title: Undiagnosed papilledema in a morbidly obese patient population:  a prospective study.
abstract: BACKGROUND
  Idiopathic intracranial hypertension (IIH) is a rare condition that can lead to significant morbidity from visual loss. The cause of IIH is unknown, but IIH is known to be associated with obesity. Obese patients may be at particularly high risk for suffering vision loss from IIH. The purpose of the present study is to determine the prevalence of undiagnosed or asymptomatic papilledema in a population of morbidly obese individuals and to determine if these patients should undergo routine screening for papilledema.
  
  
  METHODS
  Patients presenting to the UC Davis Bariatric Surgery Clinic between February 2008 and January 2011 who met the National Institutes of Health criteria for bariatric surgery were invited to participate in the study. Those patients who met the inclusion criteria and consented to the study were included. Participants were screened for IIH by nonmydriatic fundus photographs and 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 neurological evaluation.
  
  
  RESULTS
  A total of 606 patients with an average body mass index of 47 kg/m2 were included in the study. Seventeen of these patients had photographic optic disc findings or symptoms suspicious for IIH. Seven of these patients did not have disc edema on clinical examination. Six patients were not evaluated in the clinic. Four of the 17 patients had subtle optic disc edema confirmed by clinical evaluation and were referred for full neurological workup. These 4 patients had normal neuroimaging, 3 of whom underwent lumbar punctures with borderline high opening pressures. All 4 patients had unremarkable visual field examinations. Fundus abnormalities other than optic disc edema were discovered in 33 patients.
  
  
  CONCLUSIONS
  Our study suggests that in a morbidly obese patient population, papilledema with significant visual loss is rare. Routine screening with fundus photography of morbidly obese patients likely is not warranted.
authors.affiliation: University of California, Davis, Eye Center, Sacramento, California 95817, USA. claudia.krispel@gmail.com
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Krispel
authors.forename: John L
authors.initials: JL
authors.lastname: Keltner
authors.forename: William
authors.initials: W
authors.lastname: Smith
authors.forename: David G
authors.initials: DG
authors.lastname: Chu
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D010211:Papilledema / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011559:Pseudotumor Cerebri / Q000175:diagnosis* / Q000453:epidemiology; D014786:Vision Disorders / Q000175:diagnosis; D014794:Visual Fields; D055815:Young Adult