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Optic nerve appearance as a predictor of visual outcome in patients with idiopathic intracranial hypertension
  1. Jonathan A Micieli1,2,
  2. Beau B Bruce2,3,4,
  3. Caroline Vasseneix2,
  4. Richard J Blanch2,
  5. Damian E Berezovsky2,5,
  6. Jason H Peragallo2,6,
  7. Nancy J Newman2,3,7,
  8. Valérie Biousse2,3
  1. 1 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
  3. 3 Department of Neurology, Emory University, Atlanta, Georgia, USA
  4. 4 Department of Epidemiology, Emory University, Atlanta, Georgia, USA
  5. 5 Barrow Neurological Institute, Phoenix, Arizona, USA
  6. 6 Department of Pediatrics, Emory University, Atlanta, Georgia, USA
  7. 7 Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Dr Valérie Biousse, Departments of Ophthalmology, and Neurology, Emory University, Neuro Ophthalmology Unit, Emory Eye Center, Atlanta, GA 30322, USA; vbiouss{at}


Background/aims It remains unclear whether the presence of optic disc haemorrhages (ODH) or cotton wool spots (CWS) at presentation in patients with papilloedema from idiopathic intracranial hypertension (IIH) has prognostic value. The aim of this study was to determine if optic disc appearance at presentation predicts visual outcome in patients with IIH.

Methods Retrospective study of 708 eyes of 360 consecutive patients with IIH who had baseline optic disc photographs before or within 30 days of their diagnostic lumbar puncture and initiation of medical treatment. Optic disc photographs were independently graded by three ophthalmologists in a standardised manner. Visual function was assessed using Snellen converted to logMAR visual acuity, Humphrey mean deviation and visual field grade.

Results At least one ODH was found in 201 (28.4%) eyes, at least one CWS was found in 101 (14.3%) eyes and 88 eyes had both ODH and CWS (12.4%). At presentation, Frisén grade was associated with the presence and severity of ODH and CWS (p<0.001). ODH were associated with a worse visual acuity and CWS were associated with a worse visual field grade and mean deviation at presentation (p<0.05). Frisén grade was associated with worse visual function at presentation and final follow-up (p<0.001). Neither ODH nor CWS at presentation were associated with visual function at final follow-up when controlling for the Frisén grade.

Conclusions and relevance ODH and CWS at baseline are not independent predictors of final visual function in IIH when controlling for the severity of papilloedema.

  • optic nerve

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  • Author Contributions JAM, BBB, NJN and VB contributed to the study conception and design, analysis and interpretation of data and drafting of manuscript. JAM, CV, RJB, DEB and JHP contributed to the acquisition of data. BBB, CV, RJB, DEB, JHP, NJN, VB contributed to the critical revision. All authors contributed to the final approval.

  • Funding This study was supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, New York, and by NIH/NEI core grant P30-EY006360 (Department of Ophthalmology). Dr VB received research support from NIH/PHS (UL1-RR025008). Dr NJN is a recipient of the Research to Prevent Blindness Lew R Wasserman Merit Award. Dr CV is the recipient of the Philippe Foundation grant.

  • Competing interest None declared.

  • Patient consent for publication Not required.

  • Ethics approval Emory University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data.

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