Idiopathic Intracranial Hypertension Treatment Trial

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• Idiopathic Intracranial Hypertension Treatment
  Trial
• Modified Frisén Scale for Grading Papilledema
• Michael Wall

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Frisén Staging Scheme
The Modified Frisén ScaleDiagnosis and Grading
of Papilledema in Patients with Raised
Intracranial PressureUsing OCT Compared to
Clinical Expert Assessment using a Clinical
Staging Scale Scott CJ, Kardon RH, Lee AG, Frisén
L, Wall M. Arch Ophth (in press).
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Modified Frisén Papilledema Scale
Grade 0 normal or optic disc edema sominimal
there is noC-shaped halo witha temporal gap
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Modified Frisén Scale for Grading Papilledema
STAGE 0 - Normal Optic Disc or Not a Disc but no Edema/Swelling
A. Prominence of the retinal nerve fiber layer at the nasal, superior and inferior poles in inverse proportion to disc diameter
B. Radial nerve fiber layer striations, without tortuosity
STAGE I Minimal
A. C-shaped halo that is subtle and grayish with a temporal gap obscures underlying retinal details
B. Disruption of normal radial NFL arrangement striations
C. Temporal disc margin normal
STAGE II Low Degree
A. Circumferential halo
B. Elevation - nasal border
C. No major vessel obscuration
STAGE III Moderate
A. Obscuration of one or more segments of major blood vessels leaving disc
B. Circumferential halo
C. Elevation - all borders
D. Halo - irregular outer fringe with finger-like extensions
STAGE IV Marked
A. Total obscuration on the disc of a segment of a major blood vessel on the disc
B. Elevation - whole nerve head, including the cup
C. Border obscuration complete
D. Halo complete
STAGE V SevereA. Partial obscuration of all vessels on disc and total obscuration of at least one vessel on disc
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Grade I Papilledema
Hallmark C-Shaped halo with a temporal gap
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Grade II Papilledema
Hallmark The halo becomescircumferential
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Grade III Papilledema
Hallmark Loss of major vessels as they leave
the disc
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Grade IV Papilledema
Hallmark Loss of major vessels on the disc
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Grade V Papilledema
Criteria of Grade IV partial or total
obscuration of all vessels on the disc
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IIH Patient Over Time
ONSF
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