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Daniel R. Agarwal, Ilana Traynis, Ravi Parikh, Megan Ridley-Lane, Marc Dinkin; Evaluation of the Relationship between Retinal Nerve Fiber Layer Thickness and Degree of Visual Field Recovery in Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3919.
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Idiopathic intracranial hypertension (IIH) typically presents with papilledema and headaches. Thickening of the peripapillary retinal nerve fiber layer (RNFL) has been demonstrated in patients with IIH and papilledema . In this study, we sought to determine whether RNFL thickness at presentation in each peripapillary sector predicted the degree of visual field (VF) recovery of corresponding VF defects after treatment for IIH.
Six eyes of three patients with IIH underwent standard automated perimetry at diagnosis and after standard of care treatment. Peripapillary RNFL thickness at presentation was measured with Cirrus spectral domain optical coherence tomography (OCT). Using the coefficient of determination R2, we examined the relationship between VF sector mean deviation and RNFL thickness via the Garway-Heath map [2,3].
In 8 out of 10 examined sectors, thicker RNFL at presentation was associated with a greater degree of improvement in the corresponding VF after treatment. The strongest relationship was seen in sectors closest to the optic nerve head, with R2 values of 0.666 for superior sector 3, 0.368 for superior sector 4, and 0.247 for inferior sector 4.
In IIH patients, increased mean RNFL thickness at presentation is associated with greater improvement in VF recovery relative to patients with thinner mean RNFL thickness at presentation. In particular, the changes observed in the RNFL closest to the optic nerve head had the strongest prognostic value for VF recovery. This suggests that RNFL thickness may be used as a predictor of recovery from IIH-induced vision loss. VF loss associated with a greater degree of corresponding RNFL thickening is more likely to improve than field loss associated with less thickening, perhaps because axonal loss has not ensued.1. Skau M, et al. Graefes Arch Clin Exp Ophthalmol. 2011; 249(5):723-730.2. Garway-Heath DF, et al. Ophthalmology. 2000; 107(10):1809-1815.3. Ferreras A, et al. Invest Ophthalmol Vis Sci. 2008; 49(7):3018-3025.
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