RETINAL NERVE-FIBER LAYER CHANGES AND VISUAL-FIELD LOSS IN IDIOPATHICINTRACRANIAL HYPERTENSION

Purpose: The authors retrospectively analyzed changes in the retinal n erve fiber layer in patients with idiopathic intracranial hypertension and studied their relation to visual field loss to determine the clin ical usefulness of retinal nerve fiber analysis in the clinical manage ment of patients with papilledema. Methods: Retinal nerve fiber layer photographs and visual fields from 36 eyes of 21 patients with papille dema due to idiopathic intracranial hypertension were analyzed for abn ormalities in a masked fashion. Results: Nerve fiber layer changes wer e found in 67% of eyes studied. Superior areas within the nerve fiber layer were affected 5.4 times more frequently than inferior regions. V isual field loss was more prevalent in eyes with diffuse nerve fiber l ayer loss (89%) than in eyes with slit defects (29%). The location of the nerve fiber layer changes correlated with corresponding areas of v isual field loss. Nerve fiber layer changes were as common in mild to moderate as in atrophic papilledema; however, slit defects predominate d in patients with mild to moderate papilledema, and diffuse loss pred ominated in atrophic papilledema. Conclusions: Changes in the retinal nerve fiber layer observed in patients with idiopathic intracranial hy pertension provide objective information regarding the status of their optic nerve and may improve their clinical management.