title: Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension.
abstract: OBJECTIVE
  To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome.
  
  
  METHODS
  A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation. Fundus photography, optical coherence tomography (OCT) of the optic disc and macula, and perimetry were used to determine the causes and prognosis of vision loss. Segmentation of the macula OCT was performed using the Iowa Reference Algorithm to determine the retinal ganglion cell-inner plexiform layer complex (GCL-IPL) thickness.
  
  
  RESULTS
  Outer retinal changes alone caused decreased BCVA at initial presentation in 22 eyes (46%): subretinal fluid in 16, chorioretinal folds in 5, and peripapillary choroidal neovascularization in 1. The vision loss was reversible except for some eyes with chorioretinal folds. Optic neuropathy alone caused decreased BCVA in 10 eyes (21%) and coexisting outer retinal changes and optic neuropathy caused decreased BCVA in 16 eyes (33%). A GCL-IPL thickness less than or equal to 70 μm at initial presentation or progressive thinning of greater than or equal to 10 μm within 2 to 3 weeks compared with baseline correlated with poor visual outcome.
  
  
  CONCLUSIONS
  Visual acuity loss in IIH can be caused by both outer retinal changes and optic neuropathy. Vision loss from outer retinal changes is mostly reversible. The outcome of patients with coexisting outer retinal changes and optic neuropathy or optic neuropathy alone depends on the degree of optic neuropathy, which can be predicted by the GCL-IPL thickness.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: John J
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 3Department of Neurology, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thurtell
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States.
authors.forename: Reid A
authors.initials: RA
authors.lastname: Longmuir
authors.affiliation: Department of Veterans Affairs, Iowa City, Iowa, United States 5Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States.
authors.forename: Mona K
authors.initials: MK
authors.lastname: Garvin
authors.affiliation: Department of Veterans Affairs, Iowa City, Iowa, United States 5Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States.
authors.forename: Jui-Kai
authors.initials: JK
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 3Department of Neurology, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Wall
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 4Department of Veterans Affairs, Iowa City, Iowa, United States.
authors.forename: Randy H
authors.initials: RH
authors.lastname: Kardon
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011559:Pseudotumor Cerebri / Q000150:complications* / Q000503:physiopathology*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D014792:Visual Acuity; D055815:Young Adult