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Peripapillary hyperreflective ovoid masslike structures in a pediatric population referred for suspected papilledema
Elizabeth L Eshun1, J Cole Gwin1, Lauren C Ditta2
1University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Peripapillary hyperreflective ovoid masslike structures (PHOMS) are common in children and can mimic papilledema. These bilateral structures may resolve with elevated intracranial pressure and show thicker retinal nerve fiber layers when papilledema is present.
Area of Science:
- Ophthalmology
- Neuro-ophthalmology
- Pediatric Optometry
Background:
- Peripapillary hyperreflective ovoid masslike structures (PHOMS) are increasingly recognized as a cause of pseudopapilledema in pediatric patients.
- The clinical presentation of PHOMS can be mistaken for papilledema, necessitating accurate diagnosis.
Purpose of the Study:
- To investigate the characteristics and clinical course of pediatric patients diagnosed with PHOMS.
- To differentiate PHOMS from true papilledema and other optic disc anomalies.
Main Methods:
- Retrospective review of medical records for patients ≤18 years with PHOMS confirmed by optical coherence tomography (OCT) between 2017 and 2021.
- Analysis of clinical presentation, referral sources, symptoms, bilaterality, association with intracranial pressure, neuroimaging findings, and retinal nerve fiber layer (RNFL) thickness.
Main Results:
- 47 pediatric patients (35 females, median age 12.7 years) were included; 51% were referred by optometrists.
- PHOMS were bilateral in all patients and 360° around the optic disc in 61% of eyes.
- Patients with elevated intracranial pressure showed a reduction in PHOMS size (P=0.0133). RNFL was thicker in patients with concomitant papilledema (P=0.002) or PHOMS alone (P=0.00051) compared to optic disc drusen.
Conclusions:
- Pediatric patients with PHOMS often present with bilateral findings and may be referred due to suspicion of papilledema.
- PHOMS can occur concurrently with other ophthalmic conditions, and their resolution may be associated with elevated intracranial pressure.
Background:
Peripapillary hyperreflective ovoid masslike structures (PHOMS) are now considered a common cause of pseudopapilledema in the pediatric population.
Methods:
The medical records of all patients ≤18 years of age with PHOMS, confirmed on optical coherence tomography, seen at single pediatric neuro-ophthalmology clinic between 2017 and 2021 were reviewed retrospectively.
Results:
A total of 47 patients (35 females), with median age of 12.7 years at initial visit, were included. Of these, 24 (51%) of patients were optometry referrals. Headache was a common symptom. PHOMS were present bilaterally in all patients and were 360° around the disk in 57 of 94 eyes (61%). Patients with elevated intracranial pressure were more likely to have a reduction in the size of PHOMS at follow-up (P = 0.0133). Of the 47, 40 (85%) had diagnostic neuroimaging as a part of their papilledema workup. The retinal nerve fiber layer was thicker in patients with concomitant papilledema rather than optic disk drusen (P = 0.002) and compared with patients with PHOMS alone (P = 0.00051).
Conclusions:
Pediatric patients with PHOMS may be referred because their clinical appearance can be suggestive of papilledema. In our study cohort, PHOMS were bilateral and frequently occurred concurrently with other ophthalmic conditions.
