Authors: Jonathan A. Micieli, Beau B. Bruce, Caroline Vasseneix, Richard J. Blanch, Damian E. Berezovsky, Jason H. Peragallo, Nancy J. Newman, Valérie Biousse
Author Disclosure Block: J.A. Micieli: None. B.B. Bruce: None. C. Vasseneix: None. R.J. Blanch: None. D.E. Berezovsky: None. J.H. Peragallo: None. N.J. Newman: None. V. Biousse: None.

Abstract Body: 

Purpose: Stratification of idiopathic intracranial hypertension (IIH) patients allows aggressive treatment to prevent vision loss in high-risk patients. We assessed whether Frisén grade, optic disc hemorrhages (ODH) and cotton wool spots (CWS) predict outcome in IIH.

Study Design: Retrospective cohort study of consecutive IIH patients.

Methods: 389/1244 consecutive IIH patients (773 eyes) were seen before or within 30 days of diagnostic lumbar puncture/medical treatment, with fundus photographs at presentation. Patients’ characteristics, visual acuity (VA), visual field (VF) grade, and Humphrey VF mean deviation were recorded. Fundus photographs graded by 3 independent reviewers used a standardized protocol for presence, type, and severity of ODH and CWS, and severity of papilledema by the modified Frisén scale. Multivariable linear and logistic mixed models evaluated the association between Frisén grade, ODH, CWS and visual outcomes controlling for confounding variables.

Results: 205/773 (26.5%) eyes had >1 ODH, 99/773 (12.8%) eyes had >1 CWS, 86/773 (11.1%) had >1 ODH and CWS. Controlling for Frisén grade, BMI, black race, and gender, the presence of ODH/CWS was associated with worse VA and VF grade at initial presentation (p<0.03), but not at final follow-up. Results were the same when limiting the analysis to the 223 patients (352 eyes) who would have qualified for the IIHTT by VF criteria (VF-MD, -2 to -7dB). More patients with ≥1 ODH (21.5% vs 6.7%) or CWS (31.3% vs 4.7%) underwent surgical treatment compared to those without ODH/CWS, but the presence of ODH/CWS was not an independent predictor of surgery. The presence of ODH/CWS was associated with higher Frisén grade (p<0.001) and Frisén grade correlated with worse mean deviation and VF grade at final follow-up (p<0.001).

Conclusions: While the IIHTT associated ODH with both worse Frisén grade and treatment failures, they did not examine whether ODH was a risk factor independent of papilledema severity (likely due to the low frequency of treatment failures in a population with mild disease). In our study, neither ODH nor CWS were independently associated with poorer visual function at last follow-up.