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The following is a summary of “True or pseudo optic disc edema: clinically-based approach to the differential diagnosis,” published in the September 2024 issue of Ophthalmology by Sefi-Yurdakul et al.

Differentiating optic disc edema (ODE) cases is crucial in neuro-ophthalmology, as they can indicate various underlying conditions. 

Researchers conducted a prospective study to share a clinically based approach to effectively distinguish between different types of disc edema (DE).

They included consecutive patients with unilateral or bilateral DE referred to the neuro-ophthalmology department. The study evaluated examination findings and differential diagnoses based on clinical signs, symptoms, and a neuro-ophthalmological approach to understanding DE cases. 

The results showed that of the 119 cases with DE, 69 (58%) were women, and 50 (420 were men. Among them, 89 (75%) had true ODE, and 30 (25%) had pseudo ODE (PODE). True ODE causes included non-arteritic anterior ischemic optic neuropathy (n=40), increased intracranial pressure (n=32), and anterior optic neuritis (n=17). For PODE, causes included small, crowded optic discs (n=12), tilted discs (n=8), myelinated nerve fibers (n=5), and optic disc drusen (n=5). The youngest patients with optic neuritis averaged 28.41 years, while those with non-arteritic anterior ischemic optic neuropathy averaged 59.98 years. Symptoms varied, with non-arteritic anterior ischemic optic neuropathy causing sudden vision loss, optic neuritis causing pain with eye movement and vision loss, and increased intracranial pressure causing headaches and blurred vision. Amblyopia accounted for 30% of PODE cases, with 70% found incidentally and having the best visual acuity. The preliminary diagnoses based on neuro-ophthalmologic examination had an accuracy of 79%. 

Investigators concluded that thorough history taking and a neuro-ophthalmological exam are crucial for accurately distinguishing between optic disc edema and pseudo optic disc edema. These steps play a key role in ensuring proper diagnosis and treatment.

Source: link.springer.com/article/10.1007/s10792-024-03316-1