Andrew G. Lee, MD Chair Ophthalmology, Houston Methodist Hospital, - - PowerPoint PPT Presentation

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andrew g lee md

Andrew G. Lee, MD Chair Ophthalmology, Houston Methodist Hospital, - - PowerPoint PPT Presentation

Dec 17, 2023 267 likes •429 views

12/4/2015 Five things every eye MD needs to I have no financial interest know about pseudotumor cerebri in the contents of this talk Andrew G. Lee, MD Chair Ophthalmology, Houston Methodist Hospital, Professor of Ophthalmology,

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Five things every eye MD needs to know about pseudotumor cerebri

Andrew G. Lee, MD

Chair Ophthalmology, Houston Methodist Hospital, Professor of

Ophthalmology, Neurology, & Neurosurgery, Weill Cornell Medical College; Clinical Professor, UTMB Galveston; UT MD Anderson Cancer Center; Adjunct Professor, Baylor COM, U. Iowa and U. Buffalo, SUNY

I have no financial interest in the contents of this talk

It’s called pseudotumor but it is a real disease that blinds people Five things to know about pseudotumor cerebri

Size does not matter in NeuroOp Obesity epidemic is here Fulminant IIH is an emergency Diamox and weight loss work Sheath fenestration vs. CSF shunt

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1978: I wanted to be a doctor… 2nd choice Jedi knight

Size doesn’t matter Little edema

Little edema can be Big problem

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Obesity Trends* Among U.S. Adults BRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1987

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1988

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

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Obesity Trends* Among U.S. Adults BRFSS, 1989

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

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Obesity Trends* Among U.S. Adults BRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

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Obesity Trends* Among U.S. Adults BRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

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Obesity Trends* Among U.S. Adults BRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. Adults BRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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Obesity Trends* Among U.S. Adults BRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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1999

Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008

(*BMI ≥30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Only in America Grades of evidence Grades translated to real world

1. Must do (standard of care, highly

recommended practice)

2. Should do (show just cause why not

following recommendation)

3. Could do (practice option)
4. Voo doo (“so new it might not be

true”)

5. Doo doo (unsupported, might be

false, evidence to suggest potentially

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Acetazolamide (+ diet) better than Placebo (+diet)

Frisen grades of papilledema

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Placebo Acetazolamide

Stenting of TSS in IIH

Pressure gradient across stenosis

Chicken and the Egg

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Collapsible sinus Rigid sinus (stented) Stent for IIH with stenosis IIH with severe acute visual loss: lumbar drain + surgery

Weight loss + Diamox

Get ready for cold steel

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More shunts for IIH (1998-2002)

Rising annual aggregate caseload of new CSF shunts for IIH increased 350% during this 14-year interval, or 9.4% annually (P < 0.001). Curry et al. Neurosurgery 2005;57:97-108

ONSF in US hospitals 1988 to 2002

Curry et al. Neurosurgery 2005;57:97-108

Rise in bariatric surgery

Curry et al. Neurosurgery 2005;57:97-108

Patient outcome: Cost & 0.5% mortality!

Curry et al. Neurosurgery 2005;57:97-108

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Five things to know about pseudotumor cerebri

Size does not matter Obesity epidemic Fulminant IIH Diamox and weight loss work Sheath fenestration vs. CSF shunt

What behavior changes do I want for you to make…. not just for your patients but for your kids, grandkids, yourself??

Drag yourself & your kid away from the computer!

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1978: I wanted to be a doctor…2nd choice Jedi knight It turns out I got to be both Thanks for your time & attention

Andrew G. Lee, MD

Chair Ophthalmology, Houston Methodist Hospital, Professor of

Ophthalmology, Neurology, & Neurosurgery, Weill Cornell Medical College; Adjunct Professor: Baylor College of Medicine,

U. Iowa & Clinical Professor, UTMB Galveston, UT MD Anderson

Cancer Center, U. Buffalo, SUNY