OFA unreliable at differentiating papilledema from pseudopapilledema in kids

A recent study showed that oral fluorescein angiography (OFA) cannot definitively distinguish papilledema from pseudopapilledema in children, highlighting the need to interpret OFA findings in conjunction with other clinical findings.

The retrospective study used data from the Arkansas Children's Hospital between May 2018 to August 2021. Researchers reviewed the medical records of 45 children aged ≤18 years who presented with suspected optic disc swelling and who underwent OFA >30 minutes after oral ingestion.

OFA images were examined by two masked specialists and interpreted as either optic disc leakage, no leakage, or borderline leakage. Optic disc swelling was clinically graded using the Frisen grading scale (0–5). The researchers compared the OFA images to the final clinical diagnosis and calculated the accuracy of the test.

Of the patients, 11 had papilledema and 34 with pseudopapilledema, with a total of 90 eyes evaluated.  The mean age of the population was 14.1 years, and 66.7 percent were girls.

The accuracy of OFA for distinguishing papilledema from pseudopapilledema was 62 percent for the first reviewer and 69 percent for the second reviewer. There was substantial agreement (k=0.779) between both reviewers in grading the OFA images.

None of the children experienced ocular or systemic side effects after OFA.

The findings suggest that OFA alone is not suitable for establishing a diagnosis of papilledema or pseudopapilledema in children.