Factors associated with vision loss in idiopathic intracranial hypertension patients with severe papilledema.
Journal
Eye (London, England)
ISSN: 1476-5454
Titre abrégé: Eye (Lond)
Pays: England
ID NLM: 8703986
Informations de publication
Date de publication:
30 Oct 2024
30 Oct 2024
Historique:
received:
27
05
2024
accepted:
15
10
2024
revised:
04
10
2024
medline:
31
10
2024
pubmed:
31
10
2024
entrez:
31
10
2024
Statut:
aheadofprint
Résumé
Our aim was to compare factors associated with poor versus good visual outcomes in idiopathic intracranial hypertension (IIH) patients with severe papilledema at initial presentation. Retrospective review of consecutive IIH patients (1/1/2013-6/10/2023) with severe papilledema (Frisén grade 4-5 and/or atrophy in at least one eye); Patients were divided into "poor visual outcome" (poor visual acuity and constricted visual field in at least one eye) and "good visual outcome" (good visual acuity and only mild visual field changes in both eyes) at >6 months for medically-treated patients and >3 months follow-up for surgically-treated patients. We included 134 IIH patients with severe papilledema (70 had poor and 64 had good visual outcomes). No significant differences existed for age, gender, race, hypertension, haemoglobin, or cerebrospinal fluid opening pressure. The poor-outcome group had significantly greater BMI (mean 39.2 vs 35.1 kg/m Although patients with poor visual outcome did not seek medical care later than good outcome patients, they had delayed diagnosis/treatment because of prior outside ED visits and lack of prior eye-care provider evaluations, suggesting that early diagnosis and specialized management of papilledema is essential for patients with symptoms of intracranial hypertension.
Sections du résumé
BACKGROUND/OBJECTIVES
OBJECTIVE
Our aim was to compare factors associated with poor versus good visual outcomes in idiopathic intracranial hypertension (IIH) patients with severe papilledema at initial presentation.
SUBJECTS/METHODS
METHODS
Retrospective review of consecutive IIH patients (1/1/2013-6/10/2023) with severe papilledema (Frisén grade 4-5 and/or atrophy in at least one eye); Patients were divided into "poor visual outcome" (poor visual acuity and constricted visual field in at least one eye) and "good visual outcome" (good visual acuity and only mild visual field changes in both eyes) at >6 months for medically-treated patients and >3 months follow-up for surgically-treated patients.
RESULTS
RESULTS
We included 134 IIH patients with severe papilledema (70 had poor and 64 had good visual outcomes). No significant differences existed for age, gender, race, hypertension, haemoglobin, or cerebrospinal fluid opening pressure. The poor-outcome group had significantly greater BMI (mean 39.2 vs 35.1 kg/m
CONCLUSIONS
CONCLUSIONS
Although patients with poor visual outcome did not seek medical care later than good outcome patients, they had delayed diagnosis/treatment because of prior outside ED visits and lack of prior eye-care provider evaluations, suggesting that early diagnosis and specialized management of papilledema is essential for patients with symptoms of intracranial hypertension.
Identifiants
pubmed: 39478195
doi: 10.1038/s41433-024-03408-3
pii: 10.1038/s41433-024-03408-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
Références
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159–65.
pubmed: 23966248
doi: 10.1212/WNL.0b013e3182a55f17
Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR, et al. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol, Neurosurg Psychiatry. 2018;89:1088.
pubmed: 29903905
doi: 10.1136/jnnp-2017-317440
Wall M, Falardeau J, Fletcher WA, Granadier RJ, Lam BL, Longmuir RA, et al. Risk factors for poor visual outcome in patients with idiopathic intracranial hypertension. Neurology. 2015;85:799–805.
pubmed: 26245929
doi: 10.1212/WNL.0000000000001896
Wall M, Hart WM, Burde RM. Visual field defects in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol. 1983;96:654–69.
pubmed: 6638133
doi: 10.1016/S0002-9394(14)73425-7
Wall M. George D. Visual loss in pseudotumor cerebri: incidence and defects related to visual field strategy. Arch Neurol. 1987;44:170–5.
pubmed: 3813933
doi: 10.1001/archneur.1987.00520140040015
Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, et al. Visual loss in pseudotumor cerebri: follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. 1982;39:461–74.
pubmed: 7103794
doi: 10.1001/archneur.1982.00510200003001
Rush JA. Pseudotumor cerebri: clinical profile and visual outcome in 63 patients. Mayo Clin Proc. 1980;55:541–6.
pubmed: 7412408
Orcutt JC, Page NGR, Sanders MD. Factors affecting visual loss in benign intracranial hypertension. Ophthalmology. 1984;91:1303–12.
pubmed: 6514295
doi: 10.1016/S0161-6420(84)34149-5
Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain: A J Neurol. 1991;114:155–80.
Behbehani R, Ali A, Al-Moosa A. Course and predictors of visual outcome of idiopathic intracranial hypertension. Neuro-Ophthalmol. 2022;46:80–4.
doi: 10.1080/01658107.2021.1984540
Digre KB, Corbett JJ. Pseudotumor cerebri in men. Arch Neurol. 1988;45:866–72.
pubmed: 3395260
doi: 10.1001/archneur.1988.00520320056015
Bruce BB, Kedar S, Stavern GPV, Monaghan D, Acierno MD, Braswell RA, et al. Idiopathic intracranial hypertension in men. Neurology. 2009;72:304–9.
pubmed: 18923135
doi: 10.1212/01.wnl.0000333254.84120.f5
Bruce BB, Preechawat P, Newman NJ, Lynn MJ, Biousse V. Racial differences in idiopathic intracranial hypertension. Neurology. 2008;70:861–7.
pubmed: 18332344
doi: 10.1212/01.wnl.0000304746.92913.dc
Szewka AJ, Bruce BB, Newman NJ, Biousse V. Idiopathic intracranial hypertension: relation between obesity and visual outcomes. J Neuro-Ophthalmol. 2013;33:4–8.
doi: 10.1097/WNO.0b013e31823f852d
Biousse V, Rucker JC, Vignal C, Crassard I, Katz BJ, Newman NJ. Anemia and papilledema. Am J Ophthalmol. 2003;135:437–46.
pubmed: 12654358
doi: 10.1016/S0002-9394(02)02062-7
Sverdlichenko I, Yu CW, Margolin E, Micieli JA. Comparison of idiopathic intracranial hypertension patients with and without anemia. J Neuro-Ophthalmol. 2023;43:535–40.
doi: 10.1097/WNO.0000000000001715
Wall M, White WN. Asymmetric papilledema in idiopathic intracranial hypertension: prospective interocular comparison of sensory visual function. Investig Ophthalmol Vis Sci. 1998;39:134–42.
Gospe SM, Bhatti MT, El-Dairi MA. Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. Br J Ophthalmol. 2016;100:505.
pubmed: 26269534
doi: 10.1136/bjophthalmol-2015-307043
Thambisetty M, Lavin PJ, Newman NJ, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology. 2007;68:229–32.
pubmed: 17224579
doi: 10.1212/01.wnl.0000251312.19452.ec
Wall M, Johnson CA, Cello KE, Zamba KD, McDermott MP, Keltner JL, et al. Visual field outcomes for the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Investig Ophthalmol Vis Sci. 2016;57:805–12.
doi: 10.1167/iovs.15-18626
Micieli JA, Gorham JP, Bruce BB, Newman NJ, Biousse V, Peragallo JH. Clinical and demographic differences between idiopathic intracranial hypertension patients with mild and severe papilledema. Taiwan J Ophthalmol. 2020;11:53–6.
pubmed: 33767955
pmcid: 7971438
doi: 10.4103/tjo.tjo_44_20
Micieli JA, Bruce BB, Vasseneix C, Blanch RJ, Berezovsky DE, Newman NJ, et al. Influence of optic nerve appearance on visual outcome in pediatric idiopathic intracranial hypertension. Can J Neurol Sci J Can des Sci Neurol. 2020;47:661–5.
doi: 10.1017/cjn.2020.89
Micieli JA, Bruce BB, Vasseneix C, Blanch RJ, Berezovsky DE, Peragallo JH, et al. Optic nerve appearance as a predictor of visual outcome in patients with idiopathic intracranial hypertension. Br J Ophthalmol. 2019;103:1429.
pubmed: 30530819
doi: 10.1136/bjophthalmol-2018-313329
Saindane AM, Bruce BB, Riggeal BD, Newman NJ, Biousse V. Association of MRI findings and visual outcome in idiopathic intracranial hypertension. Am J Roentgenol. 2013;201:412–8.
doi: 10.2214/AJR.12.9638
Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of idiopathic intracranial hypertension. Eye. 2019;33:478–85.
pubmed: 30356129
doi: 10.1038/s41433-018-0238-5
Shaia JK, Sharma N, Kumar M, Chu J, Maatouk C, Talcott K, et al. Changes in prevalence of idiopathic intracranial hypertension in the United States between 2015 and 2022, stratified by sex, race, and ethnicity. Neurology. 2024;102:e208036.
pubmed: 38181397
doi: 10.1212/WNL.0000000000208036
Frisén L. Swelling of the optic nerve head: a staging scheme. J Neurology Neurosurg Psychiatry. 1982;45:13.
doi: 10.1136/jnnp.45.1.13
Hoyt W, Beeston D. The ocular fundus in neurologic disease: a diagnostic manual and stereo atlas. St Louis: Mosby; 1966.
Brusini P, Johnson CA. Staging functional damage in glaucoma: review of different classification methods. Surv Ophthalmol. 2007;52:156–79.
pubmed: 17355855
doi: 10.1016/j.survophthal.2006.12.008
Ng M, Sample PA, Pascual JP, Zangwill LM, Girkin CA, Liebmann JM, et al. Comparison of visual field severity classification systems for glaucoma. J Glaucoma. 2012;21:551–61.
pubmed: 21878817
doi: 10.1097/IJG.0b013e31821dac66
Mackay DD, Garza PS, Bruce BB, Newman NJ, Biousse V. The demise of direct ophthalmoscopy. Neurology Clin Pract. 2015;5:150–7.
doi: 10.1212/CPJ.0000000000000115
Sachdeva V, Vasseneix C, Hage R, Bidot S, Clough LC, Wright DW, et al. Optic nerve head edema among patients presenting to the emergency department. Neurology. 2018;90:e373–9.
pubmed: 29305439
doi: 10.1212/WNL.0000000000004895
Bruce BB, Lamirel C, Wright DW, Ward A, Heilpern KL, Biousse V, et al. Nonmydriatic ocular fundus photography in the Emergency Department. New Engl J Medicine. 2011;364:387–9.
doi: 10.1056/NEJMc1009733
Bruce BB, Thulasi P, Fraser CL, Keadey MT, Ward A, Heilpern KL, et al. Diagnostic accuracy and use of monmydriatic ocular fundus photography by emergency physicians: phase II of the FOTO-ED study. Ann Emerg Med. 2013;62:28–33.e1.
pubmed: 23433654
doi: 10.1016/j.annemergmed.2013.01.010
Stunkel L, Newman-Toker DE, Newman NJ, Biousse V. Diagnostic error of neuro-ophthalmologic conditions: state of the science. J Neuro-ophthalmol. 2020;41:98–113.
doi: 10.1097/WNO.0000000000001031
Kelly LP, Garza PS, Bruce BB, Graubart EB, Newman NJ, Biousse V. Teaching ophthalmoscopy to medical students (the TOTeMS study). Am J Ophthalmol. 2013;156:1056–1061.e10.
pubmed: 24041982
doi: 10.1016/j.ajo.2013.06.022
Irani NK, Bidot S, Peragallo JH, Esper GJ, Newman NJ, Biousse V. Feasibility of a nonmydriatic ocular fundus camera in an outpatient neurology clinic. Neurologist. 2020;25:19–23.
pubmed: 32132494
doi: 10.1097/NRL.0000000000000259
Bruce BB, Bidot S, Hage R, Clough LC, Fajoles-Vasseneix C, Melomed M, et al. Fundus photography vs. ophthalmoscopy outcomes in the Emergency Department (FOTO-ED) phase III: web-based, in-service training of emergency providers. Neuro-ophthalmology. 2018;42:1–6.
doi: 10.1080/01658107.2017.1419368
Biousse V, Bruce BB, Newman NJ. Ophthalmoscopy in the 21st century. Neurology. 2018;90:167–75.
pubmed: 29273687
doi: 10.1212/WNL.0000000000004868
Bouthour W, Biousse V, Newman NJ. Diagnosis of optic disc oedema: fundus features, ocular imaging findings, and artificial intelligence. Neuro-Ophthalmol. 2023;47:177–92.
doi: 10.1080/01658107.2023.2176522
Milea D, Najjar RP, Zhubo J, Ting D, Vasseneix C, Xu X, et al. Artificial intelligence to detect papilledema from ocular fundus photographs. New Engl J Med. 2020;382:1687–95.
pubmed: 32286748
doi: 10.1056/NEJMoa1917130
Biousse V, Najjar RP, Tang Z, Lin MY, Wright DW, Keadey MT, et al. Application of a deep learning system to detect papilledema on nonmydriatic ocular fundus photographs in an Emergency Department. Am J Ophthalmol. 2024;261:199–207.
pubmed: 37926337
doi: 10.1016/j.ajo.2023.10.025
Biousse V, Newman NJ. The expanding spectrum of idiopathic intracranial hypertension. Eye. 2023;37:2361–4.
pubmed: 36509997
doi: 10.1038/s41433-022-02361-3
Bonelli L, Menon V, Arnold AC, Mollan SP. Managing idiopathic intracranial hypertension in the eye clinic. Eye. 2024;38:2472–81.
pubmed: 38789788
doi: 10.1038/s41433-024-03140-y
Brady T, Vegunta S, Crum AV, Marx D, Patel BCK, Seay MD, et al. Interdisciplinary protocol for the management of vision-threatening papilledema. J Neuro-Ophthalmol. 2022;42:495–501.
doi: 10.1097/WNO.0000000000001594
Smolar ALO, Ray HJ, Dattilo M, Bouthour W, Berman G, Peragallo JH, et al. Neuro-ophthalmology emergency department and inpatient consultations at a large academic referral center. Ophthalmology. 2023;130:1304–12.
doi: 10.1016/j.ophtha.2023.07.028
Ray HJ, Smolar ALO, Dattilo M, Bouthour W, Berman G, Peragallo JH, et al. The increasing burden of Emergency Department and inpatient consultations for “Papilledema.” J Neuro-Ophthalmol. 2024. https://doi.org/10.1097/WNO.0000000000002120 .
Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. New Engl J Med. 2019;381:2440–50.
pubmed: 31851800
doi: 10.1056/NEJMsa1909301
Craig JJ, Mulholland DA, Gibson JM. Idiopathic intracranial hypertension; incidence, presenting features and outcome in Northern Ireland (1991-1995). Ulst Med J. 2001;70:31–5.
Carta A, Bertuzzi F, Cologno D, Giorgi C, Montanari E, Tedesco S. Idiopathic intracranial hypertension (pseudotumor cerebri): descriptive epidemiology, clinical features, and visual outcome in Parma, Italy, 1990 to 1999. Eur J Ophthalmol. 2003;14:48–54.
doi: 10.1177/112067210401400108
Mrejen S, Vignal C, Bruce BB, Gineys R, Audren F, Preechawat P, et al. Idiopathic intracranial hypertension: a comparison between French and North-American white patients. Rev Neurol. 2009;165:542–8.
pubmed: 19157473
doi: 10.1016/j.neurol.2008.11.021
Blanch RJ, Vasseneix C, Liczkowski A, Yiangou A, Aojula A, Micieli JA, et al. Differing presenting features of idiopathic intracranial hypertension in the UK and US. Eye. 2019;33:1014–9.
pubmed: 30783258
pmcid: 6662244
doi: 10.1038/s41433-019-0359-5
Thaller M, Homer V, Hyder Y, Yiangou A, Liczkowski A, Fong AW, et al. The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes. J Neurol. 2023;270:851–63.
pubmed: 36242625
doi: 10.1007/s00415-022-11402-6
DeBusk A, Subramanian PS, Bryan MS, Moster ML, Calvert PC, Frohman LP. Mismatch in supply and demand for neuro-ophthalmic care. J Neuro-Ophthalmol. 2022;42:62–7.
doi: 10.1097/WNO.0000000000001214
Mollan SP, Menon V, Cunningham A, Plant GT, Bennetto L, Wong SH, et al. Neuro-ophthalmology in the United Kingdom: providing a sustainable, safe and high-quality service for the future. Eye (Lond). 2024;38:2235–7.
pubmed: 38778141
doi: 10.1038/s41433-024-03141-x