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New research · Ophthalmology
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society · 1d
Randomized trialJournal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society · 2026

What Have We Learned From the Idiopathic Intracranial Hypertension Treatment Trial the William F. Hoyt Lecture.

Michael Wall
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OphthalmologyRandomized trial

Acetazolamide plus diet improved visual field function more than diet alone in intracranial hypertension

What Have We Learned From the Idiopathic Intracranial Hypertension Treatment Trial the William F. Hoyt Lecture.

Michael Wall
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society · 2026
Background

The Idiopathic Intracranial Hypertension Treatment Trial's (IIHTT) objective was to evaluate the efficacy and safety of acetazolamide, combined with a low-sodium weight-reduction diet, in improving visual function in patients with idiopathic intracranial hypertension (intracranial hypertension) and mild visual loss.

Methods

Were randomized to acetazolamide or placebo, each combined with a structured dietary program.

n = 165 participants
Results

Extra improvement in visual field testing with acetazolamide vs placebo.

1.43dB
Acetazolamide
0.71dB
Placebo
More results

Acetazolamide significantly improved papilledema grade and OCT optic disc volume and reduced cerebrospinal fluid pressure by an additional 60-mm H2O compared with placebo (P = 0.002).

Seven participants experienced treatment failure (6 placebo, 1 acetazolamide).

More results

Risk factors for treatment failure were high-grade papilledema, more than 30 transient visual obscurations per month, visual acuity loss, and male sex.

Compliance of study drug was high (89% vs 93%).

“
Conclusion · 1 of 2

Acetazolamide plus diet gave statistically significant improvements of visual function, papilledema, cerebrospinal fluid pressure, and quality of life in patients with intracranial hypertension with mild visual loss.

Conclusion · 2 of 2

A maximally tolerated dose up to 4 g/day is recommended.

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