OCT in Papilledema: What Am I Missing?

To the experienced neuro-ophthalmologist, the most relevant question is: Do we really need an imaging modality such as optical coherence tomography (OCT) to evaluate papilledema? Most clinicians feel that careful ophthalmoscopy or digital fundus photography is more than adequate for diagnosing the presence of papilledema, determining its severity and deciding on whether it has changed over time. After all, this is what has been done for years, so why do we need something more? The need for something more derives from a number of studies, including the multicenter NIH-sponsored Idiopathic Intracranial Pressure Treatment Trial (IIHTT).