Retinal Vessel Dynamics Analysis As a Surrogate Marker for Raised Intracranial Pressure in Patients with Suspected Idiopathic Intracranial Hypertension

Introduction: Retinal vessel dynamics analysis has proven to be a viable, non-invasive surrogate marker for increased intracranial pressure. We aimed to test this method in patients with suspected idiopathic intracranial hypertension.

Methods: Patients with suspected idiopathic intracranial hypertension were prospectively enrolled for hand-held fundus-videography during diagnostic lumbar puncture. After extracting optic disc images, peripapillary arteriole-to-venule-ratios were measured using machine-learning algorithms with manual identification control. A general linear model was applied to arteriole-to-venule-ratios and corresponding lumbar opening pressures to estimate cerebrospinal fluid pressure.

Results: Twenty-five patients were included with a significant difference in arteriole-to-venule-ratio between patients with ( = 17) and without ( = 8) idiopathic intracranial hypertension (0.78 ± 0.10 vs 0.90 ± 0.08,  = 0.006). Arteriole-to-venule-ratio correlated inversely with lumbar opening pressure (slope regression estimate -0.0043 (95% CI -0.0073 to -0.0023),  = 0.002) and the association was stronger when lumbar opening pressure exceeded 15 mm Hg (20 cm HO) (slope regression estimate -0.0080 (95% CI -0.0123 to -0.0039),  < 0.001). Estimated cerebrospinal fluid pressure predicted increased lumbar opening pressure >20 mm Hg (27 cm HO) with 78% sensitivity and 92% specificity (AUC 0.81,  = 0.02). A stand-alone arteriole-to-venule-ratio measurement predicting lumbar opening pressure >20 mm Hg (27 cm HO) was inferior with a 48% sensitivity and 92% specificity (AUC 0.73, 0.002).

Conclusion: Retinal vessel dynamics analysis with the described model for estimating cerebrospinal fluid pressure is a promising non-invasive method with a high sensitivity and specificity for detecting elevated intracranial pressure at follow-up assessments of patients with confirmed idiopathic intracranial hypertension if initial lumbar opening pressure and arteriole-to-venule-ratio data are available.