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Advantages and Pitfalls of the Use of Optical Coherence Tomography for Papilledema

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A Publisher Correction to this article was published on 08 February 2024

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Abstract

Purpose of Review

Papilledema refers to optic disc swelling caused by raised intracranial pressure. This syndrome arises from numerous potential causes, which may pose varying degrees of threat to patients. Manifestations of papilledema range from mild to severe, and early diagnosis is important to prevent vision loss and other deleterious outcomes. The purpose of this review is to highlight the role of optical coherence tomography (OCT) in the diagnosis and management of syndromes of raised intracranial pressure associated with papilledema.

Recent Findings

Ophthalmoscopy is an unreliable skill for many clinicians. Optical coherence tomography is a non-invasive ocular imaging technique which may fill a current care gap, by facilitating detection of papilledema for those who cannot perform a detailed fundus examination. Optical coherence tomography may help confirm the presence of papilledema, by detecting subclinical peripapillary retinal nerve fiber layer (pRNFL) thickening that might otherwise be missed with ophthalmoscopy. Enhanced depth imaging (EDI) and swept source OCT techniques may identify optic disc drusen as cause of pseudo-papilledema. Macular ganglion cell inner plexiform layer (mGCIPL) values may provide early signs of neuroaxonal injury in patients with papilledema and inform management for patients with syndromes of raised intracranial pressure.

Summary

There are well-established advantages and disadvantages of OCT that need to be fully understood to best utilize this method for the detection of papilledema. Overall, OCT may complement other existing tools by facilitating detection of papilledema and tracking response to therapies.  Moving forward, OCT findings may be included in deep learning models to diagnose papilledema.

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Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada

    Fiona Costello

  2. Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada

    Fiona Costello

  3. Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark

    Steffen Hamann

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  1. Fiona Costello
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Contributions

F.C. wrote the main manuscript with input from S.H. The figures were prepared by S.H. All authors reviewed the manuscript.

Corresponding author

Correspondence to Fiona Costello.

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The authors declare no competing interests.

Conflict of Interest

Dr. Costello has received speaker fees or advisory board honoraria from Alexion, Novartis, Horizon Therapeutics, Sanofi, Vindico, and Healio Live.

Dr. Hamann has nothing to disclose.

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Costello, F., Hamann, S. Advantages and Pitfalls of the Use of Optical Coherence Tomography for Papilledema. Curr Neurol Neurosci Rep 24, 55–64 (2024). https://doi.org/10.1007/s11910-023-01327-6

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