Can anyone confidently/accurately visualize papilledema by non-dilated ophthalmoscopy? Even with a pan-optic and years of looking at fundi with it, I still cannot say that I can reliably call papiledema. Do others have this problem?
I would say (with my panoptic) that I can call obvious/severe papilledema, but there's no way that I'm going to reliably pick up mild grade 1. I usually document "no frank papilledema visualized" if I don't see it to reflect the limitations of my exam, and never really exclude elevated ICP on the basis of my fundoscopic exam alone.