Use of MultiColor imaging in the assessment of suspected papilledema in 20 consecutive children

Malem, Andrew; Salvo, Gabriella De; West, Stephanie

doi:10.1016/j.jaapos.2016.08.012

Cited by 14 publications

(13 citation statements)

References 9 publications

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“…Of the 6 studies included in this assessment, 2 evaluated OCT only 2,3 ; 1 assessed ultrasonography only 17 ; 1 evaluated multicolor cSLO only 18 ; 1 used OCT and ultrasonography 19 ; and 1 evaluated ultrasonography, OCT, autofluorescence, fluorescein angiography, and fundus photography. 4 The published studies were heterogeneous with regard to 3 main characteristics: (1) study design (retrospective or prospective); (2) participant characteristics, including diagnoses considered (ODD only or all pseudopapilledema; idiopathic intracranial hypertension only or all papilledema), diagnostic criteria, and severity of diagnoses (mild papilledema only vs. all grades of papilledema); and (3) image interpretation, particularly the number and masking of image readers.…”

Section: Published Resultsmentioning

confidence: 99%

“…Both were reported to have 100% positive percent agreement and more than 90% negative percent agreement with a clinical diagnosis of papilledema. 4,18 However, each method was evaluated by only 1 study that had a small number of participants, leading to wide CIs for both positive and negative percent agreement (range, 70%e100%). Additionally, the study of multicolor cSLO had other significant limitations, including only a single image reader with no masking reported and no reported followup of children with pseudopapilledema, which is important when a lumbar puncture is not performed to confirm stability of findings and reduce the possibility of misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, Malem et al 18 prospectively collected multicolor cSLO imaging data in 20 consecutive children (age range, 5e16 years) with suspected papilledema, of whom 11 were diagnosed with papilledema and 9 were diagnosed with pseudopapilledema. In this study, the underlying diagnosis in children with pseudopapilledema was ODD in 4 patients and anomalous, crowded, or hypermetropic discs in the remaining 5 patients.…”

Section: Review Of Studiesmentioning

confidence: 99%

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Imaging Methods for Differentiating Pediatric Papilledema from Pseudopapilledema

et al. 2020

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Purpose: To review the published literature on the accuracy of ophthalmic imaging methods to differentiate between papilledema and pseudopapilledema in children.Methods: Literature searches were conducted in January 2020 in the PubMed database for Englishlanguage studies with no date restrictions and in the Cochrane Library database without any restrictions. The combined searches yielded 354 abstracts, of which 17 were reviewed in full text. Six of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. All 6 included studies were rated as level III evidence.Results: Fluorescein angiography, a combination of 2 OCT protocols, and multicolor confocal scanning laser ophthalmoscopy (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) demonstrated the highest positive percent agreement (92%e100%; 95% confidence interval [CI], 69%e100%) and negative percent agreement (92%e100%; 95% CI, 70%e100%) with a clinical diagnosis of papilledema in children. However, results must be interpreted with caution owing to methodologic limitations, including a small sample size leading to wide CIs and an overall lack of data (there was only 1 study each for the above methods and protocols). Ultrasonographic measures showed either a high positive percent agreement (up to 95%) with low negative percent agreement (as low as 58%) or vice versa. Autofluorescence and fundus photography showed a lower positive (40%e60%) and negative (57%) percent agreement.Conclusions: Although several imaging methods demonstrated high positive and negative percent agreement with clinical diagnosis, no ophthalmic imaging method conclusively differentiated papilledema from pseudopapilledema in children because of the lack of high-quality evidence. Clinicians must continue to conduct thorough history-taking and examination and make judicious use of ancillary testing to determine which children warrant further workup for papilledema.

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Section: Published Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Review Of Studiesmentioning

confidence: 99%

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Imaging Methods for Differentiating Pediatric Papilledema from Pseudopapilledema

et al. 2020

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“…[ 3 ] MC image characteristics in papilledema have recently been reported. [ 4 ] The authors reported an elevated green ring surrounding a central shadow, blurring of disc margins, and obscuration of disc vasculature in ODE whereas lack of a ring shape, clear disc margins, well-delineated disc vasculature, and presence of a central shadow were observed in PODE.…”

Section: Discussionmentioning

confidence: 99%

Multicolor imaging in optic disc swelling

Thomas

Ghosh

Chowdhury

et al. 2017

Indian J Ophthalmol

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Differentiating optic disc edema (ODE) from pseudo optic disc edema (PODE) continues to pose a diagnostic dilemma. Current report highlights the role of multicolor imaging (MC) in differentiating ODE from PODE. Composite multicolor images of the disc in ODE show greenish hyperreflectance that extends beyond the optic disc margins with irregular blurry margins and obscured disc vasculature whereas PODE shows a greenish hyperreflectance with clear and distinct margins and well delineated disc vasculature. MC imaging adds to the present armamentarium of imaging modalities obviating needless neurological evaluation mandatory in a case of true disc edema.

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“…studied multicolor imaging in 20 pediatric patients with suspected papilledema and characterized the findings of true disc edema and pseudo disc edema in these cases. [ 6 ] Although it was a small sample size, they laid down some general points favoring papilledema on multicolor imaging.…”

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confidence: 99%