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Suspected optic disc swelling is a common referral for children and creates significant demand on acute services. The differentiation of it from other conditions can present a diagnostic challenge but is essential to avoid unnecessary investigations (Chang, M.Y. et al Ophthalmology 2022; 127; 10.1016/j.ophtha.2020.03.027).An online survey was created to evaluate the national patterns for the initial assessment of children referred with suspected disc swelling and was sent to NHS paediatric ophthalmology consultants obtained via BIPOSA platform.35 responses - 91% consultants, 6% non-consultant doctors, 3% orthoptist. 39% of patients were reviewed in eye casualty, 36% general paediatric clinics, 21% disc clinics and 21% emergency paediatric clinics. Clinical tests undertaken included visual acuity (100%), Ishihara plates (80%), pupil assessment (94%), motility assessment (74%), slit lamp bio-microscopy (80%) and dilated examination (74%). Investigations included OCT imaging (100%), disc photos (94%), Humphrey visual fields (26%), autofluorescence (66%) and b-scan ultrasound (26%). The decision maker varied - 53% consultants, 37% non-consultant doctors and 10% allied health professionals.Results show variation in practice with no consistent pathway. Ancillary tests are heavily relied on, but limited evidence exists demonstrating if these can truly differentiate pathology (Li, Y. et al Clinical and Experimental Optometry 2023; 106(7); 10.1080/08164622.2022.2156775). Decision makers are not always paediatric consultants, with a risk of over or under diagnosis when seen by non-specialists.The survey demonstrates wide variation in practice nationally for the initial assessment of children with suspected optic disc swelling. Further work is needed to standardise the approach in such cases.