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The sensitivity and specificity of retinal and choroidal folds to distinguish between mild papilloedema and pseudopapilledema

Abstract

Purpose

To determine if the presence or absence of retinal and choroidal folds on SD-OCT imaging can distinguish between mild papilloedema and pseudopapilledema.

Design

Cross-sectional cohort study

Methods

Subjects with optic disc elevation (Frisen grades 1 and 2 only) were eligible to be enrolled prospectively. Pseudopapilledema was defined as a lack of change in optic disc appearance between two visits <6 months apart, and papilloedema was defined as change in optic disc appearance between two visits <6 months apart determined by review of fundus photographs by a masked neuro-ophthalmologist. Three masked neuro-ophthalmologists independently reviewed en face and axial optical coherence tomography (OCT) images of the optic nerve of the study subjects for the presence or absence of retinal and choroidal folds. Concordance was determined when there was agreement between at least 2 of the 3 observers.

Results

Forty-five subjects (78 eyes) met inclusion criteria. There were 32 eyes with papilloedema and 46 eyes with pseudopapilledema. Choroidal and/or retinal folds were detected in 38% of eyes (12/32) with papilloedema and 19.6% of eyes (9/46) with pseudopapilledema. Post-hoc analyses eliminated six questionable cases of pseudopapilledema that had ancillary testing suggestive of elevated intracranial pressure and resulted in one remaining eye (2%) with more certain pseudopapilledema that was found to have folds. En face OCT imaging was more sensitive (71%) in detection of folds than axial OCT imaging (57%).

Conclusions

Choroidal and/or retinal folds on OCT are commonly observed in patients with mild papilloedema and are uncommon in those with pseudopapilledema. The presence of folds on OCT in patients presenting with disc elevation suggests papilloedema.

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Fig. 1: Examples of SD-OCT images of a mildly elevated optic nerve.
Fig. 2: SD-OCT images from the one pseudopapilledema patient with folds.

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Authors and Affiliations

Authors

Contributions

SNR was responsible for designing the review protocol, writing the protocol and report, extracting and analyzing data, interpreting results, and writing the paper. RAA was responsible for reviewing images in a masked fashion, interpreting results, and editing the paper. JCB was responsible for designing the review protocol and editing the paper. IJ was responsible for designing the review protocol and editing the paper. CA was responsible for designing the review protocol and editing the paper. MP was responsible for analyzing data and producing statistics for the paper. AAK was responsible for designing the review protocol and editing the paper. GTL was responsible for designing the review protocol, interpreting results and editing the paper. KSS was responsible for designing the review protocol, interpreting results, and editing the paper. AGR was responsible for designing the review protocol, interpreting results, and editing the paper. RHK was responsible for designing the review protocol, interpreting results, and editing the paper. PAS was responsible for designing the review protocol, interpreting results, and editing the paper. MT was responsible for designing the review protocol, reviewing images in a masked fashion, writing the protocol and report, extracting and analyzing data, interpreting results, and editing the paper.

Corresponding author

Correspondence to Sara N. Reggie.

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Conflict of interest

Author RHK receives an unrestricted grant for OCT research funded by Heidelberg Engineering, although this was not utilized in his involvement of this manuscript. No other authors have any conflicts of interest related to this study.

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Reggie, S.N., Avery, R.A., Bavinger, J.C. et al. The sensitivity and specificity of retinal and choroidal folds to distinguish between mild papilloedema and pseudopapilledema. Eye 35, 3131–3136 (2021). https://doi.org/10.1038/s41433-020-01368-y

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  • DOI: https://doi.org/10.1038/s41433-020-01368-y

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