Pilot study: Papillary thickness in optic nerve head edema

Fort Lauderdale, FL-A spectral-domain optical coherence tomography (SD-OCT) star-pattern scan (SPS) acquisition protocol may be a more accurate and sensitive baseline measure for the diagnosis and follow-up of papilledema than presently used methods, according to the results of a pilot study, said Mazen Y. Choulakian, MD.

Eight eyes from four newly diagnosed patients with papilledema secondary to idiopathic intracranial hypertension (IIH) were compared with 8 eyes from healthy controls using SD-OCT SPS and peripapillary total retinal thickness (PRT). PRT and PT were both evaluated with SD-OCT, and a macular cube acquisition protocol centered on the optic disc was used to evaluate PRT.

“Papillary thickness measured with SD-OCT SPS is significantly higher than PRT when compared [with] the control group,” said Dr. Choulakian, Ophthalmology, Centre Hospitalier Universitaire de Sherbrooke, QC, Canada. “We speculate that papillary thickness is a more sensitive sign to monitor disease progression and response to treatment than PRT since it represents more accurately the clinical evaluation of papilledema.”

The SPS protocol may allow for a more precise follow up of patients who are under treatment for IHH, may develop a recurrence, or have chronic papilledema and are at risk for hemorrhages.

“I think it could be a really innovative, interesting tool,” said Dr. Choulakian, adding that the SD-OCT SPS protocol would be practical in the clinic.

The findings from the small pilot study must be compared with other protocols. If the results are borne out, the new protocol may become widely adopted.

“I think OCT to papilledema will probably become what OCT is to macular edema today, a standard of care,” Dr. Choulakian concluded.

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