Sensory visual testing in idiopathic intracranial hypertension: measures sensitive to change

Management decisions in idiopathic intracranial hypertension (IIH; pseudotumor cerebri) are based on the presence and change of visual loss. To study this change, we evaluated tests of sensory visual function over time. We used the results of the right eye of 19 patients whose clinical status improved (decrease in papilledema grade), and compared the outcome measures of the initial and final examinations. Contrast sensitivity testing showed significant improvement in the middle and high spatial frequency targets. Snellen acuity and color tests did not change significantly over the same period. Both Goldmann and automated visual field grade significantly improved from the initial to the final visit, while the presence of a defect on confrontation visual fields did not. Numerical analyses of automated perimetry thresholds also showed significant improvement. Generalized loss, most pronounced on the nasal side of the visual field, was present on the initial examination. Generalized improvement followed, least in the central and inferior paracentral areas. Patients with IIH should be followed with contrast sensitivity testing and perimetry using a disease-specific strategy.