Differentiating Papilledema from Pseudopapilledema Using RNFL OCT

The difficulty in distinguishing optic discs with true pathology (i.e papilledema) from pseudopapilledema is a frequently encountered one in neuro-ophthalmology clinics. Observation of optic discs alone may over- or under-diagnose papilledema. The addition of RNFL OCT provides quantitative information on RNFL thickness and can identify other causes of elevated optic discs such as drusen. We have instituted a formal protocol for all cases of anomalous optic discs. Baseline disc photos and RNFL OCT are obtained. Patients return to clinic at 4-6 weeks with repeat imaging and measurements. If stable, diagnosis of anomalous optic discs is made. If there is any change in RNFL thickness and/or disc appearance, presumed papilledema is diagnosed and further work-up is obtained.