Diagnostic Accuracy of Fundoscopy, Optical Coherence Tomography, and Ocular Ultrasound for Detecting Elevated Intracranial Pressure in Chronic Conditions: A Systematic Review

DOI

10.2991/978-94-6239-836-8_5How to use a DOI?

Keywords

Intracranial hypertension; elevated intracranial pressure; fundoscopy; optical coherence tomography; ocular ultrasonography; Optic nerve sheath diameter

Abstract

Chronic elevated intracranial pressure (ICP) causes progressive optic nerve damage and visual impairment, requiring reliable early detection and long-term monitoring. Non-invasive ocular modalities, including fundoscopy, optical coherence tomography (OCT), and ocular ultrasonography, are increasingly investigated for ICP assessment. This systematic review evaluated the diagnostic accuracy and clinical role of fundoscopy, OCT, and ocular ultrasonography in detecting chronic or non-acute elevated intracranial pressure. Studies published between 2020 and 2026 were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. Diagnostic accuracy studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, while studies reporting structural changes, correlations, or longitudinal monitoring were synthesized as supportive evidence. Of 2,048 identified records, 17 studies were included after screening. Seven studies provided diagnostic accuracy evidence, primarily evaluating fundoscopy, fundus imaging, and ocular ultrasonography, while ten provided supportive evidence, predominantly evaluating OCT-based structural and vascular changes. Fundoscopy demonstrated specificity for detecting papilledema but limited sensitivity. Ocular ultrasonography, particularly optic nerve sheath diameter measurement, demonstrated promising performance as a noninvasive screening approach, although differences in cutoff values and reference standards affected comparability. OCT provided a quantitative assessment of the retinal nerve fiber layer, optic nerve head, and retinal microvascular changes, supporting disease characterization and longitudinal monitoring rather than a standalone diagnostic test. Evidence suggests that fundoscopy, OCT, and ocular ultrasonography provide complementary information for assessing chronic elevated ICP. Fundoscopy may confirm papilledema-related manifestations, ONSD ultrasonography screening, and OCT structural monitoring. Further standardized prospective studies using consistent reference standards are required to establish the utility of these modalities.

Copyright

© 2026 The Author(s)

Open Access

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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TY  - CONF
AU  - Cut Hafidzah Usrah
AU  - Joandre Fauza
PY  - 2026
DA  - 2026/11/11
TI  - Diagnostic Accuracy of Fundoscopy, Optical Coherence Tomography, and Ocular Ultrasound for Detecting Elevated Intracranial Pressure in Chronic Conditions: A Systematic Review
BT  - Proceedings of the3rd Malikussaleh International Conference on Health and Disaster Medicine 2026  (MICOHEDMED 2026)
PB  - Atlantis Press
SP  - 36
EP  - 48
SN  - 2468-5739
UR  - https://doi.org/10.2991/978-94-6239-836-8_5
DO  - 10.2991/978-94-6239-836-8_5
ID  - Usrah2026
ER  -