2 Frisén Staging SchemeThe Modified Frisén Scale Diagnosis and Grading of Papilledema in Patients with Raised Intracranial Pressure Using OCT Compared to Clinical Expert Assessment using a Clinical Staging ScaleScott CJ, Kardon RH, Lee AG, Frisén L, Wall M. Arch Ophth (in press).
3 Modified Frisén Papilledema Scale Grade 0: normal or optic disc edema so minimal there is no C-shaped halo with a temporal gap
4 Modified Frisén Scale for Grading Papilledema STAGE 0 - Normal Optic Disc or Not a Disc but no Edema/SwellingA. Prominence of the retinal nerve fiber layer at the nasal, superior and inferior poles in inverse proportion to disc diameterB. Radial nerve fiber layer striations, without tortuositySTAGE I – Minimal*A. C-shaped halo that is subtle and grayish with a temporal gap; obscures underlying retinal detailsB. Disruption of normal radial NFL arrangement striationsC. Temporal disc margin normalSTAGE II – Low Degree*A. Circumferential haloB. Elevation - nasal borderC. No major vessel obscurationSTAGE III – Moderate*A. Obscuration of one or more segments of major blood vessels leaving discB. Circumferential haloC. Elevation - all bordersD. Halo - irregular outer fringe with finger-like extensionsSTAGE IV – Marked*A. Total obscuration on the disc of a segment of a major blood vessel on the discB. Elevation - whole nerve head, including the cupC. Border obscuration – completeD. Halo – completeSTAGE V – Severe *A. Partial obscuration of all vessels on disc and total obscuration of at least one vessel on disc
5 Grade I PapilledemaHallmark: C-Shaped halo with a temporal gap
6 Grade II PapilledemaHallmark: The halo becomes circumferential
7 Grade III PapilledemaHallmark: Loss of major vessels as they leave the disc
8 Grade IV PapilledemaHallmark: Loss of major vessels on the disc
9 Grade V PapilledemaCriteria of Grade IV + partial or total obscuration of all vessels on the disc