Optic Nerve Head Quantification in Idiopathic Intracranial Hypertension by Spectral Domain OCT

Abstract

ObjectiveTo evaluate 3D spectral domain optical coherence tomography (SDOCT) volume scans as a tool for quantification of optic nerve head (ONH) volume as a potential marker for treatment effectiveness and disease progression in idiopathic intracranial hypertension (IIH).Design and PatientsCross-sectional pilot trial comparing 19 IIH patients and controls matched for gender, age and body mass index. Each participant underwent SDOCT. A custom segmentation algorithm was developed to quantify ONH volume (ONHV) and height (ONHH) in 3D volume scans.ResultsWhereas peripapillary retinal nerve fiber layer thickness did not show differences between controls and IIH patients, the newly developed 3D parameters ONHV and ONHH were able to discriminate between controls, treated and untreated patients. Both ONHV and ONHH measures were related to levels of intracranial pressure (ICP).ConclusionOur findings suggest 3D ONH measures as assessed by SDOCT as potential diagnostic and progression markers in IIH and other disorders with increased ICP. SDOCT may promise a fast and easy diagnostic alternative to repeated lumbar punctures and could therefore ease monitoring of treatment or disease progression.

Improved diagnostic value of a TCD-based non-invasive ICP measurement method compared with the sonographic ONSD method for detecting elevated intracranial pressure

“…Compared with sonography, it is expected to have better accuracy and precision for optic nerve head volume measurements. 27 A systematic review and meta-analysis of the ONSD literature for detection of raised ICP has already been published by Dubourg et al 13 Data were extracted from electronic databases, with manual review of literature and conference proceedings from 1960 up until July 2010. Six studies were included in the meta-analysis, which included 231 patients.…”

Macular thickness measurements with frequency domain-OCT for quantification of axonal loss in chronic papilledema from pseudotumor cerebri syndrome

“…The development of technologies with which RNFL loss may be quantified, including OCT, scanning laser polarimetry, and confocal scanning laser ophthalmoscopy (CSLO), has been an important landmark in the diagnosis and management of a number of optic nerve diseases. Nevertheless, although these technologies have been used to diagnose and monitor optic disc edema in patients with raised intracranial hypertension, 15,16,18,[32][33][34][35][36][37][38] very few studies have attempted to quantify axonal loss in eyes with papilledema. Using CSLO and automated perimetry, Salgarello et al 34 evaluated eight patients with recently diagnosed papilledema and found a significant correlation between the amount of disc edema and VF loss.…”

“…Previous studies have indicated that OCTmeasured peripapillary RNFL thickness can be used to estimate the degree of papilledema and, consequently, to monitor treatment efficacy. [14][15][16][17][18] The presence of optic disc edema, however, artificially increases OCTmeasured RNFL thickness measurements and prevents accurate estimation of peripapillary axonal loss.…”

Noninvasive methods of detecting increased intracranial pressure

“…Kaufhold et al found that the OCT parameter optic nerve head volume (ONHV) was actually a better measure of ICP compared to RNFL thickness with AUC = 0.835 and AUC = 0.464, respectively [65]. The major flaw with their study, however, is that the ICP measurements were acquired from lumbar puncture (LP) opening pressures that were performed anytime within 0 to 24 months of the OCT scan, which in some cases, resulted in a large time gap between ICP and OCT measurements.…”