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Detecting optic nerve head swelling on ultrasound and optical coherence tomography in children and young people: an observational study
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  • Published on:
    Optic nerve head swelling on ultrasound and optical coherence tomography in children
    • Maddalena De Bernardo, Assistent Professor in Ophthalmology Department of Medicine Surgery and Dentistry, University of Salerno, Salerno, Italy.
    • Other Contributors:
      • Nicola Rosa, Full Professor in Ophthalmology

    Dear Editor,
    we read with great interest the article by Dahlmann-Noor et al. concerning the possibility to detect optic nerve (ON) head swelling on ultrasound and OCT. 1
    They reported 61 children , investigated for ‘suspicious discs’ that underwent both US and OCT. Among these only 3 children had intracranial hypertension (IHT) but all of them were diagnosed as having drusen on US; even the three children with IHT had ‘small linear’ drusen.
    We would like to comment on small linear drusen that seem to have been undetected by OCT. This is very unlikely. Much care must be taken to diagnose linear drusen with ultrasound because this image could be an artifact due to the strong echoes coming from a surface where the sound beam is perpendicular .
    Measuring optic nerve sheath diameter (ONSD) with B-scan has recently become popular, but there is not a global agreement on how to perform such a measurement as some authors suggest performing axial measurements, some others coronal axis measurements.3-5 Furthermore to establish a cutoff between normal and increased ONSD can be very challenging due to the so-called blooming effect. This B-scan related effect, that should not be confused with the Doppler related one, is due to the lack of sensitivity standard setting: the ON image obtained with a low sensitivity setting will result in larger ON dimensions compared to the ones provided by the same image, increasing the sensitivity setting.
    The authors...

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    Conflict of Interest:
    None declared.