11.54 Current challenges in the assessment and diagnosis of optic disc swelling and idiopathic intracranial hypertension

Optic disc swelling is a challenging presentation with a wide differential including potentially life-threatening diagnoses alongside benign causes. In this retrospective review, we assess over 33,000 referrals to an Eye Treatment Centre between 2014 and 2018. We identify 167 referrals for ‘optic disc swelling’ or similar terms. The overall rate of referrals to the ETC remained stable throughout this period, however the rate of referrals for optic disc swelling increased almost threefold from 2016 onwards. This was primarily due to a large increase in the number of referrals from Opticians, which correlates chronologically with the case of missed papilloedema resulting in a criminal conviction of the optometrist in question, Honey Rose. 77 patients were confirmed to have papilloedema, and in this group the most common final diagnosis was Idiopathic Intracranial Hypertension (IIH). 74 patients were diagnosed with pseudopapilloedema, the most common cause of which was drusen. Of note, over one-fifth were found to have normal optic discs on examination. Pathways for the workup of patients with suspected IIH were examined. A large proportion of patients experienced delays of up to 31 months awaiting essential imaging or lumbar puncture. Importantly, 37% never had venography.