13 We used ONSF effectively for treating papilledema secondary to dural sinus thrombosis and intracranial masses, besides IIH, causing sufficient raised ICP to cause visual deterioration.
Resolution of papilledema is therefore expected to improve vision in patients undergoing ONSF.
The improvement in BCVA after ONSF is a debatable subject.
ONSF is primarily meant to improve vision only, but studies have shown efficacy of ONSF in improvement of symptoms also.
So there is indirect evidence from improvement in headache in 10 out of 13 patients undergoing ONSF bilaterally, that ONSF is also helpful in controlling chief symptom of IIH or raised ICP.
In the largest metaanalysis done on efficacy of ONSF, including 8 studies, and 432 cases with follow up of 20 months, mean frequency of improvement in headache, visual acuity and papilledema was 26%, 42% and 92% respectively.