Episode 7: GLP-1s and Idiopathic Intracranial Hypertension

In Episode 7 of From Paper to Clinic, "GLP-1 Receptor Agonists and Idiopathic Intracranial Hypertension," host Hamza Shah, OD, is joined by Leonard Messner, OD, FAAO, vice president and professor of optometry at the Illinois College of Optometry, joins the show to explore what a landmark randomized trial on exenatide reveals about the underlying mechanisms of IIH—and what it means for how optometrists manage the disease today.

For ODs managing or comanaging IIH, Messner's diagnostic framework is as instructive as the pharmacology. He emphasizes the case history, not just current BMI, but the trajectory of weight gain—and the 2 symptoms he drills down on above all others: chronic daily headaches and synchronous pulsatile tinnitus. OCT remains central, but not just for RNFL thickness—the morphology of the optic nerve on B-scan, specifically the inward displacement of Bruch's membrane complex at the lamina cribrosa, is among the most clinically meaningful findings. So is the ganglion cell complex, which he treats as the critical indicator of how much time the clinician has. "It's the glaucoma of the brain," he notes of IIH—progressive, trackable, and consequential in ways that only become clear with consistent visual field monitoring.

The paper inspiring this discussion is "The Effect of GLP-1RA Exenatide on Idiopathic Intracranial Hypertension: A Randomized Clinical Trial," by Mitchell and colleagues, published in Brain.