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Comment & Response
November 2018

Measuring Optic Nerve Sheath Diameter as a Proxy for Intracranial Pressure

Author Affiliations
  • 1Schoolof Medicine, University of California, Irvine
  • 2Gavin Herbert Eye Institute, University of California, Irvine
JAMA Ophthalmol. 2018;136(11):1310. doi:10.1001/jamaophthalmol.2018.3432

To the Editor The article by Wang et al1 is a timely contribution to the ophthalmology literature, because it increases awareness of ultrasonography as a potential noninvasive tool compared with lumbar puncture in detecting and monitoring elevated intracranial pressure (ICP). We agree with the finding that optic nerve sheath diameter (ONSD) is a predictor of elevated ICP. However, it is important to consider newer evidence for other applications of the ONSD finding via ultrasonography. The mechanism proposed in this article for the correlation of elevated ICP increased ONSD is the continuity of the intraorbital and intracranial subarachnoid spaces. While we agree with this finding, edema in the intraorbital subarachnoid space is also subject to local insults to the intraorbital optic nerve sheath.