Coinciding with leaves changing colour in the beautiful grounds of Remuera Golf Club, Eye Doctors’ first Grand Round is a trusted autumn calling card. While guests enjoyed a delicious dinner, practice manager Shellene Garofalakis welcomed everyone with a quick-fire quiz to switch our brains into gear.
Next, Dr Arvind Gupta delved into idiopathic intracranial hypertension (IIH). While this chronic condition is rare in the general population globally, it is much more common in this part of the world due to a genetic predisposition. Most patients (>90%) are female and within reproductive age, with the most commonly presented symptom being headache, typically in the early morning. The most common ocular sign of IIH is bilateral disc oedema.
The condition is associated with a high body mass index (BMI) and, for many patients, its impact tends to fluctuate over time with lifestyle changes and medication. Dr Gupta said there is also a very small group of atypical patients he sees where headaches and optic disc oedema are absent, but with transient visual obscurations (70%), back and neck pain (50%), pulsatile tinnitus (>50%) and some (10–20%) who are completely asymptomatic.
Pseudotumor cerebri (PTC) has the clinical features of IIH but is due to a secondary cause, with or without obesity. Medications known to elevate the risk of developing IIH include tetracycline antibiotics (eg. minocycline, doxycycline), ciclosporin (immunosuppressant), sertraline (anti-depressant) and topical retinoic acid (for acne treatment). These patients typically present with a sudden onset of symptoms with rapid improvement after removal of the offending factor.
There was a discussion about the new weight-loss drugs (glucagon-like peptide-1 receptor agonists) available and their role in lowering BMI. Dr Gupta agreed that while patients are on the drugs, they appear effective and also help bring the disc swelling right down but there are other side effects and a lack of long-term data, he said. More on this in May’s issue of NZ Optics.
