Abstract
PurposeTo assess the usefulness of spectral-domain optical coherence tomography (SD-OCT) peripapillary retinal nerve fiber layer (RNFL) thickness measurement in discriminating early phase optic disc edema (ODE) from pseudoedema (PODE).MethodsHospital-based, multicenter, cross-sectional study involving external patients referred for recent identification of “presumed ODE”. Patients underwent SD-OCT optic nerve head (ONH) RNFL thickness measurement at their first evaluation. In 155 of these, the causative etiology was subsequently ascertained and the respective eyes (one per patient) were assigned to the ODE (95 eyes) or PODE (60 eyes) group. Admission SD-OCT data were retrieved and used for the analysis. ROC curve analysis was used to calculate specificity, sensitivity and predictive value (PV) of the RNFL values.ResultsThe PODE group was significantly younger than the ODE group (p = 0.007). The average and any single-quadrant RNFL thickness was significantly higher in the ODE group compared with the PODE and control groups. The average and the inferior quadrant thicknesses tested the most powerful parameters to differentiate ODE from PODE. A cutoff value of ≥ 110 μm for the average area, or of ≥ 150 μm for the inferior quadrant was associated with maximal sensitivity and specificity with positive PV greater than 80%.ConclusionsThe SD-OCT evaluation of the peripapillary RNFL achieved good specificity, sensitivity and positive PV in discriminating between ODE and PODE. Despite the correct differential diagnosis between these categories still relies on a careful medical history taking and other ancillary testing, we proved the usefulness of SD-OCT RNFL measurement in supporting the diagnostic process.
Highlights
Optic disc edema (ODE) encompasses various findings related to the elevation of the optic nerve head (ONH) in relation to the retinal plane
The PODE group was significantly younger than the ODE group (p = 0.007)
The average and any single-quadrant retinal nerve fiber layer (RNFL) thickness was significantly higher in the ODE group compared with the PODE and control groups
Summary
Optic disc edema (ODE) encompasses various findings related to the elevation of the optic nerve head (ONH) in relation to the retinal plane. The presence of mono- or bilateral edema of the optic disc usually represents a very serious evidence because of its potential as an indicator of severe neuro-ophthalmological disease, that may be visual and, at times, life-threatening. Considering current first-line examinations, the effectiveness of funduscopy is markedly operator-dependent and there is no objective metric for indexing severity. This may explain the high misdiagnosis percentage (about 40% in adults, up to 76% in children at their first fundus examination), where misdiagnosis usually occurs when funduscopy is not performed by a skilled physician [1,2,3]. FA, is somewhat invasive and not always viable in pediatric patients
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