Quality of life in idiopathic intracranial hypertension at diagnosis: IIH Treatment Trial results

Abstract

Objective: The study purpose was to examine vision-specific and overall health-related quality of life (QOL) at baseline in Idiopathic Intracranial Hypertension Treatment Trial patients who were newly diagnosed and had mild visual loss. We also sought to determine the associations between vision-specific QOL scores and visual symptoms, visual function, pain, headache-related disability, and obesity.

Methods: We assessed QOL using the 36-Item Short Form Health Survey, National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), and 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement. We compared these results with those of previously reported idiopathic intracranial hypertension (IIH) QOL studies. We assessed relationships between QOL and other clinical characteristics.

Results: Among 165 participants with IIH (161 women and 4 men with a mean age ± SD of 29.2 ± 7.5 years), vision-specific QOL scores were reduced compared with published values for disease-free controls. Scores of participants were comparable to published results for patients with multiple sclerosis and a history of optic neuritis. A multiple linear regression model for the NEI-VFQ-25 composite score found that perimetric mean deviation in the best eye, visual acuity in the worst eye, visual symptoms, and pain symptoms (headache, neck pain), but not obesity, were independently associated with QOL.

Conclusions: IIH affects QOL at time of diagnosis even in patients with mild visual impairment. Vision-specific QOL in patients with newly diagnosed IIH may be as decreased as that for patients with other neuro-ophthalmic disorders. IIH treatment should target visual loss and other symptoms of increased intracranial pressure associated with reduced QOL. Reduced QOL does not simply reflect obesity, an underlying IIH risk factor.

Figure. Baseline NEI-VFQ-25 composite score vs HIT-6 score in IIHTT participants with newly diagnosed IIH

Plot of the NEI-VFQ-25 composite score (y-axis) vs HIT-6 score (x-axis) at baseline in participants with newly diagnosed IIH in the IIHTT. The plot also shows the least-squares regression line. Higher HIT-6 scores, consistent with worse headache disability, were significantly associated with worse NEI-VFQ-25 composite scores (−0.75 per point increase on the HIT-6; 95% confidence interval: −1.00, −0.50; p < 0.001). HIT-6 = 6-item Headache Impact Test; IIH = idiopathic intracranial hypertension; IIHTT = Idiopathic Intracranial Hypertension Treatment Trial; NEI-VFQ-25 = National Eye Institute Visual Function Questionnaire–25.