The Use of Combined Fundus Photography and Perimetry for the Assessment of Patients Referred for Intracranial Hypertension or Follow-Up of the Diagnosis in a Tertiary Headache Center

OBJECTIVES: Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure and papilledema. If left untreated, it can lead to vision loss, and, timely detection of papilledema is of paramount importance. Direct ophthalmoscopy can be difficult to perform and interpret for non-ophthalmologists. Therefore, this study aimed to investigate the impact of combined fundus photography and perimetry (CFPP) on patients with suspicion of new-onset IIH or IIH follow-up.

METHOD: The study was based on a cross-sectional, retrospective chart review of all patients who underwent CFPP examination due to suspicion of new-onset IIH or IIH follow-up at the Danish Headache Center between 2020 and 2023.

RESULTS: 258 patients were included for analysis, 92% females aged 17-72 years (mean age: 35.8 years). CFPP was performed due to clinical suspicion of new-onset IIH (38%), worsening/relapse of IIH (24%), assurance check in known IIH (19%), subjective symptoms (5%) or other reasons (14%). Overall, 62% had normal fundus photos, 21% had optic disc edema, 10% had other coincidental findings in the retina and/or optic disc, and 6% had an optic disc status unchanged from previous examinations. The use of CFPP confirmed the suspicion of IIH in 8% of patients and disproved it in 40% of patients. The CFPP results changed the treatment plan in 28% and caused referral to a neuroophthalmologist in 16% of patients.

CONCLUSION: CFPP can be used as a time- and resource-saving screening tool in headache patients with suspicion of new-onset IIH or follow-up in a tertiary neurology setting.