The hidden dangers of papilloedema

Papilloedema in its early stages isn’t always easy to spot – and the consequences of getting it wrong can be catastrophic. Steve Smethurst asks: how should optometrists approach diagnosis and referral?

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In 2016, Honey Rose, an Ipswich optometrist, was handed a two-year suspended sentence for gross negligence manslaughter for a failure to spot papilloedema. An appeal court later quashed the conviction, but the journal Nature reported an increased awareness of disc pathology, a rise in referrals from community optometrists and a spike in neuroimaging requests in the aftermath (Poostchi et al, 2018). 

“It’s certainly a condition that optometrists worry about seeing in practice,” says Daniel Hardiman-McCartney FCOptom, Clinical Adviser for the College. “I’ve only seen five or six cases in 15 years, which I suspect is broadly typical.”

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