PHOMS: Time to change the acronym?

González Martín-Moro, J.

doi:10.1016/j.oftale.2023.10.008

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "89" "paginaFinal" => "90" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J. González Martín-Moro" "autores" => array:1 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "González Martín-Moro" "email" => array:1 [ 0 => "julio.gonzalez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Ophthalmology, University Hospital of Henares, Coslada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University Francisco de Vitoria, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "PHOMS: ¿ha llegado el momento de cambiar el acrónimo?" ] ] "textoCompleto" => "The differentiation between papilledema and pseudopapilledema is one of the most complex differential diagnoses in ophthalmology. With the appearance of the new optical coherence tomography modalities which, due to their greater penetration, allowed us to look inside the optic nerve head, it seemed that this differential diagnosis would be simplified.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> However, the truth is that even with the support of new technologies, those of us who work in neuro-ophthalmology or pediatric ophthalmology are confronted every day with optic discs in which it is very difficult to determine whether the patient has true or false papilledema.The new technology made visible what appeared to be more or less oval-shaped corpuscles, which were initially thought to be optic nerve drusen (OND). However, these lesions did not have the tomographic features of them. OND usually have a central hyporeflective core surrounded by a calcified and therefore hyperreflective periphery. Therefore, it was thought that they could be immature drusen that as they traveled from the depths to the surface of the optic nerve head, would acquire the tomographic characteristics of OND.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>It soon became clear that these lesions were present in various clinical situations and to differentiate them from OND, the consortium for the study of optic nerve drusen decided to coin the acronym PHOMS. This acronym stands for Peripapillary hyperreflective ovoid mass-like structures.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The term was created at a time when the nature of the tissue that generated these images was unknown. It was not known what PHOMS were, but it was beginning to be clear that they were not OND.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The presence of these images has been identified in various clinical contexts: coexisting with OND, papilledema, anterior ischemic optic neuropathy, oblique discs, demyelinating disorders of the optic nerve and retinal venous occlusions, among others. The number of optic nerve diseases in which these lesions can be identified is growing every month and to add further complexity we now know that these images appear in a significant proportion of healthy children with various forms of pseudopapilledema.<a class="elsevierStyleCrossRefs" href="#bib0010">2–6</a>The currently accepted theory is that PHOMS are not corpuscules, but axons dislocated into the adjacent intraretinal space, and that the ovoid appearance is an optical illusion. It is simply the product of the cross section of a structure that is globally toric in shape (i.e. doughnut-shaped).<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Everything seems to indicate that PHOMS are neither lesions in the strict sense, nor are they ovoid in shape, and that these images are highly nonspecific. Probably the term PHOMS, which was useful in its beginnings to differentiate these images from OND, has already served its purpose. In light of what is known today, the term is rather confusing. It seems clear that PHOMS are not structures, they seem to be just a clinical sign (the term structure implies the presence of differentiated tissue and displaced axons would not fit this idea). If this is so, it would be advisable to replace the acronym by another that better reflects this clinical reality. Perhaps a much simpler term such as intra-retinal axonal herniation (IRAH) would more accurately describe this clinical sign and generate less confusion, and the term PHOMS, which has already fulfilled its function, could be retired.StatementNo artificial intelligence was used in the preparation of this article.FundingThe work has been carried out without financial support from any institution.Conflict of interestThe author declares no conflict of interest." 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