title: Differentiating mild papilledema and buried optic nerve head drusen using spectral domain optical coherence tomography.
abstract: OBJECTIVE
  To evaluate the clinical utility of spectral domain optical coherence tomography (SD-OCT) in differentiating mild papilledema from buried optic nerve head drusen (ONHD).
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  Sixteen eyes of 9 patients with ultrasound-proven buried ONHD, 12 eyes of 6 patients with less than or equal to Frisén grade 2 papilledema owing to idiopathic intracranial hypertension. Two normal fellow eyes of patients with buried ONHD were included.
  
  
  METHODS
  A raster scan of the optic nerve and analysis of the retinal nerve fiber layer (RNFL) thickness was performed on each eye using SD-OCT. Eight eyes underwent enhanced depth imaging SD-OCT. Images were assessed qualitatively and quantitatively to identify differentiating features between buried ONHD and papilledema. Five clinicians trained with a tutorial and masked to the underlying diagnosis independently reviewed the SD-OCT images of each eye to determine the diagnosis.
  
  
  METHODS
  Differences in RNFL thickness in each quadrant between the 2 groups and diagnostic accuracy of 5 independent clinicians based on the SD-OCT images alone.
  
  
  RESULTS
  We found no difference in RNFL thickness between buried ONHD and papilledema in any of the 4 quadrants. Diagnostic accuracy among the readers was low and ranged from 50% to 64%. The kappa coefficient of agreement among the readers was 0.35 (95% confidence interval, 0.19-0.54).
  
  
  CONCLUSIONS
  We found that SD-OCT is not clinically reliable in differentiating buried ONHD and mild papilledema.
authors: Department of Ophthalmology, Sharp Rees-Stealy Medical Group, San Diego, California; Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida. Electronic address: kaushal.kulkarni@gmail.com.
authors: Kaushal M
authors: KM
authors: Kulkarni
authors: Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.
authors: Joshua
authors: J
authors: Pasol
authors: Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.
authors: Potyra R
authors: PR
authors: Rosa
authors: Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.
authors: Byron L
authors: BL
authors: Lam
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D015594:Optic Disk Drusen / Q000175:diagnosis*; D010211:Papilledema / Q000175:diagnosis*; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014463:Ultrasonography; D058609:Visual Field Tests; D014794:Visual Fields; D055815:Young Adult