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Diagnostic performance of optical coherence tomography-derived structural parameters in differentiating pediatric
Elie Zaher1, Nemer Sayed Ahmad2, Siraa Hilf3
1Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, Haifa, 31096, Israel. el_zaher@rambam.health.gov.il.
Purpose:
To evaluate whether optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) thickness measurements can aid in differentiating papilledema from pseudopapilledema in pediatric patients, to assess the prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both conditions, and to examine the diagnostic utility of Bruch's membrane opening (BMO) parameters.
Methods:
Retrospective cohort study. Medical records of pediatric patients (aged 4-18 years) evaluated for suspected papilledema at a tertiary center between 2016 and 2023 were reviewed. All included patients underwent OCT imaging at initial presentation prior to lumbar puncture or treatment. RNFL thickness parameters were compared between patients diagnosed with papilledema and pseudopapilledema. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves. PHOMS prevalence was compared using Fisher's exact test. Bruch's membrane opening (BMO) diameter measurements were compared using a Welch t-test.
Results:
Eighty-four patients met inclusion criteria, including 49 with papilledema and 35 with pseudopapilledema. RNFL thickness was significantly greater in papilledema across all analyzed parameters. Superior quadrant RNFL thickness averaged across both eyes demonstrated the highest diagnostic performance (area under the curve (AUC) 0.92), followed by worse-eye global average RNFL thickness (AUC 0.89). RNFL-based diagnostic performance remained robust after exclusion of patients with severe papilledema. PHOMS were observed in both groups, with no significant difference in prevalence (p = 0.21). No significant differences were found in BMO measurements between the groups.
Conclusions:
Peripapillary RNFL thickness measurements derived from OCT demonstrate meaningful diagnostic value in differentiating papilledema from pseudopapilledema in pediatric patients and may serve as a useful adjunct to clinical evaluation, particularly in diagnostically uncertain cases. In contrast, PHOMS and BMO measurements did not reliably distinguish between these entities. Prospective studies are needed to validate these findings and refine clinically applicable diagnostic thresholds.
