Severity Of Papilledema Research Articles

Classifying and quantifying changes in papilloedema using machine learning

BackgroundMachine learning (ML) can differentiate papilloedema from normal optic discs using fundus photos. Currently, papilloedema severity is assessed using the descriptive, ordinal Frisén scale. We hypothesise that ML can quantify...

Neurofilament light chain is elevated in patients with newly diagnosed idiopathic intracranial hypertension: A prospective study.

Idiopathic intracranial hypertension is a secondary headache disorder potentially causing visual loss. Neurofilament light chain is a candidate, prognostic biomarker, but further studies of neuronal biomarkers are needed. Our objective was to investigate neurofilament light chain in cerebrospinal fluid (cNfL) and plasma (pNfL), amyloid-beta 42 (Aβ-42), total-tau and phosphorylated-tau in cerebrospinal fluid in new-onset idiopathic intracranial hypertension. Prospective case-control study including new-onset idiopathic intracranial hypertension and age, sex and BMI matched controls. Biomarkers were compared between patients and controls and related to papilledema, visual fields and opening pressure. We included 37 patients and 35 controls. Patients had higher age-adjusted cNfL (1.4 vs. 0.6 pg/mL, p-adjusted < 0.001), pNfL (0.5 vs. 0.3 pg/mL, p-adjusted < 0.001) and total-tau/Aβ-42 (0.12 vs. 0.11, p-adjusted = 0.039). Significant, positive linear correlations were found between cNfL, pNfL, total-tau/Aβ-42 and opening pressure. Patients with severe papilledema had elevated cNfL compared to mild-moderate papilledema (median cNfL: 4.3 pg/mL (3.7) versus 1.0 pg/mL (1.4), p-adjusted = 0.009). cNFL was inversely associated with perimetric mean deviation (r = -0.47, p-adjusted < 0.001). cNfL, pNfL and total-tau/Aβ-42 were elevated in new-onset idiopathic intracranial hypertension. cNfL was associated with severity of papilledema and visual field defects at diagnosis. This indicates early axonal damage. Neurofilament light chain is a candidate biomarker for disease severity.

Role of Obstructive Sleep Apnea in Idiopathic Intracranial Hypertension (P10-4.004)

<h3>Objective:</h3> It remains unclear if the presence or treatment of Obstructive Sleep Apnea (OSA) influences the severity or natural history of Idiopathic Intracranial Hypertension (IIH). Hence, we did retrospective analysis to investigate the correlation of OSA in IIH with regards to opening pressure and papilledema grading. <h3>Background:</h3> Retrospective review of all IIH patients seen between 2018–2020 in Neuro-Ophthalmology clinic at University of Kentucky. <h3>Design/Methods:</h3> 80 IIH patients were categorized into three groups. Group 1 had IIH and OSA (19 patients), group 2 had IIH, but no OSA (21 patients) and Group 3 had IIH with suspected OSA, but sleep study not completed (40 patients). Comparison of these three groups on demographic and clinical outcomes were done. <h3>Results:</h3> Chi-square tests were used to compare the three groups on categorical outcomes. One-way analysis of variance (ANOVA) or Wilcoxon rank-sum tests were used to compare the groups on continuous outcomes that were either normally or non-normally distributed, respectively. Patients in group 1 were significantly older than group 2 (p = .013). Group 1 weighed significantly more than group 2 and 3 (p = .004 and p &lt; .001, respectively). Group 1 had a significantly higher BMI than those on group 3 (p = .024), but their difference compared to group 2 did not reach significance (p = .061). When comparing the three groups on clinical outcomes, overall, there were no significance differences in opening pressure, or papilledema grading for either eye. <h3>Conclusions:</h3> In our study, there was no significant difference between the association of OSA on IIH in terms of opening pressure and the severity of papilledema. Larger, prospective and controlled studies are required to further evaluate the relationship between OSA and IIH, and the effect of OSA treatment on the clinical course of IIH. <b>Disclosure:</b> Dr. Thandampallayam Ajjeya has nothing to disclose. Dr. Sudhakar has nothing to disclose.

Analysis of the Ophthalmological Manifestations of Diagnosed Cases of Idiopathic Intracranial Hypertension

Purpose: The purpose of this study was to explore the ophthalmological involvement in diagnosed cases of Idiopathic Intracranial Hypertension (IIH). Methods: Case series of all patients diagnosed with IIH from October 2012-2014 at the Neurology Department of Amrita Institute of Medical Sciences were prospectively analysed. Analysis was done for 35 patients who fulfilled the updated diagnostic criteria. Results: 80% of the patients were women with a mean age of 34.5. The chief complaint was a throbbing headache in 85.7%.The least common complaints were tinnitus, phonophobia, and photophobia, and one patient had right facial paresis. All patients had well-preserved visual acuity. 30 patients had normal extraocular movements, bilateral abduction restriction was found in 4 patients, and one was reported to be with third and sixth nerve paresis. 22 patients were in Obese class I. CSF opening pressure was elevated in all patients. 80% had Grade 1 papilledema. Enlargement of blindspot and peripheral constriction of fields were commonly seen. 41.4% of patients showed inferior RNFL thickness to be the most affected. A statistically significant association was found between the grade of papilloedema and the visual field. Conclusion: All our patients had papilledema clinically, with well-preserved central vision. Visual field defects were found, which showed a positive correlation with the severity of papilledema, showing the visual field to be a sensitive indicator. Contrary to expectation, an increase in RNFL on OCT was not a universal finding in our patients despite clinically observable papilledema.

Neurofilament light chain marks severity of papilledema in idiopathic intracranial hypertension

BackgroundNeurofilament light chain (NfL) reflects axonal damage in neurological disorders. It has recently been evaluated in idiopathic intracranial hypertension (IIH). A biomarker indicating the severity of optic nerve damage in IIH could support diagnostic accuracy and therapeutic decisions.MethodsWe retrospectively reviewed NfL concentrations in the cerebrospinal fluid (CSF) of 35 IIH patients and 12 healthy controls, who had received diagnostic workup for IIH in our clinic. The diagnosis of IIH was made according to the modified Friedman criteria for IIH and for IIH without papilledema Friedman DI et al Neurol 81:1159–1165 (2013) [1]. NfL in the CSF (CSF-NfL) was correlated with the severity of papilledema and with CSF opening pressure.ResultsCSF-NfL correlated with CSF opening pressure at the time of collection. In patients with IIH and moderate or severe papilledema, CSF-NfL was significantly increased compared to patients with mild or no papilledema. Healthy controls with raised intracranial pressure showed no relevant elevation of CSF-NfL.ConclusionCSF-NfL appears to correlate with the severity of papilledema in IIH and with CSF opening pressure and may therefore be a predictor of optic nerve damage in IIH patients.

Visual outcomes in idiopathic intracranial hypertension in children

ObjectiveThe purpose of this study was to report the clinical characteristics and long-term visual outcomes in a cohort of children with idiopathic intracranial hypertension (IIH). DesignRetrospective, observational cohort study. ParticipantsConsecutive children who met the diagnostic criteria for definite IIH at a tertiary care pediatric hospital between 2009 and 2020. MethodsThe charts of pediatric patients with IIH were reviewed. The main outcome measure was long-term visual impairment, with an analysis of clinical features by age and risk factors for a poor visual outcome. ResultsThere were 110 children (75 females) with IIH. At presentation, younger children with IIH were less likely to present with headaches (p = 0.01) and more likely to be asymptomatic (p = 0.03). There was a strong association with female sex (p < 0.001) and higher body mass index (p < 0.001) in adolescents in comparison to younger children. Of the 90 patients with long-term visual outcome data, only 8 (9%) had evidence of mild visual impairment (1 loss of visual acuity, 7 loss of visual field) with no cases of severe visual impairment. On risk factor analysis, the only variable associated with a poor visual outcome was greater severity of papilledema at diagnosis. ConclusionsIn this large series of pediatric IIH, the long-term visual outcomes were favourable, with evidence of mild visual impairment in less than 10% of patients.

Effect of changes in optic nerve elasticity on central retinal artery blood flow in patients with idiopathic intracranial hypertension

PurposeTo assess changes in central retinal artery (CRA) blood flow by orbital color-coded Doppler ultrasonography in patients with idiopathic intracranial hypertension (IIH) and their relation with optic nerve (ON) elasticity assessed by shear wave elastography (SWE). MethodsThis study was carried out on 68 eyes of patients diagnosed with IIH and 32 eyes of healthy controls. The severity of papilledema in IIH patients was sub-classified into mild and moderate/severe groups. Color-coded Doppler was used to measure peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (Vmean) and pulsatility index (PI) of the CRA. ResultsPSV, Vmean, and SWE were significantly higher in patients with IIH than in controls (p = 0.001). The optimal cut-off values of PSV and Vmean for differentiating IIH patients from controls were 11.25 and 6.75 cm/s with AUC 0.81 and 0.785 respectively. AUC was 0.92 and accuracy 91% for combined PSV, Vmean and SWE differentiation between IIH patients and controls. PSV, Vmean and SWE were significantly different between mild versus moderate/severe papilledema (p = 0.001). PSV and Vmean were correlated with papilledema (r = 0.790 and 0.722 respectively) and SWE (r = 0.818 and 0.761 respectively). ConclusionIIH is associated with decreased ON elasticity and reduced CRA blood flow. Individual and combined color-coded Doppler of the CRA and SWE help in diagnosis of IIH. CRA hemodynamic changes are correlated with papilledema severity and with the extent of biomechanical changes in the ON represented by SWE.

Accuracy of a Deep Learning System for Classification of Papilledema Severity on Ocular Fundus Photographs.

To evaluate the performance of a deep learning system (DLS) in classifying the severity of papilledema associated with increased intracranial pressure on standard retinal fundus photographs. A DLS was trained to automatically classify papilledema severity in 965 patients (2,103 mydriatic fundus photographs), representing a multiethnic cohort of patients with confirmed elevated intracranial pressure. Training was performed on 1,052 photographs with mild/moderate papilledema (MP) and 1,051 photographs with severe papilledema (SP) classified by a panel of experts. The performance of the DLS and that of 3 independent neuro-ophthalmologists were tested in 111 patients (214 photographs, 92 with MP and 122 with SP) by calculating the area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, and specificity. Kappa agreement scores between the DLS and each of the 3 graders and among the 3 graders were calculated. The DLS successfully discriminated between photographs of MP and SP, with an AUC of 0.93 (95% confidence interval [CI] 0.89-0.96) and an accuracy, sensitivity, and specificity of 87.9%, 91.8%, and 86.2%, respectively. This performance was comparable with that of the 3 neuro-ophthalmologists (84.1%, 91.8%, and 73.9%, p = 0.19, p = 1, p = 0.09, respectively). Misclassification by the DLS was mainly observed for moderate papilledema (Frisén grade 3). Agreement scores between the DLS and the neuro-ophthalmologists' evaluation was 0.62 (95% CI 0.57-0.68), whereas the intergrader agreement among the 3 neuro-ophthalmologists was 0.54 (95% CI 0.47-0.62). Our DLS accurately classified the severity of papilledema on an independent set of mydriatic fundus photographs, achieving a comparable performance with that of independent neuro-ophthalmologists. This study provides Class II evidence that a DLS using mydriatic retinal fundus photographs accurately classified the severity of papilledema associated in patients with a diagnosis of increased intracranial pressure.

Combined accuracy of optic nerve sheath diameter, strain ratio, and shear wave elastography of the optic nerve in patients with idiopathic intracranial hypertension.

PurposeThis study assessed the combined accuracy of optic nerve sheath diameter (ONSD), strain ratio (SR), and shear wave elastography (SWE) of the optic nerve (ON) in patients with idiopathic intracranial hypertension (IIH).MethodsThis prospective study was carried out on both ONs of 34 consecutive patients diagnosed with IIH and 16 age- and sex-matched healthy volunteers. All of the study participants were women. The ONSD, SR, and SWE of the ON were measured. The severity of papilledema of IIH patients was sub-classified into mild papilledema and moderate/severe papilledema.ResultsThe mean ONSD (5.6±1.1 mm), SR (0.7±0.1), and SWE (30.1±16.7 kPa) of the IIH patients were significantly different (P=0.001) from the ONSD (4.1±0.5 mm), SR (0.9±0.1), and SWE (8.2±3.4 kPa) of controls. The cutoff values of ONSD, SR, and SWE of the ON for differentiating IIH patients from controls were 5.45 mm, 0.8, and 10.3 kPa with areas under the curve (AUCs) of 0.91, 0.86, and 0.96 and accuracy values of 91%, 81%, and 93%, respectively. Combined SWE and ONSD and combined SWE, ONSD, and SR for differentiating IIH patients from controls revealed AUCs of 0.98 and 0.99 and accuracy values of 96% and 96%, respectively. ONSD, SR, and SWE showed significant differences between mild and moderate/severe papilledema (P=0.001). Papilledema was correlated with SWE (r=0.8, P=0.001), ONSD (r=0.4, P=0.001), and SR (r=-0.4, P=0.001).ConclusionThe combination of ONSD, SR, and SWE may be helpful for diagnosing IIH, and a good indicator of the degree of papilledema.

A patient with papilloedema

A 45-year-old Jordanian man had 2 weeks of gradual onset headache, neck stiffness and loss of vision. The headache was occipital with pulsatile tinnitus and exacerbated by coughing, sneezing and...

Optic Nerve Angle in Idiopathic Intracranial Hypertension.

The tortuosity of the optic nerve can be quantified radiologically by measuring the angle of optic nerve deformation (the "optic nerve angle" [ONA]). In patients with idiopathic intracranial hypertension (IIH), lowering the intracranial pressure (ICP) to a normal range by lumbar puncture leads to straightening of the optic nerve and an increase in the measured sagittal ONA on MRI. It is uncertain whether there is any correlation between ONA and cerebrospinal fluid (CSF) opening pressure or visual function. Retrospective study of patients with and without IIH who had MRI of the brain followed by lumbar puncture with CSF opening pressure within 24 hours of MRI. Before LP and within 24 hours of MRI of the brain, all patients with IIH had neuro-ophthalmologic assessment including visual acuity, Humphrey Visual Field (HVF), and fundus photography. Sagittal ONA was measured on multiplanar T2-SPACE images on a DICOM viewer. Papilledema on the fundus photographs was graded using the Frisén scale. Fifty-four patients with IIH and 30 unmatched controls were included. The IIH group was 6.3 years younger (95% CI 2.4-10.3, P = 0.002), had 8.7 kg/m2 higher body mass index (4.9-12.5, P < 0.001), and 26.3% more women (P = 0.011) compared with controls. In both eyes, the ONA was significantly smaller in patients with IIH by 12° compared with controls (7°-17°, P < 0.00001). In the IIH group, no correlation between ONA and the CSF opening pressure was present in either eye (right eye r = 0.19, P = 0.15; left eye r = 0.18, P = 0.19) The ONA did not correlate with logarithm of the minimum angle of resolution visual acuity (right eye r = 0.26, P = 0.063; left eye r = 0.15, P = 0.27), HVF mean deviation (right eye r = 0.0059, P = 0.97; left eye r = -0.069, P = 0.63), or Frisén grade (Spearman's rho right eye 0.058, P = 0.67; left eye 0.14, P = 0.30). The ONA is significantly smaller in patients with IIH compared to controls, but does not correlate with CSF opening pressure, severity of papilledema, or visual function. The ONA may be useful in identifying patients with raised ICP, but not necessarily those with a poor visual prognosis.

Reliability of optic disc edema area in estimating the severity of papilledema in patients with POEMS syndrome

BackgroundPolyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome is a rare paraneoplastic syndrome involving multisystem. Optic disc edema (ODE) is the most common ocular manifestation in patients with POEMS syndrome and serves as an independent prognostic factor. However, parameters previously used to estimate its severity were inconvenient and costly. This study was designed to bring forward a novel and practical parameter, optic disc edema area, to evaluate ODE in patients with this disease and applied it to assess effectiveness of lenalidomide combined with dexamethasone in respect of ODE.ResultsForty-one treatment-naive patients with POEMS syndrome were enrolled in this single-center prospective study and treated with lenalidomide combined with dexamethasone. They received ocular examination to determine optic disc edema (ODE) area and other optic manifestations. Meanwhile, serum VEGF was measured before and after treatment. Among 41 enrolled patients, 38 received complete ocular examinations, and 25 of which had ODE at initial visit. Binocular mean ODE area of patients with ODE was significantly related to ODE grade (r = 0.620, p = 0.003) and peripapillary retinal thickness (r = 0.760, p < 0.001) before treatment. Serum VEGF was significantly higher in patients with ODE than their counterparts (p = 0.025) and positively correlated with binocular mean ODE area (r = 0.460, p = 0.036). After treatment, ODE area, along with serum VEGF, decreased markedly (p < 0.001).ConclusionODE area was a reliable index to evaluate ODE severity and could precisely reflect ODE improvement through systemic treatment. Additionally, it was related to serum VEGF, a key factor in disease pathogenesis, suggesting its potential as an indicator of the overall severity of this disease.Trial registrationClinicaltrials, NCT01816620. Registered March 222,013.

Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension.

To determine whether optic disc hemorrhages (ODH) and cotton wool spots (CWS) at presentation are associated with worse visual outcomes in pediatric patients with idiopathic intracranial hypertension (IIH). Retrospective institutional review of 100 eyes of 50 consecutive pediatric IIH patients (aged 16 years or less) who had baseline optic disc photographs before or within 30 days of their diagnostic lumbar puncture and initiation of medical treatment. Optic disc photographs were independently graded by three ophthalmologists in a standardized manner. Visual function was assessed using visual acuity (VA) and visual field grade (VFG). At least one ODH was found in 41% of eyes, at least one CWS was found in 27% of eyes, and 20% of eyes had both ODH and CWS. At presentation, Frisén grade was associated with the presence of CWS (p = 0.013) and showed no association with ODH (p = 0.060). When controlling for Frisén grade, ODH and CWS were not associated with worse VA or VFG at final follow-up. Severe ODH were associated with worse VA and VFG at presentation (p < 0.03), but not at final follow-up. Severe CWS at presentation was strongly associated with a worse Humphrey mean deviation of 5.0 dB (95% confidence interval 1.6-8.3) at final follow-up (p = 0.002). When controlling for the severity of papilledema, ODH do not provide any additional prognostic value in pediatric IIH patients. Frisén grade and severe CWS at presentation were independently associated with worse visual outcomes at the final follow-up.

The relationship between optic canal size and severity of papilledema in children with intracranial hypertension

Bony optic canal size has been proposed to affect the dynamics of cerebrospinal fluid pressure from the cranium to the subarachnoid space within the optic nerve sheath. This may contribute to variations in clinically observed optic nerve edema (ONE) in patients with intracranial hypertension (IH). The purpose of this study was to determine if a relationship exists between optic canal size and the grade of clinically observed ONE in pediatric IH patients.

Evaluation of optic canal anatomy and symmetry using CT

ObjectiveWe aim to describe the anatomy and symmetry patterns of the optic canal in patients having undergone maxillofacial CT imaging.MethodsIn this retrospective chart review, we included all patients who received...

Lack of Relationship between Central Corneal Thickness and Papilloedema in Idiopathic Intracranial Hypertension

ABSTRACTTranslaminar pressure gradient abnormalities have been implicated in the pathogenesis and progression of glaucoma. A “reversed” translaminar pressure gradient may be related to papilloedema severity in idiopathic intracranial hypertension. Central corneal thickness is related to intraocular pressure measurements and, by extension, to translaminar pressure gradients. We evaluated if central corneal thickness could be a marker of worse papilloedema due to altered translaminar pressure gradients in patients with idiopathic intracranial hypertension. We found that central corneal thickness was not related to the severity of papilloedema in idiopathic intracranial hypertension.

The use of optical coherence tomography in neuro-ophthalmology

In the last decade, with the advances of optical coherence tomography (OCT) technology, different imaging protocols and analysis algorithms have been introduced to maximize the potential of this diagnostic tool in the evaluation of different eye diseases. This review aims to provide an update on these additional features, with respect to the management of a diverse range of neuro-ophthalmologic conditions. Macular ganglion cell complex (mGCC) analysis has been shown to be superior to peripapillary retinal nerve fiber layer (pRNFL) analysis in certain settings, such as differentiating Leber's hereditary optic neuropathy from functional visual loss; monitoring neurodegenerative diseases or multiple sclerosis; and predicting visual loss in nonarteritic ischemic optic neuropathy. mGCC analysis also demonstrates high correlation with perimetry and might serve as an early structural indicator of irreversible neuronal loss. Compared to pRNFL, retinal thickness analysis of the optic nerve head demonstrates better correlation with the severity of papilledema, thus enabling its possible application in detecting raised intracranial pressure, especially in the pediatric group. Upcoming research on emerging OCT technologies including OCT-angiography, enhanced depth imaging, retinal single-layer analysis and portable systems will hopefully further enhance the utility of OCT in the field. It is crucial for neuro-ophthalmologists to be updated and familiar with these newer OCT imaging protocols and to make appropriate choices for different clinical scenarios, in order to optimize the diagnostic sensitivity and specificity.

Efficacy and safety of optic nerve sheath fenestration in patients with raised intracranial pressure.

Objective:To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration (ONSF) in patients with raised intracranial pressure (ICP).Methods:This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015. Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure.Results:Thirteen (72.22%) patients underwent ONSF bilaterally, while five (27.78%) underwent unilateral ONSF. Best corrected visual acuity (BCVA) improved in 24 (77.4%), remained stable in four (12.9%) and deteriorated in three (9.7%) patients. Papilledema improved in 27 (87.1%) while remained stable in four (12.9%) according to Frisénscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant (p<0.001). There was significant negative correlation (r= -0.434, p=.017) between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia.Conclusion:ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema.

Retrospective analysis of translaminar, demographic, and physiologic parameters in relation to papilledema severity

ObjectiveSome case reports suggest that the translaminar pressure difference is important in cases of papilledema. The purpose of this study was to determine ocular, physiologic, and demographic factors associated with papilledema severity. DesignRetrospective, blinded study. ParticipantsPatients who had undergone a diagnostic lumbar puncture and had a diagnosis of papilledema in conjunction with idiopathic intracranial hypertension between 2004 and 2012 were included in the study. One-hundred and fifty-one patients were identified in initial screening. Sixty of 151 patients met all inclusion criteria, and 120 eyes were eligible for investigation. MethodsA retrospective review of optic nerve photographs by 2 masked experts was used to grade papilledema severity using the Modified Frisén Scale (MFS). Patients with any systemic or neurologic disease that could affect cerebrospinal fluid pressure (CSFP) were excluded. Patients on acetazolamide were excluded. Assessments within 1 MFS grade were averaged and correlated to intraocular pressure, CSFP, translaminar pressure differential, MFS, age, weight, height, and systolic and diastolic blood pressure. ResultsIn univariate and multivariate type 3 generalized estimating equation analyses, only age (Z = −2.70; p < 0.01) and sex (Z = 2.81; p < 0.0001) were significantly correlated with MFS. ConclusionsPapilledema severity decreased with advancing age and was higher for female sex. We found no association between severity of papilledema and CSFP, intraocular pressure, blood pressure, or any other physiologic parameter. Factors other than the translaminar pressure differential may be important in determining the severity of papilledema.

Update on the evaluation of pediatric idiopathic intracranial hypertension.

Papilledema associated with idiopathic intracranial hypertension (IIH) may result in irreversible, progressive visual loss. The development of tools for the evaluation of pediatric patients with IIH is particularly relevant as many patients may not be able to comply with the detailed clinical evaluation utilized in adults for the treatment and management of this disease. The purpose of this review is to summarize relevant articles on the diagnostic tools used in evaluation and management of pediatric IIH. Studies suggest that characteristic pediatric IIH MRI findings include empty sella turcica, decreased pituitary gland size, optic nerve tortuosity, perioptic subarachnoid space enlargement, posterior globe flattering, and intraocular protrusion of the optic nerve head. On optical coherence tomography (OCT), increased retinal nerve fiber layer and macular thickness may be observed in children with IIH compared with controls. The retinal nerve fiber layer thickness seems to coincide with the severity of papilledema and may be more sensitive than funduscopy for detecting optic nerve head elevation. Research on ultrasound of the optic nerve shows increased size of the optic nerve sheath diameter in pediatric IIH patients, and this may correlate with increased opening pressure on lumbar puncture. There appears to be characteristic findings on MRI, OCT, and ultrasound studies in pediatric IIH patients. Although ultrasound is rarely used for monitoring these patients nowadays, MRI and OCT can be useful in the evaluation and management of these individuals.