Retinal Nerve Fiber Layer Changes and Visual Field Loss in Idiopathic Intracranial Hypertension

Purpose: The authors retrospectively analyzed changes in the retinal nerve fiber layer in patients with idiopathic intracranial hypertension and studied their relation to visual field loss to determine the clinical usefulness of retinal nerve fiber analysis in the clinical management of patients with papilledema. Methods: Retinal nerve fiber layer photographs and visual fields from 36 eyes of 21 patients with papilledema due to idiopathic intracranial hypertension were analyzed for abnormalities in a masked fashion. Results: Nerve fiber layer changes were found in 67% of eyes studied. Superior areas within the nerve fiber layer were affected 5.4 times more frequently than inferior regions. Visual field loss was more prevalent in eyes with diffuse nerve fiber layer loss (89%) than in eyes with slit defects (29%). The location of the nerve fiber layer changes correlated with corresponding areas of visual field loss. Nerve fiber layer changes were as common in mild to moderate as in atrophic papilledema; however, slit defects predominated in patients with mild to moderate papilledema, and diffuse loss predominated in atrophic papilledema. Conclusions: Changes in the retinal nerve fiber layer observed in patients with idiopathic intracranial hypertension provide objective information regarding the status of their optic nerve and may improve their clinical management.