may also correlate with disease severity and duration. Future studies to evaluate whether the formation of PHOMS may be useful as an early indicator of disease or a prognostic tool are warranted.

Peripapillary Hyperreflective Ovoid Mass-Like Structures: Prevalence and Associations in the Adult Population of the Beijing Eye Study

“…In contrast with our study and the Copenhagen Study, most other previous studies reported on the concurrence of PHOMS with other optic nerve head anomalies and neurological diseases. 2 , 4 – 8 , 10 , 14 , 16 – 18 , 29 , 30 In a hospital-based study, Maalej et al 16 examined 154 patients with prominent optic discs and found that PHOMS were associated with idiopathic intracranial hypertension in 38% of the cohort, posterior uveitis (11%), optic disc drusen (10%), or tilted optic discs (5%) or were isolated (36%). PHOMS were over-represented in the nasal region (96%).…”

Peripapillary Hyperreflective Ovoid Mass-Like Structures: Prevalence and Associations in the Adult Population of the Beijing Eye Study

“…In contrast with our study and the Copenhagen Study, most other previous studies reported on the concurrence of PHOMS with other optic nerve head anomalies and neurological diseases. 2 , 4 – 8 , 10 , 14 , 16 – 18 , 29 , 30 In a hospital-based study, Maalej et al 16 examined 154 patients with prominent optic discs and found that PHOMS were associated with idiopathic intracranial hypertension in 38% of the cohort, posterior uveitis (11%), optic disc drusen (10%), or tilted optic discs (5%) or were isolated (36%). PHOMS were over-represented in the nasal region (96%).…”

Pseudopapilledema Related to Staphylomatous Optic Nerve Elevation in a Child

“…4 Recently described and found only on OCT, PHOMS represent benign axoplasmic stasis from crowding at the optic nerve head, found in both pathologic and nonpathologic processes without clear understanding of their origin. 4,5…”

Peripapillary hyperreflective ovoid mass-like structures: multimodal imaging and associated diseases

“…They named the structures PHOMS based on their morphological characteristics on optical coherence tomography (OCT) B-scans ( 1 ). PHOMS are believed to correspond to the laterally bulging herniation of the optic nerve fibers and axoplasmic stasis ( 5 , 6 ). In recent years, PHOMS have been recognized in several neuro-ophthalmic diseases, such as ODD, tilted disc syndrome (TDS), papilloedema, non-arteritic anterior ischemic optic neuropathy (NAION), optic neuritis (ON), Leber hereditary optic neuropathy (LHON) and so on ( 7 – 12 ).…”

Peripapillary Hyperreflective Ovoid Mass-Like Structures: Prevalence and Associations in the Adult Population of the Beijing Eye Study

“…In contrast with our study and the Copenhagen Study, most other previous studies reported on the concurrence of PHOMS with other optic nerve head anomalies and neurological diseases. 2 , 4 – 8 , 10 , 14 , 16 – 18 , 29 , 30 In a hospital-based study, Maalej et al 16 examined 154 patients with prominent optic discs and found that PHOMS were associated with idiopathic intracranial hypertension in 38% of the cohort, posterior uveitis (11%), optic disc drusen (10%), or tilted optic discs (5%) or were isolated (36%). PHOMS were over-represented in the nasal region (96%).…”

Pseudopapilledema Related to Staphylomatous Optic Nerve Elevation in a Child

“…4 Recently described and found only on OCT, PHOMS represent benign axoplasmic stasis from crowding at the optic nerve head, found in both pathologic and nonpathologic processes without clear understanding of their origin. 4,5…”

Peripapillary hyperreflective ovoid mass-like structures: multimodal imaging and associated diseases

“…They named the structures PHOMS based on their morphological characteristics on optical coherence tomography (OCT) B-scans ( 1 ). PHOMS are believed to correspond to the laterally bulging herniation of the optic nerve fibers and axoplasmic stasis ( 5 , 6 ). In recent years, PHOMS have been recognized in several neuro-ophthalmic diseases, such as ODD, tilted disc syndrome (TDS), papilloedema, non-arteritic anterior ischemic optic neuropathy (NAION), optic neuritis (ON), Leber hereditary optic neuropathy (LHON) and so on ( 7 – 12 ).…”

Peripapillary Hyperreflective Ovoid Mass-Like Structures: Prevalence and Associations in the Adult Population of the Beijing Eye Study

“…In contrast with our study and the Copenhagen Study, most other previous studies reported on the concurrence of PHOMS with other optic nerve head anomalies and neurological diseases. 2 , 4 – 8 , 10 , 14 , 16 – 18 , 29 , 30 In a hospital-based study, Maalej et al 16 examined 154 patients with prominent optic discs and found that PHOMS were associated with idiopathic intracranial hypertension in 38% of the cohort, posterior uveitis (11%), optic disc drusen (10%), or tilted optic discs (5%) or were isolated (36%). PHOMS were over-represented in the nasal region (96%).…”

Pseudopapilledema Related to Staphylomatous Optic Nerve Elevation in a Child

“…4 Recently described and found only on OCT, PHOMS represent benign axoplasmic stasis from crowding at the optic nerve head, found in both pathologic and nonpathologic processes without clear understanding of their origin. 4,5…”

Peripapillary hyperreflective ovoid mass-like structures: multimodal imaging and associated diseases

“…They named the structures PHOMS based on their morphological characteristics on optical coherence tomography (OCT) B-scans ( 1 ). PHOMS are believed to correspond to the laterally bulging herniation of the optic nerve fibers and axoplasmic stasis ( 5 , 6 ). In recent years, PHOMS have been recognized in several neuro-ophthalmic diseases, such as ODD, tilted disc syndrome (TDS), papilloedema, non-arteritic anterior ischemic optic neuropathy (NAION), optic neuritis (ON), Leber hereditary optic neuropathy (LHON) and so on ( 7 – 12 ).…”