Risk factors for Poor Visual Outcome in Idiopathic Intracranial Hypertension Patients with Mild Visual Loss (S26.004)

OBJECTIVE: To study risk factors related to progressive visual field loss in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). BACKGROUND: IIHTT is a multicenter randomized, double-masked, placebo-controlled clinical trial (NCT01003639). Analysis from the IIHTT has shown the use of acetazolamide (maximally tolerated up to 4 g/day) with a low-sodium weight-reduction diet compared with diet alone resulted in modest improvement in visual field function in IIH patients with mild visual DESIGN/METHODS: Participants (n=165) were enrolled from 2010 to 2012 and followed for 6 months. All participants met the modified Dandy criteria and had a perimetric mean deviation between -2 to -7 dB. The mean age was 29 years and all but four participants were women. 151 subjects were followed for more than one month and were used for analysis. Seven patients (5 women, 2 men; 6 placebo, 1 acetazolamide) had progressive visual field loss that met IIHTT criteria for treatment failure. RESULTS: Patients with higher grade papilledema but lower ETDRS visual acuity in the study eye were more likely to have progressive field loss. The odds ratio (OR) for patients with grades III-V grade papilledema vs. those of grades I-II was 8.6 (95[percnt]CI:1.7,infinite;p-value=0.025). A one unit increase in the number of ETDRS letters correct at baseline was associated with a decrease in the odds of progressive field loss by a factor of 0.86 (CI:0.77,0.96:p=0.005). Compared to female patients, the OR for male patients was 26.3 (CI:1.6,5000;p-value=0.0054). Subjects with progressive field loss had over 2½ times as many transient visual obscurations monthly; the difference was not significance (p=0.13). CONCLUSIONS: Male patients, those with high grade papilledema and those with decreased visual acuity at baseline were more likely to experience progressive field loss. These patients should be monitored closely and provided with appropriate treatment of their IIH. Study Supported by: NEI-1U10EY017281-01A1 Disclosure: Dr. Lam has nothing to disclose. Dr. Falardeau has nothing to disclose. Dr. Fletcher has nothing to disclose. Dr. Granadier has nothing to disclose. Dr. Longmuir has nothing to disclose. Dr. Patel has nothing to disclose. Dr. He has nothing to disclose. Dr. McDermott has nothing to disclose. Dr. Wall has received personal compensation for activities with Boeringer Ingelheim as a consultant.