Onset of idiopathic intracranial hypertension (IIH) at a later age is not associated with worse visual outcomes and should be managed similarly to younger patients with the same condition, according to research published in the American Journal of Ophthalmology. 

Researchers conducted a multicenter, retrospective, clinical cohort study of 65 patients aged 50 or older diagnosed for the first time with IIH. A medical record review was conducted at 3 sites in the United States to identify patients for inclusion. Each center also provided a randomly selected patient diagnosed with IIH who was younger than 50 years of age.

Median age in the IIH cohort was 54 years (interquartile range [IQR] 51-60]. Patients in this group were 78.5% male, had fewer headaches at presentation 50.8%), and were more frequently asymptomatic, with incidental 29.2% having IIH discovered during unrelated eye care. These patients also demonstrated lower cerebrospinal fluid opening pressures (median, 33; IQR 27 to 39) and more commonly had comorbid medical conditions such as hypertension, diabetes, and thyroid disease. 


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Investigators found that older age at diagnosis was not associated with worse outcomes; insignificant differences in automated perimetry mean deviation at first and final visits were recorded (-2.63 vs -2.64 in the older group and -1.94 vs -1.16 in the younger group; P =.190), need for surgical treatment with cerebrospinal fluid shunt (6.5% vs 7.7%, P >.999), and optic nerve sheath fenestration (6.3% vs 11.3%; P =.360). Both groups demonstrated similar optic disc grade at first and final visits (2 vs 3; P =.955 and 0 vs 0; P =.808). 

Final visual acuity was worse in the cohort of older patients, but no significant difference in change between the first and final visits was noted (0 vs 0; P =.097). Multiple variable analyses were conducted and did not identify any additional significant associations between study endpoints and age group or other covariates.

The primary study limitation was the low incidence of patients 50 or older diagnosed with IIH, result in a small study sample size. 

“We found that older patients with IIH experience a similar presentation, clinical course, treatment, and other visual outcome as younger patients and should be managed similarly,” the study concludes. “Given that older patients have fewer symptoms of IIH, this could suggest these patients represent delayed recognition of longstanding IIH.” 

Reference 

Downie PA, Chen JJ, Bhatti MT, et al. Clinical characteristics of idiopathic intracranial hypertension in patients over 50 years of age: A multicenter clinical cohort study. Am J Ophthalmol. Published online November 27, 2020. doi: 10.1016/j.ajo.2020.11.007