Journal article
Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema
Journal of neuro-ophthalmology, Vol.41(1), pp.77-92
03/01/2021
DOI: 10.1097/WNO.0000000000001078
PMCID: PMC7882012
PMID: 32909979
Abstract
Distinguishing optic disc edema from pseudopapilledema is a common, sometimes challenging clinical problem. Advances in spectral-domain optical coherence tomography (SD-OCT) of the optic nerve head (ONH) has proven to be a cost effective, noninvasive, outpatient procedure that may help. At its core are tools that quantify the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL). The SD-OCT also provides a set of tools that may be qualitatively interpreted in the same way that we read an MRI. They include the transverse axial, en face, and circular tomogram. Our goal is to describe a practical office-based set of tools using SD-OCT in the diagnosis and monitoring of papilledema, optic disc edema, and pseudopapilledema.\nSearches on PubMed were performed using combinations of the following key words: OCT, papilledema, pseudopapilledema, optic disc drusen, retinal folds (RF), and choroidal folds (CF).\nThe principal elements of SD-OCT analysis of the ONH are the RNFL and GC-IPL thickness; however, these metrics have limitations when swelling is severe. Qualitative interpretation of the transverse axial SD-OCT aids in assessing peripapillary shape that may help distinguish papilledema from pseudopapilledema, evaluate atypical optic neuropathies, diagnose shunt failures, and identify outer RF and CF. There is a consensus that the SD-OCT is the most sensitive way of identifying buried optic disc drusen. En face SD-OCT is especially effective at detecting peripapillary wrinkles and outer retinal creases, both of which are common and distinctive signs of optic disc edema that rule out pseudopapilledema. Mechanically stressing the ONH in the adducted eye position, in patients with papilledema, may expose folds and peripapillary deformations that may not be evident in primary position. We also discuss how to optimize the acquisition and registration of SD-OCT images.\nThe SD-OCT is not a substitute for a complete history and a careful examination. It is, however, a convenient ancillary test that aids in the diagnosis and management of papilledema, optic disc edema, and pseudopapilledema. It is particularly helpful in monitoring changes over the course of time and distinguishing low-grade papilledema from buried drusen. The application of the SD-OCT toolbox depends on optimizing the acquisition of images, understanding its limitations, recognizing common artifacts, and accurately interpreting images in the context of both history and clinical findings.
Details
- Title: Subtitle
- Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema
- Creators
- Patrick A Sibony - Department Ophthalmology (PAS), State University of New York at Stony Brook, Stony Brook, New York; Departments of Neurology, Ophthalmology, Neurosurgery (MJK), Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology and Visual Sciences (RHK), the University of Iowa, Iowa City, Iowa; and Center for the Prevention and Treatment of Visual Loss (RHK), Iowa City VA Health Care System, Iowa City, IowaMark J KupersmithRandy H Kardon
- Resource Type
- Journal article
- Publication Details
- Journal of neuro-ophthalmology, Vol.41(1), pp.77-92
- DOI
- 10.1097/WNO.0000000000001078
- PMID
- 32909979
- PMCID
- PMC7882012
- NLM abbreviation
- J Neuroophthalmol
- ISSN
- 1070-8022
- eISSN
- 1536-5166
- Publisher
- United States
- Grant note
- U10 EY017387 / NEI NIH HHS\nU10 EY017281 / NEI NIH HHS\nI50 RX003002 / RRD VA
- Language
- English
- Date published
- 03/01/2021
- Academic Unit
- Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
- Record Identifier
- 9984071612602771
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