Impairment of retinal nerve fiber layer and macular impairment identified, according to papilledema severity
By Elana Gotkine HealthDay Reporter
THURSDAY, Oct. 30, 2025 (HealthDay News) — Two mechanisms of structural and functional retinal impairment based on papilledema severity have been identified among patients with idiopathic intracranial hypertension (IIH), according to a study published online Oct. 29 in Neurology.
Laleh D. Molander, M.D., from Odense University Hospital in Denmark, and colleagues conducted a prospective cohort study at two tertiary headache centers from January 2018 to September 2022, including 154 adult patients with IIH to map patterns of structural and functional retinal damage according to papilledema severity.
The researchers identified two mechanisms of structural and functional retinal damage according to papilledema severity. The first was impairment of the retinal nerve fiber layer, with increasing papilledema severity paralleled by increasing atrophy of the retinal nerve fiber layer and the ganglion cell layer, yielding peripheral scotomata, which did not affect visual acuity. The second mechanism was macular impairment, with persisting reduction of visual acuity resulting from grade 4 papilledema combined with macular edema, macular exudate, or disorganization of the inner retinal layer. A score was proposed to predict visual outcome using modified desirability of outcome ranking. There was a correlation for the score with papilledema severity and disorganization of the inner retinal layer, but no correlation with lumbar puncture opening pressure, neurofilament light chain, or magnetic resonance imaging characteristics associated with IIH.
“This score needs to be validated by external groups before it can be considered ready for use, but we identified the severity of papilledema and the disorganization of the inner layer of the retina as major predictors for who will have persistent vision problems,” coauthor Dagmar Beier, M.D., from the University of Southern Denmark, said in a statement.
Several authors disclosed ties to the pharmaceutical industry.
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