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Retinal vessel diameter changes after 6 months of treatment in the Idiopathic Intracranial Hypertension Treatment Trial
  1. Heather E Moss1,2,
  2. Rachel A Hollar3,
  3. William S Fischer3,
  4. Steven E Feldon3
  1. 1 Byers Eye Institute, Stanford University, Palo Alto, California, USA
  2. 2 Department of Neurology & Neurological Sciences, Stanford University, Stanford, California, USA
  3. 3 David and Ilene Flaum Eye Institute, University of Rochester, Rochester, New York, USA
  1. Correspondence to Dr Heather E Moss, Department of Ophthalmology, Stanford University, Palo Alto, California, USA; hemoss{at}


Background/Aims Prior studies support an association between increased retinal venule diameter and elevated intracranial pressure (ICP). The purpose of this study was to test the hypothesis that retinal venule diameters decrease in association with long-term therapy for high ICP in subjects with idiopathic intracranial hypertension (IIH).

Methods This is a retrospective analysis of multicentre randomised controlled trial data. Standardised procedures were used to measure area of optic nerve head elevation (ONHA) and diameters of 4 arterioles and 4 venules 2.7 mm from the optic disc centre on fundus photos collected at baseline and after 6 months of randomised treatment with placebo+diet or acetazolamide+diet in subjects participating in the IIH Treatment Trial (IIHTT) (n=115). Change in arteriole (Da) and venule (Dv) diameters from baseline to 6 months was studied as a function of IIH, haemodynamic and demographic variables.

Results Dv decreased following 6 months of therapy (8.1 µm, 5.9%, p<0.0005) but Da did not change. Dv change was associated with ONHA change (p<0.0005, r=0.47) and this association persisted in multiple variable models.

Conclusions Retinal venule diameter decreased, and arteriole diameter did not change in association with treatment for elevated ICP with a weight loss intervention and placebo or acetazolamide in IIHTT participants. Further study is needed to determine how retinal vessel measurements can be combined with other clinical observations to inform disease management.

  • diagnostic tests/investigation
  • imaging
  • optic nerve
  • retina

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  • Presented at Association for Research in Vision and Ophthalmology 2018 Annual Meeting

  • Twitter Heather E Moss @HeatherMossMD

  • Contributors Conception or design of the work: HEM and SEF. Acquisition, analysis or interpretation of data: HEM, RAH, WSF and SEF. All authors contributed to drafting the work or revising it critically for important intellectual content and have approved the final version.

  • Funding This work was supported by the National Institutes of Health (Grants 1U10EY017281-01A1 (NORDIC), 1U10EY017387-01A1 (Data Coordination and Biostatistics Center), 3U10EY017281-01A1S1 (American Recovery and Reinvestment Act for NORDIC), 1U10EY017387-01A1S1 (Data Coordination and Biostatistics Center), 3U10EY017281-01A1S2 (supplements for NORDIC), K23EY024345 (HM), P30 EY026877), Research to Prevent Blindness (unrestricted grants to the Departments of Ophthalmology at the University of Rochester and Stanford University).

  • Competing interests SEF is a consultant to Association of University Professors of Ophthalmology and a Trustee of Doheny Eye Institute.

  • Patient consent for publication Not required.

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

  • Data availability statement Data were obtained from IIHTT study management, to whom any requests for study data should be referred.

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