Lazy V sign unreliable indication of papilledema in children

Issue: May 10, 2019

SAN DIEGO — Masked reviewers could not reliably identify any grade of papilledema in pediatric eyes using the “lazy V” sign, according to a poster presentation.

“The lazy V sign is a subretinal hyporeflective space that’s seen on OCT that is present between the neurosensory retina and retinal pigment epithelium. The sign has been described in adults who have optic nerve etiologies and has been suggested for use in differentiating between cases of true optic nerve edema and pseudoedema,” Hilliary E. Inger, MD, said at the American Association for Pediatric Ophthalmology and Strabismus annual meeting.

Inger, of Nationwide Children’s Hospital, and colleagues at The Ohio State University conducted a retrospective review of cross-sectional B-scan images of 83 eyes with known papilledema. Four masked pediatric ophthalmologists commented on the presence or absence of the lazy V sign in each scan.

In 38 eyes with mean edema grade of 2.89, at least three of the reviewers recorded presence of the lazy V sign. In 27 eyes with a mean edema grade of 1.44, at least three reviewers recorded absence of the lazy V sign. In 10 eyes with a mean edema grade of 2.20, the reviewers had a mixed response. Images for eight eyes with a mean edema grade of 3.37 were deemed unreadable by at least two reviewers.

“The lazy V is an unreliable sign for differentiating papilledema from optic disc drusen,” Inger said. “A combination of testing modalities may be needed to differentiate papilledema from optic disc drusen in pediatric patients.” – by Patricia Nale, ELS

Reference:

Inger HE. Rapid fire posters: Utility of the OCT lazy V sign in diagnosing optic nerve edema in a pediatric population. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; March 28 to 31, 2019; San Diego.

Disclosure: Inger reports no relevant financial disclosures.