Use of Ocular Coherence Tomography in Children With Idiopathic Intracranial Hypertension—A Single-Center Experience

Background Idiopathic intracranial hypertension is a disorder characterized by elevated intracranial pressure without an identifiable etiology. Detection of papilledema may be challenging and leads to diagnostic uncertainty in evaluating a child for possible idiopathic intracranial hypertension. Ocular coherence tomography has the potential to add accuracy to the diagnosis of idiopathic intracranial hypertension. The goal of the present study was to determine if there was a relationship between severity of papilledema (as determined by direct ophthalmoscopy and confirmed by fundus photography) and measures of ocular coherence tomography in a pediatric population with idiopathic intracranial hypertension. Methods Thirteen pediatric patients were recruited prospectively after diagnosis of either definitive idiopathic intracranial hypertension (with papilledema) or possible idiopathic intracranial hypertension (without papilledema) at Children's Hospital of Michigan over a period of one year. Clinical data and results of initial ocular coherence tomography and visual field testing were collected and statistically analyzed. Results The Frisén scale of papilledema significantly correlated with average retinal nerve fiber layer thickness of each eye (r = 0.633, P = 0.02 in right eye and r = 0.868, P = 0.001 in left eye). The retinal nerve fiber layer thickness (mean ± SD) was significantly higher in the definitive group than in the possible group (189 ± 65 μm vs 104 ± 10 μm in right eye, 165 ± 42 μm vs 106 ± 9 μm in left eye, P < 0.01 in both eyes). Conclusions Ocular coherence tomography may be used as a supplementary method to aid in the reliable detection of papilledema in evaluating a child for idiopathic intracranial hypertension.