Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension

John J Chen; Matthew J Thurtell; Reid A Longmuir; Mona K Garvin; Jui-Kai Wang; Michael Wall; Randy H Kardon

doi:10.1167/iovs.15-16450

Back

Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension

Journal article

Open access

Peer reviewed

Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension

John J Chen, Matthew J Thurtell, Reid A Longmuir, Mona K Garvin, Jui-Kai Wang, Michael Wall and Randy H Kardon

Investigative ophthalmology & visual science, Vol.56(6), pp.3850-3859

06/2015

DOI: 10.1167/iovs.15-16450

PMCID: PMC4697859

PMID: 26070058

Files and links (1)

url

https://doi.org/10.1167/iovs.15-16450View

Published (Version of record) Open Access

Abstract

To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome. A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation. Fundus photography, optical coherence tomography (OCT) of the optic disc and macula, and perimetry were used to determine the causes and prognosis of vision loss. Segmentation of the macula OCT was performed using the Iowa Reference Algorithm to determine the retinal ganglion cell-inner plexiform layer complex (GCL-IPL) thickness. Outer retinal changes alone caused decreased BCVA at initial presentation in 22 eyes (46%): subretinal fluid in 16, chorioretinal folds in 5, and peripapillary choroidal neovascularization in 1. The vision loss was reversible except for some eyes with chorioretinal folds. Optic neuropathy alone caused decreased BCVA in 10 eyes (21%) and coexisting outer retinal changes and optic neuropathy caused decreased BCVA in 16 eyes (33%). A GCL-IPL thickness less than or equal to 70 μm at initial presentation or progressive thinning of greater than or equal to 10 μm within 2 to 3 weeks compared with baseline correlated with poor visual outcome. Visual acuity loss in IIH can be caused by both outer retinal changes and optic neuropathy. Vision loss from outer retinal changes is mostly reversible. The outcome of patients with coexisting outer retinal changes and optic neuropathy or optic neuropathy alone depends on the degree of optic neuropathy, which can be predicted by the GCL-IPL thickness.

Prevalence

Prognosis

Humans

Male

Visual Acuity

Pseudotumor Cerebri - physiopathology

Young Adult

Vision Disorders - diagnosis

Adolescent

Pseudotumor Cerebri - complications

Adult

Female

Retrospective Studies

Vision Disorders - epidemiology

Vision Disorders - etiology

Details

Title: Subtitle: Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension
Creators: John J Chen - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
Matthew J Thurtell - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 3Department of Neurology, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States
Reid A Longmuir - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States
Mona K Garvin - Department of Veterans Affairs, Iowa City, Iowa, United States 5Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
Jui-Kai Wang - Department of Veterans Affairs, Iowa City, Iowa, United States 5Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
Michael Wall - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 3Department of Neurology, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States
Randy H Kardon - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States
Resource Type: Journal article
Publication Details: Investigative ophthalmology & visual science, Vol.56(6), pp.3850-3859
DOI: 10.1167/iovs.15-16450
PMID: 26070058
PMCID: PMC4697859
NLM abbreviation: Invest Ophthalmol Vis Sci
ISSN: 0146-0404
eISSN: 1552-5783
Publisher: United States
Grant note: 1U10EY017281-01A1 / NEI NIH HHS 3U10 EY017281 / NEI NIH HHS R01 EY023279 / NEI NIH HHS U10 EY017281 / NEI NIH HHS 2R01 EY018853 / NEI NIH HHS EY017281 / NEI NIH HHS 5 R01 EY02211536 / NEI NIH HHS R01 EY018853 / NEI NIH HHS
Language: English
Date published: 06/2015
Academic Unit: Neurology; Electrical and Computer Engineering; Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
Record Identifier: 9983980049902771

Metrics

35 Record Views

72 Times Cited - Web of Science

See more details