A new study recently found that Frisén score does not reflect the photographic area and optical coherence tomography (OCT) volume of papilledema after treatment with acetazolamide in patients with idiopathic intracranial hypertension (IIH).

This retrospective study evaluated 126 patients with IIH and mild visual loss. The team assessed weight-management and treatment with acetazolamide compared with placebo and took fundus photographs and OCT scans of the optic disc at baseline and at six and 12 months after enrollment. Trained readers then scored each eye using a modified Frisén scale and measured the area of disc elevation to find the correlation between volume and area.

The researchers discovered that disc area and optic nerve head (ONH) volume were positively correlated at baseline; the correlation was similar in the treatment group at baseline but weaker in the acetazolamide group compared with the placebo group at six and 12 months. They note that at six and 12 months after enrollment, there was no consistent relationship between Frisén score, disc area and ONH volumes in the group treated with acetazolamide.

The study concludes, “clinicians should use caution when using the Frisén scale to monitor the effect of treatment on papilledema over time.” 

Sheils CR, Fischer WS, Hollar RA, et al. The relationship between optic disc volume, area and Frisén score in patients with idiopathic intracranial hypertension. Am J Ophthalmol. August 17, 2018. [Epub ahead of print].