Patient Factors Associated With Vision Complaints in Idiopathic Intracranial Hypertension: A Cross-Sectional Study.

Introduction Idiopathic intracranial hypertension (IIH), formerly known as pseudotumor cerebri, is characterized by elevated intracranial pressure (ICP) and papilledema in the absence of focal neurological deficits or structural brain abnormalities. This study aimed to describe the demographic and clinical characteristics of a sample of patients with IIH and examine associations between visual complaints and various demographic, clinical, and ophthalmologic variables. Methods This retrospective cross-sectional study included 106 patients diagnosed with IIH in a neurology practice in the Southeast United States. Demographic data, clinical features, and ophthalmologic parameters were collected, including intraocular pressure (IOP) measurements and reports of visual complaints (blurred vision, vision loss, and transient visual obscuration). Lumbar punctures were conducted in either a seated (n=46) or lateral decubitus (n=60) position. Translaminar pressure difference (TLPD) was calculated. Chi-squared tests were used for categorical comparisons, and t-tests were used for continuous variables. Primary outcomes included the presence of visual complaints and their relationship with ICP, IOP, TLPD, and other clinical factors. Results Overall, 61% of patients reported at least one form of visual complaint, with symptom-specific prevalence ranging from 12% to 37%. In the lateral decubitus group, blurred vision occurred with higher TLPD (mean 44.0 vs 34.3, p=0.03, d=0.82). In the lateral decubitus group, blurred vision occurred with higher TLPD (mean 44.0 vs 34.3, p=0.03, Cohen's d=0.82). Vision loss occurred with lower IOP (mean 26.3 vs 36.1 mmHg, p=0.04, Cohen's d=1.09). Any vision complaint was associated with higher ICP (mean 38.0 vs 34.6 mmHg, p=0.04, Cohen's d=0.44). Conclusions IOP and TLPD showed outcome-specific associations with visual complaints, particularly blurred vision in patients sampled in lateral decubitus. These pressure measures may help risk-stratify visual symptoms in IIH and potentially warrant prospective validation.