Cup-to-Disc Ratio in Patients With Idiopathic Intracranial Hypertension Is Smaller Than That in Normal Subjects

Geddie, Brooke; Altiparmak, Uğur; Eggenberger, Eric

doi:10.1097/wno.0b013e3181dee8c6

Cited by 5 publications

(5 citation statements)

References 12 publications

(2 reference statements)

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“…Glaucomatous optic neuropathy is characterized by thinning of the neural rim and enlargement of CV. The opposite characters are seen in IIH . However, an overcrowded disc cup can be physiological .…”

Section: Discussionmentioning

confidence: 92%

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Huang‐Link

Eleftheriou

Yang

et al. 2019

Euro J of Neurology

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Background and purpose We previously reported that certain optical coherence tomography (OCT) measures were sensitive and reliable in identifying idiopathic intracranial hypertension (IIH). This prospective study aimed to define OCT measures that allow differentiation of IIH with and without papilledema, thereby helping clinical decision‐making. Methods Eight patients with IIH with papilledema, nine without papilledema and 19 with other neurological diseases were included. OCT measures were obtained before lumbar puncture and within 2 h, 1, 3 and 6 months after lumbar puncture with cerebrospinal fluid (CSF) removal. Results All patients with papilledema had increased retinal nerve fiber layer (RNFL) thickness and elevated CSF pressure. All patients without papilledema had normal RNFL but elevated CSF pressure. After CSF removal, reduced RNFL thickness was registered in all eight patients with IIH with papilledema. No significant change in RNFL thickness after CSF removal was observed in IIH without papilledema or in patients with other neurological diseases, although reduced CSF pressure was documented. RNFL thickness tended to be normal in patients with IIH with papilledema at 3–6 months after CSF removal. All patients with IIH showed increased rim area and rim thickness, but reduced optic cup volume regardless of RNFL thickness or papilledema. Conclusions Retinal nerve fiber layer thickness is sensitive for monitoring acute IIH and evaluating treatment effect. Increased rim area and rim thickness and decreased optic cup volume are reliable parameters that indicate persistently increased CSF pressure and risk of relapse. OCT measures are sensitive and reliable for diagnosing subtle IIH even in the absence of papilledema.

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Section: Discussionmentioning

confidence: 92%

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Huang‐Link

Eleftheriou

Yang

et al. 2019

Euro J of Neurology

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“…10 Likewise, translaminar pressure with subsequent optic nerve damage in primary open angle glaucoma (POAG) can manifest as a typical glaucomatous cupping with an increased CDR. 11 Although two previous studies of IIH have documented a smaller CDR in patients with IIH with papilloedema (IIHWP) as compared with normal subjects, 13,14 to our knowledge, no prior study has examined the CDR in patients with IIHWOP. Based upon our initial clinical impressions about CDR in IIH, we hypothesised that, as in NAION, a small CDR might be a structural risk factor for the development of IIHWP and a larger CDR might be associated with IIHWOP.…”

Section: Introductionmentioning

confidence: 95%

Cup-to-Disc Ratio in Idiopathic Intracranial Hypertension without Papilloedema

Hamill

Kim

Yalamanchili

et al. 2014

Neuro-Ophthalmology

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This study seeks to characterise potential differences in the cup-to-disc ratio (CDR) of patients with idiopathic intracranial hypertension (IIH) with papilloedema (IIHWP) compared with IIH without papilloedema (IIHWOP). The medical charts, optical coherence tomography (OCT), and digital optic disc photos of 30 patients (59 eyes) with IIHWP and 4 patients (8 eyes) with IIHWOP were reviewed retrospectively. The CDR values of the two groups were analysed using the Wilcoxon-Mann-Whitney test. Results showed a statistically significant smaller CDR in patients with IIHWP as compared with IIHWOP. These findings suggest that structural factors of the optic disc may play a role in the development of or lack thereof of papilloedema in patients with IIH.

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“…26,27 Investigations into the association between optic cup size and ODE development due to causes other than NAION are limited. To date, 2 studies have reported that patients with IIH have smaller cup-disc ratios than do normal controls after the ODE resolves, 16,17 and a third study identified that patients with IIH and papilledema have smaller cup-disc ratios after ODE resolution than do patients with IIH who never developed papilledema. 15 Although the present study also found that optic cup size (quantified as cup volume, width, or depth) is associated with ODE development, an association between cupdisc ratio and ODE was not observed.…”

Section: Discussionmentioning

confidence: 99%

“…This discat-risk profile has been associated with at least 2 terrestrial conditions involving ODE both in the absence and presence of elevated intracranial pressure. Specifically, a crowded ONH is a risk factor for nonarteritic anterior ischemic optic neuropathy (NAION) [9][10][11][12][13][14] and may be associated with an increased risk of papilledema in idiopathic intracranial hypertension (IIH), [15][16][17] a condition that shares several clinical findings with SANS, including ODE, chorioretinal folds, and globe flattening. A second potential factor is higher body weight, which has been reported to have an association with the presence of ODE and choroidal folds after spaceflight.…”

mentioning

confidence: 99%

Identification of Factors Associated With the Development of Optic Disc Edema During Spaceflight

et al. 2022

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ImportanceApproximately 70% of crew members who complete long-duration missions to the International Space Station develop signs of optic disc edema, a hallmark finding of spaceflight-associated neuro-ocular syndrome. The onset and magnitude of edema differ across individuals, and the reason for this variability remains unknown. Identifying risk factors for spaceflight-induced disc edema is important because this condition may become more severe during extended-duration missions to the moon and Mars and could be associated with irreversible vision loss.ObjectiveTo assess whether preflight indicators of crowded optic nerve head morphology, other ocular measures (such as choroid thickness and axial length), body weight, body mass index, sex, age, and previous flight experience are associated with optic disc edema development.Design, Setting, and ParticipantsThis cohort study analyzed ocular, body weight, and demographic data collected from 31 US and international crew members before, during, and after spaceflight at the NASA Johnson Space Center and International Space Station. Ocular factors assessed included preflight and in-flight peripapillary total retinal thickness, minimum rim width, optic cup volume, mean cup depth, mean cup width, cup-disc ratio, Bruch membrane opening area, retinal nerve fiber layer thickness, choroid thickness, axial length, and refractive error. In addition, body weight, body mass index, sex, age, and previous spaceflight experience were assessed for associations with optic disc edema development. The data were analyzed from August 2021 to June 2022.ExposureApproximately 6 to 12 months of spaceflight.Main Outcomes and MeasuresIn-flight increases in peripapillary total retinal thickness. Linear mixed models were used to assess for associations between a wide range of risk factors and in-flight increases in peripapillary total retinal thickness, which is a sensitive objective measure for detecting optic disc edema.ResultsThis study included 31 International Space Station crew members with a mean (SD) age of 46.9 (6.0) years (25 men [80.6%]). During spaceflight, mean (SE) peripapillary total retinal thickness increased from 392.0 (5.8) μm to 430.2 (9.6) μm (P &lt; .001), and greater individual changes were associated with smaller preflight cup volume (slope [SE], −62.8 [18.9]; P = .002), shallower preflight cup depth (slope [SE], −0.11 [0.03]; P &lt; .001), and narrower preflight cup width (slope [SE], −0.03 [0.01]; P = .03). No associations were observed between changes in peripapillary total retinal thickness and any other variable evaluated.Conclusions and RelevanceFindings of this cohort study suggest that smaller optic cup morphology may be associated with optic disc edema development during spaceflight. Crew members with this cup profile may benefit from enhanced ophthalmic monitoring during spaceflight and use of countermeasures against spaceflight-associated neuro-ocular syndrome.

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Cup-to-Disc Ratio in Patients With Idiopathic Intracranial Hypertension Is Smaller Than That in Normal Subjects

Cited by 5 publications

References 12 publications

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Cup-to-Disc Ratio in Idiopathic Intracranial Hypertension without Papilloedema

Identification of Factors Associated With the Development of Optic Disc Edema During Spaceflight

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