Monitoring
The frequency of reevaluation after beginning therapy depends mainly on the severity of the papilledema and loss of vision, and the rate of progression of the loss.[46] For example, patients with mild optic disk edema who have mild loss of vision (perimetric mean deviation abnormal but <3 dB) that is stable can be followed every 6 months. Patients with a loss of vision that is mild to moderate at the onset can be followed every 2 to 6 weeks until improvement is noted. However, patients with a severe loss of vision should be considered for emergency surgery - either optic nerve sheath fenestration or a cerebrospinal fluid (CSF) shunting procedure. They should be followed daily to weekly until their condition improves.
When the patient's condition becomes stable or improves, the examination intervals are gradually extended. The follow-up examination should include quantitative visual field examination, stereo photographs of the optic disks if there has been any change in their appearance. Patients with high-grade papilledema should be closely followed.
The success of a therapy is judged by the stability or recovery of vision, headache relief, elimination of pulse-synchronous tinnitus, transient visual obscurations, and diplopia, and decreased papilledema. Repeated fundus photographs are more helpful in accurately assessing papilledema than descriptions of the optic disk. However, the Frisén grading scale for papilledema is very useful if serial fundus photographs are not available.[37][44]
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