Michael Wall1, Mark J Kupersmith2, Karl D Kieburtz3, James J Corbett4, Steven E Feldon5, Deborah I Friedman6, David M Katz7, John L Keltner8, Eleanor B Schron9, Michael P McDermott10. 1. Department of Neurology, University of Iowa, Iowa City2Department of Ophthalmology, University of Iowa, Iowa City. 2. Roosevelt Hospital, New York, New York4New York Eye and Ear Infirmary, New York, New York. 3. Center for Human Experimental Therapeutics, University of Rochester, Rochester, New York. 4. Department of Neurology, University of Mississippi, Jackson7Department of Ophthalmology, University of Mississippi, Jackson. 5. Department of Ophthalmology, University of Rochester, Rochester, New York. 6. Department of Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center, Dallas10Department of Neurology, University of Texas Southwestern Medical Center, Dallas. 7. Bethesda Neurology, Bethesda, Maryland. 8. Department of Ophthalmology, University of California-Davis. 9. Division of Extramural Research, National Eye Institute, Bethesda, Maryland. 10. Center for Human Experimental Therapeutics, University of Rochester, Rochester, New York14Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York.
Abstract
IMPORTANCE: To our knowledge, there are no large prospective cohorts of untreated patients with idiopathic intracranial hypertension (IIH) to characterize the disease. OBJECTIVE: To report the baseline clinical and laboratory features of patients enrolled in the Idiopathic Intracranial Hypertension Treatment Trial. DESIGN, SETTING, AND PARTICIPANTS: We collected data at baseline from questionnaires, examinations, automated perimetry, and fundus photography grading. Patients (n = 165) were enrolled from March 17, 2010, to November 27, 2012, at 38 academic and private practice sites in North America. All participants met the modified Dandy criteria for IIH and had a perimetric mean deviation between -2 dB and -7 dB. All but 4 participants were women. MAIN OUTCOMES AND MEASURES: Baseline and laboratory characteristics. RESULTS: The mean (SD) age of our patients was 29.0 (7.4) years and 4 (2.4%) were men. The average (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 39.9 (8.3). Headache was the most common symptom (84%). Transient visual obscurations occurred in 68% of patients, back pain in 53%, and pulse synchronous tinnitus in 52%. Only 32% reported visual loss. The average (SD) perimetric mean deviation in the worst eye was -3.5 (1.1) dB, (range, -2.0 to -6.4 dB) and in the best eye was -2.3 (1.1) dB (range, -5.2 to 0.8 dB). A partial arcuate visual field defect with an enlarged blind spot was the most common perimetric finding. Visual acuity was 85 letters or better (20/20) in 71% of the worst eyes and 77% of the best eyes. Quality of life measures, including the National Eye Institute Visual Function Questionnaire-25 and the Short Form-36 physical and mental health summary scales, were lower compared with population norms. CONCLUSIONS AND RELEVANCE: The Idiopathic Intracranial Hypertension Treatment Trial represents the largest prospectively analyzed cohort of untreated patients with IIH. Our data show that IIH is almost exclusively a disease of obese young women. Patients with IIH with mild visual loss have typical symptoms, may have mild acuity loss, and have visual field defects, with predominantly arcuate loss and enlarged blind spots that require formal perimetry for detection. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01003639.
IMPORTANCE: To our knowledge, there are no large prospective cohorts of untreated patients with idiopathic intracranial hypertension (IIH) to characterize the disease. OBJECTIVE: To report the baseline clinical and laboratory features of patients enrolled in the Idiopathic Intracranial Hypertension Treatment Trial. DESIGN, SETTING, AND PARTICIPANTS: We collected data at baseline from questionnaires, examinations, automated perimetry, and fundus photography grading. Patients (n = 165) were enrolled from March 17, 2010, to November 27, 2012, at 38 academic and private practice sites in North America. All participants met the modified Dandy criteria for IIH and had a perimetric mean deviation between -2 dB and -7 dB. All but 4 participants were women. MAIN OUTCOMES AND MEASURES: Baseline and laboratory characteristics. RESULTS: The mean (SD) age of our patients was 29.0 (7.4) years and 4 (2.4%) were men. The average (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 39.9 (8.3). Headache was the most common symptom (84%). Transient visual obscurations occurred in 68% of patients, back pain in 53%, and pulse synchronous tinnitus in 52%. Only 32% reported visual loss. The average (SD) perimetric mean deviation in the worst eye was -3.5 (1.1) dB, (range, -2.0 to -6.4 dB) and in the best eye was -2.3 (1.1) dB (range, -5.2 to 0.8 dB). A partial arcuate visual field defect with an enlarged blind spot was the most common perimetric finding. Visual acuity was 85 letters or better (20/20) in 71% of the worst eyes and 77% of the best eyes. Quality of life measures, including the National Eye Institute Visual Function Questionnaire-25 and the Short Form-36 physical and mental health summary scales, were lower compared with population norms. CONCLUSIONS AND RELEVANCE: The Idiopathic Intracranial Hypertension Treatment Trial represents the largest prospectively analyzed cohort of untreated patients with IIH. Our data show that IIH is almost exclusively a disease of obese young women. Patients with IIH with mild visual loss have typical symptoms, may have mild acuity loss, and have visual field defects, with predominantly arcuate loss and enlarged blind spots that require formal perimetry for detection. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01003639.
Authors: Michael Wall; Michael P McDermott; Karl D Kieburtz; James J Corbett; Steven E Feldon; Deborah I Friedman; David M Katz; John L Keltner; Eleanor B Schron; Mark J Kupersmith Journal: JAMA Date: 2014 Apr 23-30 Impact factor: 56.272
Authors: Deborah I Friedman; Michael P McDermott; Karl Kieburtz; Mark Kupersmith; Ann Stoutenburg; John L Keltner; Steven E Feldon; Eleanor Schron; James J Corbett; Michael Wall Journal: J Neuroophthalmol Date: 2014-06 Impact factor: 3.042
Authors: Yongsheng Yang; Alan S Carlin; Patrick J Faustino; Mónica I Pagán Motta; Mazen L Hamad; Ruyi He; Y Watanuki; E E Pinnow; Mansoor A Khan Journal: J Womens Health (Larchmt) Date: 2009-03 Impact factor: 2.681
Authors: Mark J Kupersmith; Patrick A Sibony; Steven E Feldon; Jui-Kai Wang; Mona Garvin; Randy Kardon Journal: Am J Ophthalmol Date: 2016-12-28 Impact factor: 5.258
Authors: Jorge C Kattah; John H Pula; Luis J Mejico; Michael P McDermott; Mark J Kupersmith; Michael Wall Journal: J Neurol Date: 2015-07-10 Impact factor: 4.849
Authors: Michael Wall; Michael P McDermott; Karl D Kieburtz; James J Corbett; Steven E Feldon; Deborah I Friedman; David M Katz; John L Keltner; Eleanor B Schron; Mark J Kupersmith Journal: JAMA Date: 2014 Apr 23-30 Impact factor: 56.272
Authors: William S Fischer; Michael Wall; Michael P McDermott; Mark J Kupersmith; Steven E Feldon Journal: Invest Ophthalmol Vis Sci Date: 2015-05 Impact factor: 4.799
Authors: Shannon J Beres; Claire A Sheldon; Chantal J Boisvert; Christina L Szperka; Grace L Paley; Evanette K Burrows; Marianne R Chilutti; Geraldine W Liu; Shana E McCormack; Grant T Liu Journal: Pediatr Neurol Date: 2018-03-30 Impact factor: 3.372