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D. G. Chu, W. Smith, C. M. Krispel, M. R. Ali, J. L. Keltner; Asymptomatic Papilledema in Morbidly Obese Patients: A Prospective Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4020.
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Idiopathic Intracranial Hypertension (IIH) is associated with obesity, however when asymptomatic, IIH is difficult to diagnose in a primary care setting because its sentinel finding is papilledema. Asymptomatic IIH has been estimated in some populations to be as high as 5%-24%. It is unknown if previously proposed screening for asymptomatic IIH based on previously published rates of asymptomatic IIH can be validated by a similarly high incidence of asymptomatic IIH in morbidly obese patients. The purpose of this study was to determine the rate of asymptomatic papilledema found on non-mydriatic fundus imaging of morbidly obese patients in a bariatric surgery clinic.
This was a prospective study. All morbidly obese patients (BMI >35) seeking bariatric surgery who consented to the study and had no visual opacity preventing a high quality fundus photo were included. Non-mydriatic fundus images were taken by trained clinic personnel. Images were reviewed by an ophthalmologist, and optic nerves were evaluated for papilledema. Patients suspected of having an optic nerve abnormality had a subsequent clinical exam by a neuro-ophthalmologist.
140 patients met the inclusion criteria for the study, 83.8% were female, with a mean age of 44.9 years. The mean BMI was 47.8. Ocular abnormalities were noted in 6 patients. Only one patient had subtle bilateral optic disc edema and referred for full neurological IIH work-up. Other findings included optic nerve hyaloid remnant, optic nerve drusen, epiretinal membrane, congenital macular scar, and proliferative diabetic retinopathy. The rate of ocular pathology found in our study was 4.3% (6 of 140 patients). The rate of asymptomatic papilledema in our study was 0.7% (1 of 140 patients).
The non-mydriatic camera can be used successfully in the primary care setting to detect even subtle optic disc edema. Many undiagnosed ocular findings were found in our study. Given the low rate of asymptomatic papilledema in this obese population, further studies are needed to determine if previously published rates of asymptomatic IIH and the association between obesity and IIH can be validated.
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