Papilledema widely misused in medical literature

The term ‘papilledema’ is often used inappropriately among case reports in ophthalmology, reveals a recent study. Such misuse, if not corrected, can result in improper care delivery to patients with optic disc edema (ODE), which may then lead to permanent vision loss.

In this cross-sectional evidence-based study, the authors searched the databases of Medline and Embase for case reports with ‘papilledema’ in their title, abstract, or article keywords between January 2011 and March 2022. They graded studies for the following errors: type 1 (using ‘papilledema’ without evidence of elevated intracranial pressure [ICP]), type 2 (declaring ‘papilledema’ on examination before finding evidence of elevated ICP), type 3 (both errors type 1 and 2), or no error.

A total of 722 case reports were identified, among which 482 errors (66.8 percent) were discovered. Of these errors, 12 were type 1, 360 type 2, 110 type 3, and 240 no errors.

Across studies, the most represented specialties were neurology, neurosurgery, and ophthalmology, but only ophthalmology had a low error prevalence. Nevertheless, all specialties with at least 10 included reports showed a high error prevalence (>30 percent).

Reduced error prevalence significantly correlated with higher impact factor journals, nonopen-access publication models, and origin countries with an English official language, but not with publication year. In addition, the association between article citation counts and the prevalence of any type of error was not statistically significant. On risk of bias analysis, error occurrence was not associated with the quality of case report study design.

“Our results, although limited to case reports, indicate a need for more thorough peer-review standards and neuro-ophthalmology exposure in medical education,” the authors said.

Papilledema, which refers to ODE secondary to raised ICP, is a leading reason for referral to neuro-ophthalmologists. This condition must be distinguished from other ODE causes, regardless of specialties, because it indicates a unique pathophysiology and management strategy, the authors noted.