Journal article
Automated Retinal Vascular Analysis Reveals Response to Acetazolamide in Idiopathic Intracranial Hypertension
Translational vision science & technology, Vol.14(12), 9
12/01/2025
DOI: 10.1167/tvst.14.12.9
PMCID: PMC12697697
PMID: 41342622
Abstract
To assess whether automated analysis of retinal arterioles and venules can identify treatment response in papilledema secondary to idiopathic intracranial hypertension (IIH).
This retrospective analysis used data from a multicenter, randomized, double-blind, placebo-controlled IIH treatment trial. Participants (n = 165) with mild visual loss were assigned to a dietary/lifestyle modification plus acetazolamide (ACZ) or placebo for 6 months. Color fundus photographs, optical coherence tomography (OCT), and clinical metrics were collected at baseline and at multiple follow-up visits. AutoMorph, a deep learning-based pipeline, quantified venule and arteriole diameters, fractal dimensionality, tortuosity, and vessel density. Venular widths were standardized to arteriolar widths to form a venule-to-arteriole (V:A) ratio, which was correlated with Frisén grade, OCT optic nerve head (ONH) parameters, and cerebrospinal fluid (CSF) opening pressure.
Baseline vascular OCT metrics and Frisén grades were similar between groups. At month 1, ACZ significantly reduced venule diameters (-4.59 µm; P = 0.02), and placebo showed no change (+1.21 µm; P = 0.54). The V:A ratio was consistently lower in the ACZ group than placebo from month 1 (1.20 vs. 1.24, respectively; P = 0.03) to month 6 (1.16 vs. 1.23, P = 0.02). Higher Frisén grades correlated strongly with increased mean V:A values (R2 = 0.91, P = 0.011). The V:A ratio was significantly associated with CSF opening pressure at month 6 (R2 = 0.47, P < 0.001).
Automated retinal vessel analysis provides a promising, non-invasive method for monitoring treatment response in IIH and may complement traditional imaging and clinical assessments.
Deep learning-based retinal vessel metrics may provide an accessible biomarker for monitoring treatment response in papilledema.
Details
- Title: Subtitle
- Automated Retinal Vascular Analysis Reveals Response to Acetazolamide in Idiopathic Intracranial Hypertension
- Creators
- Brian Woods - University Hospital GalwayDavid Szanto - New York Eye and Ear InfirmaryJui-Kai Wang - The University of Texas Southwestern Medical CenterAsala Erekat - Icahn School of Medicine at Mount SinaiLola Stern - New York Eye and Ear InfirmaryAaron Golden - Ollscoil na Gaillimhe – University of GalwayMona K Garvin - University of IowaRandy H Kardon - University of IowaMark J Kupersmith - Icahn School of Medicine at Mount Sinai
- Resource Type
- Journal article
- Publication Details
- Translational vision science & technology, Vol.14(12), 9
- DOI
- 10.1167/tvst.14.12.9
- PMID
- 41342622
- PMCID
- PMC12697697
- NLM abbreviation
- Transl Vis Sci Technol
- ISSN
- 2164-2591
- eISSN
- 2164-2591
- Publisher
- ARVO
- Grant note
- Research to Prevent BlindnessNational Eye Institutes, National Institutes of Health: R01 EY015473 Department of Veteran Affairs Center for the Prevention and Treatment of Visual Loss, Rehabilitation Research and Development: I50 RX003002, VA RRD I01RX003797 UT Southwestern Medical Center Ophthalmology Challenge Grant from Research to Prevent Blindness
Supported by the Health Research Board (ICAT-2022-001) and the Irish Clinical Academic Training (ICAT) Programme, which is supported by the Health Service Executive-National Doctors Training and Planning; Northern Ireland Health and Social Care Research & Development Division; Northern Ireland Medical and Dental Training Agency; Department of Agriculture, Food and the Marine; and the College of Anaesthesiologists of Ireland. This work is also supported by the New York Eye and Ear Infirmary Foundation; Barry Family Center for Ophthalmic Artificial Intelligence and Human Health; Shulman Family NAION Fund; Neuro-Ophthalmology Research Fund of New YorkEye and Ear Infirmary; Research to Prevent Blindness; an unrestricted grant to the Department of Ophthalmology, Mass Eye and Ear, from the National Eye Institutes, National Institutes of Health (R01 EY015473) ; grants from the Department of Veteran Affairs Center for the Prevention and Treatment of Visual Loss, Rehabilitation Research and Development (I50 RX003002, VA RR&D I01RX003797) ; and UT Southwestern Medical Center Ophthalmology Challenge Grant from Research to Prevent Blindness. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.r Eye and Ear Infirmary; Research to Prevent Blindness; an unrestricted grant to the Department of Ophthalmology, Mass Eye and Ear, from the National Eye Institutes, National Institutes of Health (R01 EY015473) ; grants from the Department of Veteran Affairs Center for the Prevention and Treatment of Visual Loss, Rehabilitation Research and Development (I50 RX003002, VA RR&D I01RX003797) ; and UT Southwestern Medical Center Ophthalmology Challenge Grant from Research to Prevent Blindness. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Language
- English
- Date published
- 12/01/2025
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Electrical and Computer Engineering; Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
- Record Identifier
- 9985090730602771
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