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M. K. Yoon, R. Mayorga, T. R. Hedges; Optical Coherence Tomography Findings and Correlations in Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1186. doi: https://doi.org/.
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Idiopathic intracranial hypertension (IIH) has been historically followed based on qualitative assessment of the optic nerve head, in addition to subjective visual field examinations. Stratus optical coherence tomography (OCT) allows the quantification of optic nerve swelling and can assist in objective follow-up of affected patients. Also, OCT may also help in the determination of when individual patients are at increased risk of vision loss so that more aggressive intervention can be initiated when needed.
In this retrospective case series, patients with IIH by Dandy criteria were identified. Subjects with HVF and retinal nerve fiber layer (RNFL) data at time of consultation were included in this study. RNFL and HVF MD data were analyzed for change in thickness and density of visual field defect. The topography of the RNFL scan was also analyzed to identify patterns of RNFL change that correlate with visual field loss.
21 patients with multiple HVF and OCT data were eligible. The change in visual acuity, RNFL thickness, mean deviation on HVF, and mode of intervention were followed. Initial Snellen visual acuity ranged from 20/15 to 20/200. Three eyes of three patients experienced severe vision loss (doubling the visual angle). Extreme RNFL thickening greater than 220 microns and superior-inferior thickness ratio of greater than 2:1 were correlated with a greater degree of visual field loss.
Severe RNFL thickening and relative superior RNFL thinning in the presence of persistent inferior RNFL thickening were associated with increased incidences of visual field lo ss. No secific NFL findings were associated with loss of viual acuity.
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