Utility of Ultrasound and Optical Coherence Tomography in Differentiating Between Papilledema and Pseudopapilledema in Children

Farazdaghi, Marybeth K; Trimboli-Heidler, Carmelina; Liu, Grant T.; Garcia, Arielle; Ying, Gui-shuang; Avery, Robert A.

doi:10.1097/wno.0000000000001248

Cited by 15 publications

(9 citation statements)

References 39 publications

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“…10 A recent study by Farazdaghi et al concluded that optic nerve sheath widening > 4.5 mm on USG has the best sensitivity and speci city for diagnosing papilloedema. 21 The results of our study and Farazdaghi's indicate a better support from USG than SDOCT in ruling out true papilledema in patients suspected to have ONHD on clinical evaluation. We found PHOMS to be more frequently associated with pseudopapilledema, a recent paper by et al also states that PHOMS are seen in 98.4% of children with pseudopapilledema.…”

Section: Discussionsupporting

confidence: 54%

Understanding Pseudopapilledema on Spectral Domain Optical Coherence Tomography

Pamu

Varghese

2022

Preprint

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Objective: Optic nerve head drusen (ONHD), peripapillary hyperreflective ovoid mass like structures (PHOMS) and horizontal hyperreflective lines (HHL) are commonly seen in eyes with pseudopapilledema on spectral domain optical coherence tomography (SDOCT) .The objective of this study is to assess the frequency of ONHD, PHOMS and HHL on spectral domain OCT in the eyes diagnosed to have pseudopapilledema on clinical evaluation.Methods: Retrospective case control study of patients with pseudopapilledema and SD OCT imaging of the optic nerve head (n=48 eyes) and controls (n=20 eyes) .Volumetric OCT scans through the optic nerve head were studied to diagnose ONHD, HHL and PHOMS. The mean retinal nerve fiber layer thickness (RNFL) of eyes with ONHD was compared in eyes with deep drusens(DD) and both deep and superficial drusens(DSD). One proportion z test was used to find the difference in proportions.Results: 48 eyes of 27 subjects were studied. ONHD as described by the optic disc drusen study consortium was noted in 19 eyes (39.48%), p value-0.032 ,PHOMS in 31 eyes (64.6%),p value 0.043,HL in 19 eyes (39.48%) ,p value-0.032. Mean RNFL thickness were significantly lower in inferior and temporal quadrants in eyes with both DSD when compared to the eyes with DD only. (p value.008)Conclusions: PHOMS are more frequently seen than ONHD and HHL in eyes with pseudopapilledema. Absence of ONHD on SD OCT doesn’t preclude the diagnosis of pseudopapilledema.

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Section: Discussionsupporting

confidence: 54%

Understanding Pseudopapilledema on Spectral Domain Optical Coherence Tomography

Pamu

Varghese

2022

Preprint

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“…However, our study observed no change in the NCD before and after HD, suggesting that the rapid changes occurring within a few hours due to HD did not significantly impact the relatively static position of the BMO. PVH can increase in cases of papilledema due to elevated CSF pressure 44 , 45 . A study examining OCT measurements of papilledema in patients with idiopathic intracranial hypertension found correlations with ICP, particularly with maximum height (similar to PVH) 46 , suggesting that PVH measurements in our study could serve as indirect indicators of ICP.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis-induced positional changes in lamina cribrosa

Kim,

Jeong,

Shin

et al. 2024

Sci Rep

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This study is aimed to investigate the effect of hemodialysis (HD) on the lamina cribrosa (LC) of the optic nerve head (ONH) using swept-source optical coherence tomography (SS-OCT) and other ophthalmological parameters in patients with end-stage kidney disease (ESKD). This prospective observational study included 29 patients who underwent HD for ESKD. ONH parameters including neural canal diameter (NCD), peripapillary vertical height (PVH), and anterior LC depth (LCD), were assessed using SS-OCT. Changes in the ONH parameters before and after HD were statistically analysed. Correlations between changes in the LCD and other ocular and systemic measurements were identified using Pearson’s correlation analyses. The mean anterior LCD significantly decreased from 441.6 ± 139.8 μm before HD to 413.5 ± 141.7 μm after HD (P = 0.001). Mean NCD and PVH did not show significant changes after HD (P = 0.841 and P = 0.574, respectively). A significant correlation was found between changes in the anterior LCD and the mean ocular perfusion pressure (r = 0.397, P = 0.036). We observed a significant decrease in anterior LCD after HD. Our study suggests that HD can influence the ONH, especially in the LC.

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“…4 While OCT is gaining ground due to its high resolution and availability, [4][5][6] many clinicians continue to rely on earlier technologies, including B-scan ultrasonography, fundus autofluorescence imaging, or fluorescein angiography. [7][8][9][10][11] In short, identification of ODD often remains a clinical challenge, which can benefit from new technologies for improved discrimination from sight-threatening or life-threatening papilledema.…”

Section: Discussionmentioning

confidence: 99%

Discriminating Between Papilledema and Optic Disc Drusen Using 3D Structural Analysis of the Optic Nerve Head

et al. 2023

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Background and Objectives:The distinction of papilledema from other optic nerve head (ONH) lesions mimicking papilledema, such as optic disc drusen (ODD), can be difficult in clinical practice. We aimed: (1) To develop a deep learning algorithm to automatically identify major structures of the optic nerve head (ONH) in three dimensional (3D) optical coherence tomography (OCT) scans; (2) To exploit such information to robustly differentiate among ODD, papilledema, and healthy ONHs.Methods:This was a cross-sectional comparative study of patients from three sites (Singapore, Denmark, Australia) with confirmed ODD, papilledema due to raised intracranial pressure, and healthy controls. Raster scans of the ONH were acquired using OCT imaging, then processed to improve deep-tissue visibility. First, a deep learning algorithm was developed to identify major ONH tissues, and ODD regions. The performance of our algorithm was assessed using the Dice coefficient. Second, a classification algorithm (random forest) was designed to perform 3-class classifications (1: ODD, 2: papilledema, 3: healthy) strictly from their drusen and prelamina swelling scores (calculated from the segmentations). To assess performance, we reported the area under the receiver operating characteristic curve (AUC) for each class.Results:A total of 241 patients (256 imaged ONHs, including 105 ODD, 51 papilledema, and 100 healthy ONHs) were retrospectively included in this study. Using OCT images of the ONH, our segmentation algorithm was able to isolate neural and connective tissues, and ODD regions/conglomerates whenever present. This was confirmed by an averaged Dice coefficient of 0.93±0.03 on the test set, corresponding to good segmentation performance. Classification was achieved with high AUCs, i.e. 0.99±0.001 for the detection of ODD, 0.99±0.005 for the detection of papilledema, and 0.98±0.01 for the detection of healthy ONHs.Discussion:Our AI approach can discriminate ODD from papilledema, strictly using a single OCT scan of the ONH. Our classification performance was very good in the studied population, with the caveat that validation in a much larger population is warranted. Our approach may have the potential to establish OCT imaging as one of the mainstays of diagnostic imaging for ONH disorders in neuro-ophthalmology, in addition to fundus photography.

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Utility of Ultrasound and Optical Coherence Tomography in Differentiating Between Papilledema and Pseudopapilledema in Children

Cited by 15 publications

References 39 publications

Understanding Pseudopapilledema on Spectral Domain Optical Coherence Tomography

Understanding Pseudopapilledema on Spectral Domain Optical Coherence Tomography

Hemodialysis-induced positional changes in lamina cribrosa

Discriminating Between Papilledema and Optic Disc Drusen Using 3D Structural Analysis of the Optic Nerve Head

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