Causes and prognosis of visual acuity loss at the time of initial presentation in idiopathic intracranial hypertension

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

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose. 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. Methods. 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. Results. 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. Conclusions. 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.

Original languageEnglish (US)
Pages (from-to)3850-3859
Number of pages10
JournalInvestigative Ophthalmology and Visual Science
Volume56
Issue number6
DOIs
StatePublished - Jan 1 2015

Fingerprint

Pseudotumor Cerebri
Optic Nerve Diseases
Visual Acuity
Optical Coherence Tomography
Ganglia
Subretinal Fluid
Choroidal Neovascularization
Visual Field Tests
Retinal Ganglion Cells
Photography
Optic Disk

Keywords

  • Ganglion cell layer
  • Idiopathic intracranial hypertension
  • Optic neuropathy
  • Optical coherence tomography
  • Subretinal fluid

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

Causes and prognosis of visual acuity loss at the time of initial presentation in idiopathic intracranial hypertension. / Chen, John; Thurtell, Matthew J.; Longmuir, Reid A.; Garvin, Mona K.; Wang, Jui Kai; Wall, Michael; Kardon, Randy H.

In: Investigative Ophthalmology and Visual Science, Vol. 56, No. 6, 01.01.2015, p. 3850-3859.

Research output: Contribution to journalArticle

Chen, John ; Thurtell, Matthew J. ; Longmuir, Reid A. ; Garvin, Mona K. ; Wang, Jui Kai ; Wall, Michael ; Kardon, Randy H. / Causes and prognosis of visual acuity loss at the time of initial presentation in idiopathic intracranial hypertension. In: Investigative Ophthalmology and Visual Science. 2015 ; Vol. 56, No. 6. pp. 3850-3859.
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abstract = "Purpose. 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. Methods. 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. Results. 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. Conclusions. 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.",
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AU - Wall, Michael

AU - Kardon, Randy H.

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N2 - Purpose. 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. Methods. 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. Results. 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. Conclusions. 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.

AB - Purpose. 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. Methods. 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. Results. 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. Conclusions. 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.

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KW - Idiopathic intracranial hypertension

KW - Optic neuropathy

KW - Optical coherence tomography

KW - Subretinal fluid

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