G180(P) Review of the pathway for children with ‘swollen’ optic discs: a service evaluation and quality improvement study

Introduction Papilloedema is defined as swelling of the optic disc caused by raised intracranial pressure. Following a recent highly publicised court case, our paediatric and other services 1have experienced an unprecedented increase in referrals of children with ‘suspicious optic discs’. We aimed to evaluate the patient journey of all children presenting with suspected optic disc swelling and make recommendations for an integrated multidisciplinary pathway. Methods A retrospective case notes review in a single UK centre of all patients under 16 presenting with suspected optic disc swelling to Paediatric or Ophthalmology departments. Results During a 9 month period in 2016, 42 referrals concerning ‘suspicious’ optic discs were received. 39 (92%) of these were from community optometrists. Mean age was 11, ranging from 4–17 years old. 38 (90%) of these patients presented to Ophthalmic Emergency, of whom 18 were sent straight to paediatrics. The remainder came via their GP. 11 (61%) were sent for urgent MRI without seeing a paediatrician or ophthalmologist; 10 (91%) of these MRI scans were normal. 6 had ‘USS proven’ disc drusen. Only 3 children(11.5%) were found to have underlying pathology. Only 2 (5%) children had ‘true’ papilloedema related to intracranial pathology (1=astrocytoma, 1=idiopathic intracranial hypertension). Conclusions The large majority of children with a suspicion of a swollen optic disc raised by a community optometrist do not have any significant pathology. Increased referrals for suspicious optic discs creates a significant workload for paediatric and eye services and generates high levels of anxiety for the patient and family.