Optical imaging may not be reliable in detecting intracranial disease in children
A recent UK study suggests that optometrists and ophthalmologists must not rely on funduscopy and ocular imaging when assessing for possible intracranial disease in children. Moreover, history and basic neurological assessment are essential in diagnosis.
The investigators conducted a retrospective service evaluation/cohort study of children and young people <16 years who were examined for “suspicious discs” over a 7-month period in 2016 at a single eye care provider in London, UK.
A total of 61 children and young people underwent clinical assessment, ultrasound (US) scan and optical coherence tomography (OCT).
Three of the total number of cases were found to have intracranial pathology. There was only one patient who presented with optic nerve sheath dilatation (ONSD) on US and anterior bowing of Bruch’s membrane on OCT. Two cases showed increased nerve fibre layer thickness in at least one of three relevant sectors.
On the other hand, all three cases of intracranial pathology had significant points in their presenting or medical history.
There had been a sharp increase in referrals for evaluation of “suspicious optic discs” to eye clinics in the UK, asking ophthalmologists to reliably distinguish between true and pseudopapilloedema, according to the investigators.
“ONSD on ocular US is considered a reliable sign of true papilloedema, but this test is not widely available,” they said. “Recently, anterior bowing of Bruch’s membrane and increased retinal nerve fibre layer thickness on OCT have emerged as indicators of intracranial hypertension, and OCT is widely available.”