Accelerated ‘papilledema protocol’ may save vision, lives
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Key takeaways:
- A study examined referral patterns and outcomes of neuro-ophthalmology consultations for papilledema.
- An accelerated papilledema protocol in the emergency department could save patients’ vision and lives.
An accelerated “papilledema protocol” in the emergency department, including prompt neuro-ophthalmology and neurology consults, blood pressure monitoring, MRI, MRV and lumbar puncture, could save patients’ vision and lives.
In a study presented in a poster at the North American Neuro-Ophthalmology Society meeting, 153 consecutive neuro-ophthalmology emergency department and inpatient consultations were collected over 1 year. Thirty-eight cases were referred for disorders of intracranial pressure, 89 for presumed papilledema and 26 for known idiopathic intracranial hypertension (IIH).
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The papilledema protocol applied to the first two groups of patients resulted in 74 cases of newly diagnosed papilledema, one-fifth with secondary causes; 10 cases of non-papilledematous optic disc edema; and 43 cases in which disc edema was ruled out, including 15 patients referred for presumed papilledema. In the group referred for IIH, 21 had no papilledema and five had papilledema, requiring urgent intervention in four cases. Overall, of the 89 patients with bilateral disc edema, 43% were diagnosed with vision-threatening or life-threatening disease.
“In the face of limited availability of neuro-ophthalmologists, this study supports the need for onsite presence of an expert eye care provider or teleophthalmology for confirmation of papilledema prior to workup in the ED, or unnecessary testing will be performed,” the authors wrote. “Our accelerated papilledema protocol in the ED observation unit resulted in high-yield care.”
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Ray H, et al. Neuro-ophthalmology papilledema consultations at a tertiary care hospital. Presented at: North American Neuro-Ophthalmology Society meeting; March 11-16, 2023; Orlando, Florida.
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