Baseline vision often predictive of final visual outcomes in IIH

This paper explores whether mean deviations in visual field recorded at diagnosis can predict visual outcomes in idiopathic intracranial hypertension (IIH).

Study design

The authors retrospectively reviewed the visual field measurements performed on standard static perimetry at diagnosis and at final encounter in 79 patients with IIH. All patients were examined in the neuro-ophthalmology clinics at a single academic medical center from 1999 to 2015.

Outcomes

Within the subset of 66 patients who entered with good vision (visual field mean deviations of −7 dB or better), the majority (89%) had final mean deviations of −4 dB or better while 56% had final mean deviations of −2 dB or better. Only one patient—who was nonadherent to prescribed medication—within this subset had a poor final mean deviation (−32 dB).

Of the 13 patients who entered with mean deviations worse than −7 dB, 11 (85%) ended up with poor visual outcomes (final mean deviations of −5 dB to −32 dB). More than half of those 13 patients had required surgery for IIH, more commonly within 3 weekss of diagnosis, owing to severe papilledema and visual dysfunction at the time of diagnosis.

Limitations

This study is limited by its retrospective nature, which limits the available data.

Clinical significance

These findings suggest patients with IIH who have relatively mild visual dysfunction at diagnosis are likely to have a favorable visual outcome, as long as they are adherent to the recommended treatment. Even with aggressive treatment, many of those with poor visual function at diagnosis will have unfavorable visual outcomes.