Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SD-OCT volumes, with the mean volume appearing to be roughly linearly related to the Frisén scale grade. Using such an approach can provide a more continuous, objective, and robust means for assessing the degree of disc swelling compared with presently available approaches.

Folds in papilledema are biomechanical signs of stress/strain on the optic nerve head and load-bearing structures induced by intracranial hypertension. Folds are best imaged with SD-OCT. The patterns of retinal and choroidal folds are the products of a complex interplay between the degree of papilledema and anterior deformation of the load-bearing structures (sclera and possibly the lamina cribrosa), both modulated by structural geometry and material properties of the optic nerve head. (ClinicalTrials.gov number, NCT01003639.).

Background Spectral domain optical coherence tomography (SD-OCT) reveals retina ganglion cell layer plus inner plexiform layer (GCL+IPL) and peripapillary nerve fiber layer (pRNFL) thinning in chronic optic nerve injury. At presentation, swelling of the pRNFL confounds evaluation of early axon loss. Objective We studied whether the GCL+IPL thins before the pRNFL, the trajectory of GCL+IPL loss and relationship to vision. Methods We prospectively evaluated 33 eyes (study) with new optic neuritis, using perimetry and SD-OCT with investigative 3-D layer segmentation and commercial 2-D segmentation to compute the GCL+IPL and pRNFL thickness. Results At presentation, GCL+IPL thickness (82.4±8.8 μm) did not differ from unaffected fellow eyes (81.2± 6.7 μm), via the 3-D method, while the 2-D method failed in 9% of study eyes. At one-two months, there was thinning of pRNFL in 10% and of GCL+IPL in 93% of study eyes. GCL+IPL reduction was greatest during the first two months. GCL+IPL thinning at one-two months correlated with GCL+IPL thinning at 6 months (r=0.84, p=0.01) and presentation visual acuity (r-0.48, p=0.006) and perimetric mean deviation (r=0.52, p=0.003). Conclusion GGL+IPL is an early biomarker of structural injury in optic neuritis as thinning develops within one-two months of onset, prior to pRNFL thinning.

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