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18 Headlines ‘Empty sella’ is a finding that is sometimes incidentally detected on MRI brain scans. It is frequently associated with raised pressure inside the skull, particularly the condition ‘idiopathic intracranial hypertension’, but can also be found in normal healthy individuals who do not have raised pressure. It is not currently known how often empty sella and other findings of raised pressure are detected in people undergoing MRI. Photographs can be taken of the back of the eyes to detect swelling of the optic nerves, a reliable sign of raised pressure inside the skull. Although the technology is available, it is not used routinely outside the eye clinic. Dr Chen designed a study that involved taking photographs of patients who were attending outpatient MRI appointments. His team reviewed all the photographs for swelling of the optic nerves. A radiologist reviewed all the MRI scans for empty sella and other signs of raised pressure. There were 296 patients in the study, with almost half showing signs of raised pressure and 33% having empty sella. However, swelling of the optic nerves was detected in only five patients. This study shows that signs of raised pressure on MRI are a lot more common than previously thought. Reassuringly, these signs are rarely associated with swelling of the optic nerves and should not cause distress to patients, especially if they do not have symptoms of raised pressure. Patients who have signs of raised pressure on their MRI scans, such as empty sella, need an eye examination first. If doctors have difficulty getting a good view of the back of the eyes in the clinic, they can consider photography as this has been shown to be comfortable, safe, and reliable. The results have been published in the prestigious clinical neurology journal JAMA Neurology[1]. The findings of this study challenge the widespread practice of performing invasive procedures on all patients with incidentally detected MRI signs of intracranial hypertension Study improves detection of optic nerve swelling Dr Benson Chen completed his core neurology training in Auckland in 2018. With the support of the VJ Chapman Research Fellowship awarded by the Neurological Foundation, he left for the USA in 2019 to undertake clinical research training in neuro-ophthalmology with Professors Nancy J. Newman and Valérie Biousse at Emory Eye Center and the Emory University School of Medicine in Atlanta, Georgia. Dr Chen is now undertaking a PhD at the University of Cambridge after being awarded the prestigious Cambridge-Rutherford Memorial Scholarship by the Cambridge Trust and The Royal Society Te Apārangi. He is also an Honorary Clinical Fellow in the Cambridge Eye Unit at Addenbrooke's Hospital, working with Dr Patrick Yu Wai Man, a leading clinician-scientist in neuro-ophthalmology.