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Correspondence: When an article is eligible for submission of Correspondence, a link to the response form is available within the full-text article. You must be a current subscriber who has activated the online portion of your subscription in order to send a Correspondence. Any reader can read published Correspondence.

Correspondence to:

BRIEF COMMUNICATIONS:
D. I. Friedman, L. K. Gordon, R. A. Egan, D. M. Jacobson, H. Pomeranz, A. R. Harrison, and Y. Goldhammer
Doxycycline and intracranial hypertension
Neurology 2004; 62: 2297-2299 [Abstract] [Full text] [PDF]
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Correspondence published:

[Read Correspondence] Reply to Chan et al
Deborah I Friedman, Lynn K. Gordon, Robert A. Egan   (27 September 2004)
[Read Correspondence] Doxycycline and intracranial hypertension
Alice Y.K. Chan, David T.L. Liu   (27 September 2004)

Reply to Chan et al 27 September 2004
Previous Correspondence Top
Deborah I Friedman,
University of Rocheter School of Medicine
601 Elmwood Avenue, Box, 659, Rochester, NY 14642,
Lynn K. Gordon, Robert A. Egan

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Re: Reply to Chan et al

Deborah_Friedman{at}urmc.rochester.edu Deborah I Friedman, et al.

We thank Chan et al for their interest in doxycycline-associated intracranial hypertension. The visual morbidity in idiopathic intracranial hypertension or intracranial hypertension from a secondary cause depends largely on how vigorously the visual function is scrutinized. It is hoped that increased awareness of increased intracranial pressure from tetracyclines has produced earlier diagnosis and treatment, and lower rates of visual loss than when Drs. Wall and George compiled their series almost 20 years ago. The number of patients in our series is so small that statistical comparison is not meaningful.

Our patients had either automated or Goldmann perimetry, depending on the preference of the treating physician. Both methods have their advantages and disadvantages. Given that most ophthalmologists in the U.S. no longer have a Goldmann perimeter in their office, it seems impractical to recommend both methods of testing for all patients. One must use the resources available and best clinical judgment to treat these patients.

Because of the devastating complication of visual loss that Chan et al emphasize, BIH is not an acceptable term for this disorder.
Doxycycline and intracranial hypertension 27 September 2004
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Alice Y.K. Chan,
Department of Medicine & Therapeutics, the Chinese University of Hong Kong, Hong Kong
Department of Medicine & Therapeutics, 9/F, Professorial Block, Prince of Wales Hospital, Hong Kong,
David T.L. Liu

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Re: Doxycycline and intracranial hypertension

alice_ykchan{at}yahoo.com.hk Alice Y.K. Chan, et al.

Friedman et al showed only two of fourteen eyes (14.3%) in seven BIH patients associated with doxycycline, ending up with moderate to severe vision loss. This figure is substantially lower than the 50% vision loss reported by Wall et al and is also lower than the 20% found by Hung et al. [1,2] Vision loss in terms of drop of visual acuity and visual field defect is not only an important complication of BIH but also an essential therapeutic indicator for treatment strategy. [2] Therefore, we disagree with the authors’ approach in managing the cases. Perhaps a serial combined perimetry consisting of manual and automated perimeters is warranted in BIH patients, especially those with high risk characteristics such as older age and systemic hypertension. [1,2]

References

1. Wall N, George D. Visual loss in pseudotumor cerebri. Incidence and defects relate to visual field strategy. Arch Neurol 1987;44:170-175.

2. Hung HL, Kao LY, Huang CC. Ophthalmic features of idiopathic intracranial hypertension. Eye 2003;17:793–795.
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