Ophthalmology AdvisorPHOMS Are Not Likely The Result of Elevated Intracranial Pressure, Study Finds

⚠️ Small Study / Early Comparative Evidence

PHOMS are observed more frequently in eyes with papilledema than in healthy eyes, prompting interest in their potential as ICP surveillance markers. This cross-sectional study assessed whether PHOMS prevalence correlated with measured opening pressure in patients with IIH diagnosed by Modified Dandy Criteria.

Clinical Considerations

• PHOMS were present in 59.3% of eyes across 39 of 54 IIH patients, lower than prior reported prevalence
• Mean LP opening pressure did not differ significantly between PHOMS-positive (31.26 cm H2O) and PHOMS-negative (34.36 cm H2O) groups (P=0.33)
• Findings suggest PHOMS may reflect underlying anatomic factors rather than active ICP elevation
• Prior assumption that PHOMS track with papilledema does not extend to a direct ICP correlation in this cohort

Practice Applications

• Interpret PHOMS on EDI-OCT as a structural finding, not a reliable ICP surrogate
• Recognize that PHOMS prevalence in IIH patients may vary from earlier reports across different cohorts
• Avoid using PHOMS presence or absence to guide lumbar puncture timing or ICP management decisions pending larger prospective data