April 2010
Volume 51, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2010
Undiagnosed Idiopathic Intracranial Hypertension in a Population of Morbidly Obese Patients: A Prospective Study
Author Affiliations & Notes
  • C. M. Krispel
    Eye Center,
    UC Davis, Sacramento, California
  • W. Smith
    Surgery,
    UC Davis, Sacramento, California
  • D. G. Chu
    Eye Center,
    UC Davis, Sacramento, California
  • M. Ali
    Surgery,
    UC Davis, Sacramento, California
  • J. L. Keltner
    Eye Center,
    UC Davis, Sacramento, California
  • Footnotes
    Commercial Relationships  C.M. Krispel, None; W. Smith, None; D.G. Chu, None; M. Ali, None; J.L. Keltner, None.
  • Footnotes
    Support  Research to Prevent Blindness
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 5469. doi:
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      C. M. Krispel, W. Smith, D. G. Chu, M. Ali, J. L. Keltner; Undiagnosed Idiopathic Intracranial Hypertension in a Population of Morbidly Obese Patients: A Prospective Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5469.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Idiopathic intracranial hypertension (IIH) is a rare condition with an annual incidence of 1 to 2 in 100,0001. Obesity is a known risk factor and increases the annual incidence to 19 per 100,0001. As many as 25% of patients with IIH may be asymptomatic2, increasing the risk of permanent visual loss. The purpose of the present study is to determine the incidence of undiagnosed or asymptomatic IIH in a population of morbidly obese individuals.

Methods: : Patients presenting to the UC Davis bariatric surgery clinic between February 2008 and September 2009 who consented to the study and had no visual opacity preventing high quality fundus photos were included in the study. Participants were screened for IIH by nonmydriatic fundus photos or by concerning symptoms prompting direct referral for neuro-ophthalmologic evaluation. Images were reviewed by a neuro-ophthalmologist, and patients with suspicious optic discs underwent neuro-ophthalmologic evaluation. Patients with findings consistent with IIH were sent for neurologic evaluation.

Results: : 427 patients with an average BMI of 47 were included in the study. 15 of these patients had findings suspicious for IIH. Four of these patients (approximate annual incidence of 560 per 100,000) had subtle optic disc edema confirmed by clinical evaluation and were referred for full neurologic workup. All four patients had normal MRIs; 3 underwent lumbar punctures with borderline high opening pressures suggesting possible IIH. An additional 4 patients had possible optic disc edema by screening photos but have not yet been confirmed by clinical evaluation.

Conclusions: : The incidence of mild optic disc edema in a morbidly obese patient population is higher compared to published estimates of the incidence of IIH in the general population. However, no cases of moderate or severe papilledema were identified.1. Radhakrishnan K et al. Idiopathic intracranial hypertension. Mayo Clin Proc 69:169-180, 1994.2. Galvin JA, Van Stavern GP. Clinical characterization of idiopathic intracranial hypertension at the Detroit Medical Center. J Neurol Sci 223(2):157-160, 2004.

Keywords: neuro-ophthalmology: optic nerve • optic disc • clinical (human) or epidemiologic studies: prevalence/incidence 
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