Men With Idiopathic Intracranial Hypertension at Risk for Vision Loss

Allison Gandey

October 23, 2008

October 23, 2008 — Men are twice as likely as women to develop severe vision loss, the largest study to date looking at idiopathic intracranial hypertension has found. Results are published online October 15 in Neurology.

"While intracranial hypertension occurs less often in men, their increased frequency of severe vision loss compared with women is a major concern," lead investigator Beau Bruce, MD, from Emory University, in Atlanta, Georgia, said in a news release.

"Our findings suggest that men with this condition should have more careful monitoring of their eyesight and likely should be treated more aggressively when they do have evidence of vision loss," he added.

The study also found men were more likely to have sleep apnea. Dr. Bruce says that more prospective studies are needed to evaluate the role of sleep apnea in the treatment of patients with intracranial hypertension, but that clinicians should consider referring affected patients — both men and women — for sleep studies.

"The take-home message is that men who meet the Dandy criteria should be extensively evaluated for causes of intracranial hypertension, including obstructive sleep apnea," Michael Wall, MD, from the University of Iowa, in Iowa City, and Valerie Purvin, MD, from Indiana University Medical Center, in Indianapolis, write in an accompanying editorial.

They suggest that it is prudent to follow visual function more closely in these patients and be more aggressive in treating them. This includes identifying and vigorously treating sleep apnea when present.

Investigators studied medical records for 721 consecutive patients from Emory University, the University of Mississippi, and Wayne State University. Researchers collected demographics, associated factors, and visual function at presentation and follow-up.

Men were on average older than the women in the study (37 years vs 28; P = .02). Men were less likely to report headache as a first symptom and continued to report fewer headaches than women at initial neuro-ophthalmologic assessment (79% vs 89%; P = .01)

Symptom Comparison Between Patients With Intracranial Hypertension

Symptom Men, n=66 (%) Women, n=655 (%) P
Sleep apnea 24 4 <.001
Headache 55 75 <.001
Visual disturbances 35 20 .005

Dr. Bruce and his team demonstrate that visual acuity and fields at presentation and last follow-up were significantly worse among men. The relative risk of severe visual loss for men compared with women was 2.1 (95% CI, 1.4 – 3.3; P = .002) for at least 1 eye and 2.1 (95% CI, 1.1 – 3.7; P = .03) for both eyes.

The researchers report that logistic regression supported sex as an independent risk factor for severe visual loss.

"Bruce et al report that 24% of the men had sleep studies that met criteria for obstructive sleep apnea," Drs. Wall and Purvin write. "But we do not know how many of the remaining 76% had negative polysomnography. Thus, the actual incidence of sleep apnea was likely underestimated. This is important because of the complex relationship between sleep apnea and intracranial hypertension."

The authors conclude that male sex remains an independent risk factor for severe visual loss in at least 1 eye when adjusted for age, diagnosis of sleep apnea, and headache as first sign of intracranial hypertension.

"While their conclusions are clearly supported statistically," the editorialists note, "sleep apnea was likely underdiagnosed. With prospective data collection, we might find that the reason for the poor visual outcome is sleep apnea rather than being male."

But regardless of the mechanism, the editorialists point out, better visual outcomes should be observed in men with intracranial hypertension.

The study was supported by a grant from Research to Prevent Blindness and the National Institutes of Health. The researchers have disclosed no relevant financial relationships.

Neurology. Published online October 15, 2008. Abstract Abstract

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