Analysis of ganglion cell thinning in paediatric papilledema ‐ at what point does visual function become affected?

Authors: Andrew Malem, Arun Reginald, Michael J. Wan. The Hospital for Sick Children.

Author Disclosures: Andrew Malem: None Arun Reginald: None Michael Wan: None


Abstract Body: 

Purpose: We studied the relationship between macula ganglion cell (GC) thinning and visual loss in children with papilledema. 

Study Design: Retrospective, single‐center study of patients (<18 years old) presenting with papilledema between 2012‐2022. 

Methods: Presenting age, sex, lumbar puncture opening pressure and etiology were recorded in addition to initial and
final BCVA, disc rNFL and macula GC thickness (GCT). Visual fields were performed when possible. We defined vision loss as a final BCVA of 20/40 or worse or an abnormal visual field (abnormal Goldmann VF or >‐3.00DB mean deviation on Humphrey VF) Results: 85 patients (170 eyes) were included. 57(67%) were female with mean age 11.4 years (3‐18). Mean follow up was 21.3 months. Etiologies were primary PTSC (74/85) and secondary PTSC in (11/85). 16 eyes (9.4%) from 14 patients experienced visual loss (8 persistent VF deficits, 8 BCVA loss). Mean final GCT was 70um vs 83um (p<0.00001) and minimum GCT 65um vs 79um (p<0.0003) in those with vision loss vs those without. A mean GCT <70um was 100% predictive of visual loss and <70um minimum GCT carried an 88% chance of visual loss. Those with visual loss had a significantly higher LP opening pressure (41vs 49cmH₂0 p=0.006). No difference between groups was found for age, sex, initial disc rNFL or etiology. 

Conclusions: In our data, GCT was significantly reduced in paediatric papilloedema patients experiencing persistent visual loss. The highest risk occurred when mean GCT was <70um. This information is important for patient management and counselling.

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