How do you utilize OCT for the diagnosis and management of IIH?

OCT can be a valuable adjunctive objective tool for diagnosing and monitoring papilledema in IIH. However, when it is used, it should not be used alone. It must be integrated with perimetry and fundus exam/photography. It has important limitations that preclude its use as a standalone modality.

Limitations and Pitfalls of OCT in IIH

1. The most critical pitfall is when there is a decrease in RNFL thickness during treatment; it may reflect either a) resolution of edema or b) axonal loss from optic atrophy. These opposing processes can mask each other, making RNFL alone unreliable for assessing disease status.

2. Macular ganglion cell–inner plexiform layer (mGCIPL) analysis partially addresses this, but adds complexity: mGCIPL declines with opti...