Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence

Abstract

Optic disc swelling is a manifestation of a broad range of processes affecting the optic nerve head and/or the anterior segment of the optic nerve. Accurately diagnosing optic disc oedema, grading its severity, and recognising its cause, is crucial in order to treat patients in a timely manner and limit vision loss. Some ocular fundus features, in light of a patient's history and visual symptoms, may suggest a specific mechanism or aetiology of the visible disc oedema, but current criteria can at most enable an educated guess as to the most likely cause. In many cases only the clinical evolution and ancillary testing can inform the exact diagnosis. The development of ocular fundus imaging, including colour fundus photography, fluorescein angiography, optical coherence tomography, and multimodal imaging, has provided assistance in quantifying swelling, distinguishing true optic disc oedema from pseudo-optic disc oedema, and differentiating among the numerous causes of acute optic disc oedema. However, the diagnosis of disc oedema is often delayed or not made in busy emergency departments and outpatient neurology clinics. Indeed, most non-eye care providers are not able to accurately perform ocular fundus examination, increasing the risk of diagnostic errors in acute neurological settings. The implementation of non-mydriatic fundus photography and artificial intelligence technology in the diagnostic process addresses these important gaps in clinical practice.

Keywords: Optic disc oedema; artificial intelligence; fundus photograph; intracranial hypertension; papilloedema.

Figure 1.

Apparent optic disc swelling from various aetiologies. Papilloedema (a) Frisén grade 1, (b) grade 2, and (c) grade 5 with cotton-wool spots on the disc. (d) Optic disc oedema from compressive optic neuropathy (optic nerve sheath meningioma). (e) Circumferential optic disc oedema with venous dilation and distal peripapillary splinter haemorrhage from myelin-oligodendrocyte glycoprotein-associated optic neuropathy. (f) Predominantly inferotemporal sectoral disc oedema from non-arteritic anterior ischaemic optic neuropathy.