Follow-up of Mild Papilledema in Idiopathic Intracranial Hypertension with Optical Coherence Tomography

PURPOSE. To evaluate optical coherence tomography (OCT) measurement of peripapillary retinal nerve fiber layer (RNFL) thickness in patients with mild papilledema associated with idiopathic intracranial hypertension. METHODS. Patients with papilledema underwent a complete ophthalmic examination, including peripapillary RNFL analysis with OCT (Fast RNFL thickness 3.46; Carl Zeiss Meditec, Inc., Dublin, CA) at diagnosis and 3, 6, and 12 months after presentation. Age- and sex-matched control subjects underwent a similar evaluation. Changes in RNFL overall thickness and by quadrant and interocular differences were evaluated and studied regarding changes in visual field global indices (mean deviation [MD] and pattern SD [PSD]). RESULTS. Both eyes of 22 patients with mild papilledema and 22 control subjects were included. At diagnosis, the RNFL thickness was 183.3 +/- 74.7 mu m and 74.9% (78.5 mu m) greater than in control eyes. Mean RNFL thicknesses in all quadrants were significantly greater in eyes with papilledema (P = 0.000). The mean average RNFL was significantly correlated with the MD (sigma = -0.451, P = 0.002) and PSD (sigma = 0.370, P = 0.013) at diagnosis. The RNFL thickness decreased significantly (P = 0.000), whereas the mean MD and the mean PSD improved (P = 0.000 and P = 0.005, respectively) at each follow-up visit. Regression analysis showed that for every 10 mu m of mean RNFL thickness increase at baseline, there was a 0.6-dB decrease in MD at the last follow-up. CONCLUSIONS. Peripapillary RNFL thickness abnormalities assessed by OCT in patients with mild papilledema were quantitatively correlated with visual field sensitivity losses. The data support the possible use of OCT as a noninvasive quantitative method of monitoring the amount and evolution of papilledema. (Invest Ophthalmol Vis Sci. 2009;50:5197-5200) DOI:10.1167/iovs.08-2528