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Gaillard-Groleas C, Ormezzano O, Pollet-Villard F, Vignal C, Gohier P, Thuret G, Rougier MB, Pepin JL, Chiquet C. Study of nycthemeral variations in blood pressure in patients with non-arteritic anterior ischemic optic neuropathy. Eur J Ophthalmol 2024; 34:1576-1585. [PMID: 38470323 DOI: 10.1177/11206721241232027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
PURPOSE The objective of this study was to analyze the nycthemeral variations in blood pressure (BP) in individuals who presented with non-arteritic anterior ischemic optic neuropathy (NAION). METHODS BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.-6 a.m.; definition 2, 10 p.m.-7 a.m.; and definition 3, 10 p.m.-8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10-20%), mild dippers (0-10%), reverse dippers (< 0%), and extreme dippers (> 20%). RESULTS The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.-6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension after ABPM. No risk factor for NAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). CONCLUSION In our population of patients who had an episode of NAION, the proportion of extreme dippers was higher than that usually found in the literature. However, extreme dipping is not a frequent feature of patients with NAION as compared to patients with systemic hypertension. ABPM is recommended for all patients with NAION and unknown history of systemic hypertension.
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Affiliation(s)
- Claire Gaillard-Groleas
- Department of Ophthalmology, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000 Grenoble, France
| | - Olivier Ormezzano
- Department of Cardiology, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000 Grenoble, France
| | | | - Catherine Vignal
- Department of Ophthalmology, Urgences et neuro-ophtalmologie, Fondation Rothschild, 75940, Paris Cedex 19, France
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie, service des urgences ophtalmologiques, 75940, Paris Cedex 19, France
| | - Philippe Gohier
- Department of Ophthalmology, CHU de Angers, 21079 Dijon Cedex, France
| | - Gilles Thuret
- Department of Ophthalmology, CHU de Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Marie-Bénédicte Rougier
- Department of Ophthalmology, CHU de Bordeaux, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - Jean-Louis Pepin
- Univ. Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, 38000 Grenoble, France
- Pôle Thorax et Vaisseaux, CHU Grenoble, Université Grenoble Alpes, Grenoble, France
| | - Christophe Chiquet
- Department of Ophthalmology, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000 Grenoble, France
- Univ. Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, 38000 Grenoble, France
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Kupersmith MJ, Fraser CL, Morgenstern R, Miller NR, Levin LA, Jette N. Ophthalmic and Systemic Factors of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in the Quark207 Treatment Trial. Ophthalmology 2024; 131:790-802. [PMID: 38211825 DOI: 10.1016/j.ophtha.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
PURPOSE We describe the baseline ophthalmic and cardiovascular risk factors across countries, race, and sex for the Quark207 treatment trial for acute nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN Prospective, randomized controlled clinical trial. PARTICIPANTS Adults 50 to 80 years of age with acute NAION recruited from 80 sites across 8 countries. MAIN OUTCOME MEASURES Ophthalmic features of NAION and cardiovascular risk factors. METHODS We evaluated demographics and clinical and ophthalmologic data, including best-corrected visual acuity (BCVA) and average visual field total deviation (TD), in affected eyes and cup-to-disc ratio in fellow eyes at enrollment. We report the prevalence (mean and standard devition, and median and interquartile range [IQR]) of ophthalmic features and cardiovascular risk factors, stratified by country, race, and sex. We corrected for multiple comparisons using Dunn's test with Bonferroni correction for continuous variables and chi-square testing with Holm-Bonferroni correction for categorical variables. RESULTS The study enrolled 500 men and 229 women with a median age of 60 and 61 years (P = 0.027), respectively. Participants were predominantly White (n = 570) and Asian (n = 149). The study eye BCVA was 71 characters (IQR, 53-84 characters; approximately 0.4 logarithm of the minimum angle of resolution), and the TD was -16.5 dB (IQR, -22.2 to -12.6 dB) for stimulus III and -15.7 dB (IQR, -20.8 to -10.9 dB) for stimulus V. The vertical and horizontal cup-to-disc ratio was 0.1 (IQR, 0.1-0.3) for unaffected fellow eyes. The prevalence of cardiovascular risk factors varied among countries. The most notable differences were in the baseline comorbidities and ophthalmologic features, which differed between Asian and White races. Men and women differed with respect to a few clinically meaningful features. CONCLUSIONS The cardiovascular risk factors in the NAION cohort varied among the 7 countries, race, and sex, but were not typically more prevalent than in the general population. Ophthalmic features, typical of NAION, generally were consistent across countries, race, and sex, except for worse BCVA and TD in China. Men have a frequency of NAION twice that of women. Having a small cup-to-disc ratio in the fellow eye was the most prevalent risk factor across all demographics. This study suggests that factors, not yet identified, may contribute to the development of NAION. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mark J Kupersmith
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Clare L Fraser
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney Australia
| | - Rachelle Morgenstern
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neil R Miller
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leonard A Levin
- Departments of Ophthalmology and Visual Science, Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Attoui O, Castelain J, Chiquet C. [Optical coherence tomography analysis of the optic nerve head and macula of the fellow eye in acute unilateral nonarteritic anterior ischemic optic neuropathy]. J Fr Ophtalmol 2023; 46:327-333. [PMID: 36822921 DOI: 10.1016/j.jfo.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The objective of the study was to compare the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) of the fellow eyes of patients with acute nonarteritic anterior ischemic optic neuropathy (NAAION) to those of control subjects. METHODS This study included 46 patients with NAAION matched for age, sex and refraction data (spherical equivalent and/or axial length) to 46 control subjects. The anatomical parameters assessed using the Cirrus SD-OCT were the mean RNFL thickness, in the 4 quadrants (inferior, nasal, temporal, superior) and according to the 12 hourly meridians, GCC mean and in 6 quadrants centered on the fovea (infero-nasal, supero-nasal, infero-temporal, supero-temporal, superior and inferior) and parameters of the optic disc (Cup ratio - Vertical and Average Disc, Rim Area, Disc Area, Cup Volume). RESULTS Compared to the control group, the eyes contralateral to those affected by NAAION showed a greater value of the area of the neuro-retinal rim (rim area), and a smaller vertical cup/disc (C/D) ratio, mean C/D, and cup volume than the control group. There was no significant difference between the two groups for peripapillary RNFL thickness and GCC parameters. CONCLUSION The absence of damage to the RNFL or GCC of the unaffected fellow eyes of patients with NAAION does not explain the perimetric damage. The eyes contralateral to those affected by NAAION are characterized by an overall size of the optic disc identical to those of the control subjects, but a smaller cup, a recognized risk factor for NAAION.
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Affiliation(s)
- O Attoui
- Clinique universitaire d'ophtalmologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, HP2 Laboratory, Inserm U1300, CS 10217, 38043 Grenoble cedex09, France
| | - J Castelain
- Clinique universitaire d'ophtalmologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, HP2 Laboratory, Inserm U1300, CS 10217, 38043 Grenoble cedex09, France
| | - C Chiquet
- Clinique universitaire d'ophtalmologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, HP2 Laboratory, Inserm U1300, CS 10217, 38043 Grenoble cedex09, France.
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Tabatabaee S, Rezania F, Soleimani S, Mirzaasgari Z. Hyperhomocysteinemia is related to large vessel occlusion in young patients with COVID-19: Two case reports. Clin Case Rep 2022; 10:e6716. [PMID: 36523374 PMCID: PMC9748218 DOI: 10.1002/ccr3.6716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Here, we report two cases of previously healthy young men with COVID-19 infection who developed acute ischemic stroke due to large vessel occlusion followed by secondary events concerning for a further thromboembolic event. We hypothesize that the hypercoagulable state related to COVID-19 exacerbated the underlying hereditary thrombophilia.
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Affiliation(s)
| | - Fatemeh Rezania
- Neurosciences DepartmentSt Vincent's hospitalMelbourneVictoriaAustralia
| | - Sevim Soleimani
- Student Research Committee, Faculty of medicineShahid Beheshti University of Medical SciencesTehranIran
| | - Zahra Mirzaasgari
- Division of NeurologyFiroozgar hospital, Iran University of Medical SciencesTehranIran
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Chiquet C, Vignal C, Gohier P, Heron E, Thuret G, Rougier MB, Lehmann A, Flet L, Quesada JL, Roustit M, Milea D, Pepin JL. Treatment of nonarteritic anterior ischemic optic neuropathy with an endothelin antagonist: ENDOTHELION (ENDOTHELin antagonist receptor in Ischemic Optic Neuropathy)—a multicentre randomised controlled trial protocol. Trials 2022; 23:916. [DOI: 10.1186/s13063-022-06786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nonarteritic anterior ischemic optic neuropathy (NAAION) is a major cause of blindness in individuals over 50 years of age, with no available effective treatment. The oral dual endothelin receptor antagonist, bosentan, increases retinal optic nerve head blood flow in healthy humans and glaucoma patients. The objective of this trial is to assess the efficacy of bosentan administered at the acute stage in improving outcomes in NAAION patients.
Methods
ENDOTHELION (ENDOTHELin antagonist receptor in Ischemic Optic Neuropathy) is a phase III, interventional, prospective, multicentre, placebo-controlled randomised double-blind clinical trial. The primary outcome is change in the visual field mean deviation (MD) at 3 months (Humphrey 30-2 SITA standard programme). Secondary outcomes include MD and visual acuity changes up to 24 months, changes in peripapillary retinal nerve fibre and macular ganglion cell layer thickness in the affected eye, as measured by optical coherence tomography, rate of NAAION bilateralisation at 2 years, and quality-of-life. Patients over 50 years of age presenting with typical NAAION of recent onset (less than 21 days) are randomly assigned to either 125 mg oral bosentan or placebo, twice a day, during 8 weeks. Besides visits during the treatment phase, patients attend follow-up visits at 2, 3, 6, 12 and 24 months. The inclusion of patients began in August 2015 at five French University hospital ophthalmology departments and two specialised ophthalmology centres. It is planned to include 86 patients in this trial. To date we have included 72 patients and 49 have completed the full follow-up process.
Discussion
An endothelin receptor antagonist is a potential approach to improving the anatomical and functional prognosis of patients with NAAION. This multicentre double-blind randomised controlled trial is an opportunity to assess (1) the effect of bosentan on the structure and function of the optic nerve in NAAION, at 3 months, (2) the effect of bosentan on the bilateralisation rate at 24 months and (3) the tolerance profile of bosentan in this population.
Trial registration
ClinicalTrials.gov NCT02377271. Registered on March 3, 2015.
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Citirak G, Malmqvist L, Hamann S. Analysis of Systemic Risk Factors and Post-Insult Visual Development in a Danish Cohort of Patients with Nonarteritic Anterior Ischemic Optic Neuropathy. Clin Ophthalmol 2022; 16:3415-3424. [PMID: 36249446 PMCID: PMC9560866 DOI: 10.2147/opth.s384740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Nonarteritic anterior ischemic optic neuropathy (NAION) is associated with vascular as well as anatomical risk factors. Following the insult, the visual development varies from minor to severe deterioration. The aim of this study was to examine possible prognostic systemic risk factors and their eventual impact on post-insult visual development in NAION patients. Methods A retrospective chart review of all NAION patients (18-79 years at time of diagnosis) seen a minimum of two times in a tertiary eye department during a 10-year period in regard to systemic diseases, medication, lifestyle factors and ophthalmic examination was performed. Visual outcome was assessed according to the development of best corrected visual acuity (BCVA) and visual field from initial to final visit. Results There were 163 eligible patients. A greater proportion of the patients in the total cohort were over 50 years of age (79.8%) and men (66.3%). In total, 59.5% of the patients had a stable BCVA, while 25.8% experienced improvement, and 14.7% had deterioration. Seventy-two percent of the patients had a stable visual field, while 14% had improvement, and 14% had deterioration. No association between visual outcome and clinical characteristics, medication or systemic risk factors were identified. Conclusion We did not find any association between patient characteristics and systemic risk factors at time of diagnosis and visual development post-insult. This could suggest that the optic nerve head anatomy plays a larger role for visual outcome than previously estimated.
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Affiliation(s)
- Gülsenay Citirak
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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Cardiometabolic factors and risk of non-arteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022; 260:1445-1456. [DOI: 10.1007/s00417-021-05522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/04/2022] Open
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Liu B, Yu Y, Liu W, Deng T, Xiang D. Risk Factors for Non-arteritic Anterior Ischemic Optic Neuropathy: A Large Scale Meta-Analysis. Front Med (Lausanne) 2021; 8:618353. [PMID: 34671609 PMCID: PMC8520961 DOI: 10.3389/fmed.2021.618353] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/02/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: We conducted a meta-analysis to explore all the potential risk factors for non-arteritic anterior ischemic optic neuropathy (NAION) based on the published literature. Methods: A comprehensive literature search through the online databases was performed to obtain studies concerning the risk factors of NAION up to June 2020. Pooled unadjusted odds ratios (ORs) or rate ratios (RRs) were calculated to evaluate the weight of risk factors. This study was registered in PROSPERO under the number CRD42018084960. Results: Our meta-analysis included 49 original studies comprising of more than 10 million patients. The following risk factors were proved to be significantly associated with NAION: male gender (OR = 1.67, 95% CI: 1.50-1.85, P < 0.00001), hypertension (RR = 1.28, 95% CI: 1.20-1.37, P < 0.00001), hyperlipidemia (RR = 1.43, 95% CI: 1.26-1.62, P < 0.00001), diabetes mellitus (DM) (RR = 1.53, 95% CI: 1.36-1.73, P < 0.00001), coronary heart disease (CHD) (RR = 1.68, 95% CI: 1.24-2.27, P = 0.0008), sleep apnea (RR = 3.28, 95% CI: 2.08-5.17, P < 0.00001), factor V Leiden heterozygous (RR = 2.21, 95% CI: 1.19-4.09, P = 0.01), and medication history of cardiovascular drugs. Conclusion: We concluded that the above risk factors were significantly related to NAION. Better understanding of these risk factors in NAION can help the direct therapeutic approaches.
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Affiliation(s)
- Bing Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Yu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tuo Deng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Daoman Xiang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Fu ZY, Li HY, Wang YL. Imageology of internal carotid artery siphon in non-arteritic anterior ischaemic optic neuropathy. Int J Ophthalmol 2020; 13:1941-1947. [PMID: 33344194 DOI: 10.18240/ijo.2020.12.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022] Open
Abstract
AIM To evaluate whether narrowing of internal carotid artery siphon (ICAS) may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS Totally 30 consecutive patients who had unilateral NAION and 30 gender-matched control subjects were recruited in the present study. The diameter of ICAS of all the participants were measured using head-and-neck computed tomographic angiography (CTA). Color doppler flow imaging (CDI) was used to measure the haemodynamics parameters of ICAS and short posterior ciliary arteries (SPCAs) in all subjects. Comparison of parameters between the NAION patients and controls as well as between the two sides within the patients were performed. The correlation between the diameter of ICAS and NAION was analyzed. RESULTS A comparison of parameters between the affected side of the NAION patients and the controls, including the diameter of ICAS, the resistance index (RI) of ICAS, the blood flow velocities of SPCAs and RI of SPCAs, showed significantly difference (P<0.01), while there was no significant difference in terms of the mean blood flow velocity (Vm) of ICAS; Similar results were found while comparing all the measurements of the affected and unaffected side of patients (P for RI of SPCAs <0.05). No marked difference was detected in nearly all parameters except for RI of ICAS and SPCAs between the unaffected side of the NAION patients and the controls (P<0.05). The diameter of ICAS were significantly positive correlated with both peak systolic velocity (PSV) of SPCAs and end diastolic velocity (EDV) of SPCAs in patients with NAION (r=0.514, P<0.01 and r=0.418, P<0.05, respectively). CONCLUSION Narrowing of ICAS may increase the risk of developing NAION.
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Affiliation(s)
- Zhi-Yong Fu
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong-Yang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yan-Ling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Transcriptomic Analysis of circRNAs in the Peripheral Blood of Nonarteritic Anterior Ischemic Optic Neuropathy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5732124. [PMID: 33294447 PMCID: PMC7718056 DOI: 10.1155/2020/5732124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/09/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022]
Abstract
The aim of the study is to explore the expression profile variation of circular RNAs (circRNAs) in the peripheral blood of subjects with nonarteritic anterior ischemic optic neuropathy (NAION) and without NAION, to analyze the differential expression results, and to predict the role of circRNAs in disease development, providing novel ideas and methods for treatment and diagnosis. High-throughput sequencing to explore the expression profiles of RNAs in the peripheral blood of 6 NAION patients and 5 healthy controls was applied. Quality control obtained the advanced data from the original data by ticking out the unqualified data. Then, cluster analysis, volcano plot, coexpression network, and protein-protein interaction network (PPI) were performed. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were used to analyze the whole expressed genes. Lastly, the quantitative real-time Polymerase Chain Reaction (qRT-PCR) was used to verify those significantly differentially expressed circRNAs and do some bioinformatics analysis and prediction in 12 NAION patients and 12 controls. There were significant differences in the expression of 49 circRNAs in the peripheral blood of NAION patients, in which there were 24 upregulations and 25 downregulations (variation folds > 2 and P < 0.05), and it was confirmed that hsa_circ_0005583, hsa_circ_0003922, hsa_circ_0002021, and hsa_circ_0000462 were significantly downregulated (variation folds > 2 and P < 0.05), especially hsa_circ_0005583 which was the most significantly changed one (P < 0.001), and are related to processes such as neurodegeneration, oxidative stress, immunity, and metabolism. The expression profile of circRNAs in the peripheral blood of NAION patients is significantly changed, enriching our understanding of the disease.
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Should Aspirin Be Prescribed to Prevent Recurrence in Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol 2020; 40:428-433. [DOI: 10.1097/wno.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fernández-Vega B, Álvarez L, García M, Artime E, Diñeiro Soto M, Nicieza J, Vega JA, González-Iglesias H. Association Study of MTHFR Polymorphisms with Nonarteritic Anterior Ischemic Optic Neuropathy in a Spanish Population. Biomed Hub 2020; 5:34-46. [PMID: 32775330 DOI: 10.1159/000505431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Nonarteritic anterior ischemic optic neuropathy (NAION), painless loss of central and/or peripheral vision, is a multifactorial disease caused by insufficient blood flow through the posterior ciliary arteries to the optic nerve head. Mutations in the methylenetetrahydrofolate reductase (MTHFR) gene, triggering hyperhomocysteinemia as a consequence of a decreased activity of the codified enzyme, have been considered to be among the risk factors of NAION. Objective The main aim was to study the association of the most common MTHFR genetic polymorphisms C677T and A1298C with NAION in a Spanish population. Methods In this case-control study, the association of the most common MTHFR polymorphisms was investigated in 94 unrelated native Spanish patients diagnosed with NAION and 204 healthy controls. Two single nucleotide polymorphisms located in the MTHFR gene, C677T (rs1801133) and A1298C (rs1801131), were analyzed by DNA sequencing and TaqMan assays. Results The allelic and genotypic frequencies of the MTHFR variants obtained in the NAION group were not significantly different when compared with the control group. A higher frequency of the C677T/A1298C genotype, codifying the nonmutated MTHFR form, was obtained in control subjects (11.27%) compared to NAION patients (4.26%), suggesting a protective effect of the wild-type protein, although this result was not conclusive considering the obtained confidence interval (CI) (95% CI: 0.13-1.06). Study of additional clinical factors including hypertension, diabetes mellitus, and dyslipidemia showed no association with a higher risk of NAION. Conversely, the clinical history of heart or cerebrovascular diseases was significantly higher in NAION patients compared to controls. Over the world, risk variants of the MTHFR gene are highly frequent, excluding African black populations, indicating a racial influence. Conclusions The MTHFR variants did not significantly increase the risk of suffering from NAION. However, considering that individuals with at least one of the risk variants have the MTHFR enzyme with decreased activity, it cannot be ruled out that these mutations are relevant for the development of NAION in a subgroup of the population with other specific characteristics. These may include high plasma levels of homocysteine along with nutritional deficiencies including low folate or vitamin B12 and the combination of systemic and local risk factors.
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Affiliation(s)
- Beatriz Fernández-Vega
- Instituto Oftalmológico Fernández-Vega, Oviedo, Spain.,Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain.,Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain
| | - Lydia Álvarez
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
| | - Montserrat García
- Instituto Oftalmológico Fernández-Vega, Oviedo, Spain.,Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
| | - Enol Artime
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
| | - Marta Diñeiro Soto
- Instituto de Medicina Oncológica y Molecular de Asturias (IMOMA), Oviedo, Spain
| | | | - José A Vega
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago de Chile, Chile
| | - Héctor González-Iglesias
- Instituto Oftalmológico Fernández-Vega, Oviedo, Spain.,Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
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Risk Factors for Fellow Eye Involvement in Nonarteritic Anterior Ischemic Optic Neuropathy. J Neuroophthalmol 2020; 39:147-152. [PMID: 30300257 DOI: 10.1097/wno.0000000000000715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in individuals older than 50 years. Demographic, ocular, and systemic risk factors for NAION have been identified, and we sought to determine which, if any, of these factors also increase risk of NAION in the fellow eye. METHODS We performed a retrospective chart review of patients with "ischemic optic neuropathy" (based on International Classification of Disease [ICD] codes) seen at a single eye center between 2007 and 2017. Patients who met diagnostic criteria for unilateral NAION without fellow eye optic neuropathy at diagnosis were included. Demographic information, ocular comorbidities, and systemic diagnoses were recorded, in addition to whether the fellow eye developed NAION during the follow-up period. Univariate and multivariate Cox proportional hazard regression were used to calculate hazard ratios (HRs) for fellow eye involvement. RESULTS Three hundred eighteen patients were identified by ICD codes, and 119 were included in the study. Twenty-nine (24%) patients developed NAION in the fellow eye over the mean follow-up period of 3.6 years (range: 1 month-11 years). Significant risk factors for fellow eye NAION included the presence of bilateral optic disc drusen (ODD, HR 2.78, 95% confidence interval [CI] 1.12-6.90, P = 0.02) and noncompliance with continuous positive airway pressure (CPAP) in patients with moderate-to-severe obstructive sleep apnea (HR 4.50, 95% CI 1.79-11.3, P = 0.0015). CONCLUSIONS Bilateral ODD and noncompliance with CPAP when indicated are associated with increased risk of NAION in the fellow eye. Patients with these risk factors should be counseled on the potentially devastating visual consequences of bilateral NAION, and compliance with CPAP should be stressed when appropriate.
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Should a Hypercoagulable Work-Up Be Performed on Young Patients With Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol 2019; 39:523-528. [DOI: 10.1097/wno.0000000000000840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Abstract
PURPOSE OF REVIEW To review recent advances in the management of acute ocular ischemic events, including: transient monocular vision loss, central and branch retinal artery occlusions, and nonarteritic anterior ischemic optic neuropathy. RECENT FINDINGS Transient monocular vision loss and acute retinal arterial occlusions require immediate diagnosis and management, with recognition of these events as transient ischemic attack or stroke equivalents, respectively. Patients should undergo an immediate stroke workup in a stroke center, similar to patients with acute cerebral ischemia. The treatment of central retinal artery occlusions remains limited despite the growing use of thrombolytic treatments. The indication for these treatments remains under debate. No quality evidence exists to support any therapy, including corticosteroids, in the treatment of nonarteritic anterior ischemic optic neuropathy. The highest priority in management is to rule-out giant cell arteritis. SUMMARY Effective therapies for the treatment of ischemic events of the retina and optic nerve remain elusive. Clinicians should focus on the prompt recognition of these events as ocular emergencies and immediately refer patients with vascular transient visual loss and acute central and branch retinal arterial occlusions to the nearest stroke center.
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Choi JH, Shin JH, Jung JH. Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant-Cell Arteritis in Korean Patients: A Retrospective Single-Center Analysis and Review of the Literature. J Clin Neurol 2019; 15:386-392. [PMID: 31286712 PMCID: PMC6620454 DOI: 10.3988/jcn.2019.15.3.386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose The aim of this study is to report the relative incidence of arteritic anterior ischemic optic neuropathy (AAION) associated with giant-cell arteritis (GCA) in a single-center and evaluate the clinical features of AAION in Korean patients. Methods The medical records of patients with presumed AION who visited our hospital from January 2013 to August 2018 were examined retrospectively. The patients were divided into two groups: AAION associated with GCA, and non AION (NAION). We additionally reviewed the literature and identified all cases of AAION in Korean and Caucasian patients. We evaluated the clinical data including the initial and final best-corrected visual acuities, fundus photographs, visual field tests, fluorescein angiography, and contrast-enhanced MRI, and compared the data with those for Caucasian patients in the literature. Results Of the 142 patients with presumed AION, 3 (2.1%) were diagnosed with AAION and 139 (97.9%) were diagnosed with NAION. Seven Korean patients with AAION associated with GCA were identified in our data and the literature review. We found no difference in any clinical features other than laterality: four of the seven Korean patients had bilateral involvement. Moreover, the optic nerve sheath was enhanced in two of our Korean patients. Conclusions AAION associated with GCA is a very rare condition compared to NAION in Korea. However, GCA should be considered in all cases of ischemic optic neuropathy because AAION is associated with poor visual outcome, and sometimes presents bilaterally.
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Affiliation(s)
- Jae Hwan Choi
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Hoon Shin
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
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Chen T, Ma J, Shan G, Zhong Y. The polymorphisms of ATOH 7, ET-1 and ACE in non-arteritic anterior ischemic optic neuropathy. Exp Eye Res 2018; 174:147-151. [PMID: 29792847 DOI: 10.1016/j.exer.2018.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/02/2018] [Accepted: 05/20/2018] [Indexed: 12/14/2022]
Abstract
Non-arteritic anterior ischemic optic neuropathy (NAION) is a common cause of acute optic neuropathy in the elderly. The role of the genetic polymorphisms of Atonal Homolog 7 (ATOH7), Endothelin-1 (ET-1) and Angiotensin Converting Enzyme (ACE) in NAION and the combined effects of the gene-gene and gene-medical comorbidities on NAION were not clear. We conducted a perspective, case-control study. 71 NAION patients and 142 age and sex-matched healthy controls were enrolled. Single nucleotide polymorphisms of ATOH7 (rs1900004), ET-1 (rs5370) and ACE (rs1799752) were identified by polymerase chain reaction (PCR) method and all PCR products were screened with Sanger sequencing. The prevalence of genetic factors in NAION patients were compared to normal people, and assessed in conditional logistic regression models. The modified effects of gene-gene or gene-medical comorbidities on NAION development were assessed with a multiplicative model. A significant high risk was found in the T allele of ATOH7 in NAION, with an odds ratio (OR) of 1.55 (P = 0.04). Conditional logistic regression analysis, including diabetes and hypertension, revealed that ATOH7 TT genotype carriers conferred a significantly increased risk of NAION (TT/CC + CT, OR = 3.32, 95% confidence interval (CI) = 1.16-9.53, P = 0.03). Interaction analysis showed that ET-1 (P = 0.01), ACE (P = 0.046) and hypertension (P = 0.02) have modified effects on NAION development. Our results showed that the polymorphism of optic disc associated gene-ATOH7 conferred a significant risk of NAION. Combination of ATOH7 and ET-1, ATOH7 and ACE, as well as ATOH7 and hypertension, increased the susceptibility of NAION. Our data may be useful for NAION predicting.
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Affiliation(s)
- Ting Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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18
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Kim JH, Kang MH, Seong M, Cho H, Shin YU. Anomalous coagulation factors in non-arteritic anterior ischemic optic neuropathy with central retinal vein occlusion: A case report. Medicine (Baltimore) 2018; 97:e0437. [PMID: 29642215 PMCID: PMC5908582 DOI: 10.1097/md.0000000000010437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Non-arteritic anterior ischemic optic neuropathy (NAION) is characterized by sudden, painless visual loss and optic disc edema. NAION occurs mainly in the presence of cardiovascular disease and hypercoagulability, mainly in patients over 50 years of age. We experienced a case of NAION associated with central retinal vein occlusion (CRVO) in a young man with no underlying disease. PATIENT CONCERNS A 46-year-old man was referred to our clinic following a sudden loss of vision in his right eye. The patient exhibited no underlying disease and reported no ongoing medication. Significant visual loss and visual disturbance of the right eye were observed. The pupil of the right eye was enlarged and an afferent pupillary defect was observed. On fundus examination, retinal hemorrhage was observed in the peripheral retina; macular edema was observed in optical coherence tomography analysis. However, optic disc edema was not evident. No abnormal findings were found in routine blood tests for hypercoagulability. After 3 days of steroid intravenous injection, macular edema disappeared and visual acuity was improved, but optic disc edema began to appear. One week later, optic disc edema was evident and visual acuity was significantly reduced; thus, the patient was diagnosed with NAION. In fluorescein angiography, peripheral retinal ischemia was observed, suggesting that CRVO was complicated. Blood tests, including analysis of coagulation factors, were performed again, showing that coagulation factors IX and XI were increased. DIAGNOSES Anomalous coagulation factors in non-arteritic anterior ischemic optic neuropathy with central retinal vein occlusion. INTERVENTIONS Systemic steroids were administered. OUTCOMES One month later, optic disc edema and retinal hemorrhage gradually diminished and eventually disappeared; however, visual acuity did not recover. CONCLUSION In young patients without underlying disease, cases of NAION require careful screening for coagulation disorders. Even if there is no abnormality in the test for routine coagulation status, it may be necessary to confirm a coagulation defect through an additional coagulation factor assay.
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19
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Finger C, Zotz RB, Scharf RE, Unsöld R. Associations between thrombophilic risk factors and determinants of atherosclerosis and inflammation in patients with non-arteritic anterior ischaemic optic neuropathy. Hamostaseologie 2018; 36:46-54. [DOI: 10.5482/hamo-15-10-0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/09/2015] [Indexed: 11/05/2022] Open
Abstract
SummaryNon-arteritic anterior ischaemic optic neuropathy (NAION) is caused by ischaemia of the optic nerve head. The pathophysiology of NAION is unclear, and no proven effective treatment exists. Patients, methods: We analyzed thrombophilic risk factors and determinants of atherosclerosis and inflammation in 109 consecutive patients and 109 age- and sex-matched volunteers using a case-control design. Results: High levels of fibrinogen (>384 mg/dl; OR 3.2, p = 0.003), factors VIII:C (>183%; OR 2.6, p = 0.02), IX (>153%; OR 2.6, p = 0.026), XI (>142%; OR 3.4, p = 0.006), von Willebrand factor (activity >205%; OR 3.1, p = 0.005; antigen >194%; OR 3.5, p = 0.002), and triglycerides (>228 mg/dl; OR 2.8, p = 0.026), higher platelet counts (>294 000/[uni03BC]l; OR 2.5, p = 0.04), low levels of HDL cholesterol (<40 mg/dl; OR 2.7, p = 0.032), and an accelerated erythrocyte sedimentation rate (>20 mm/h; OR 4.4, p = 0.003) were associated with NAION. Conclusion: Our findings support the contention of a complex pathogenesis of NAION resulting from the coincidence of proatherogenic, prothrombotic and proinflammatory processes. The alterations described could be causative, side effects, or just coincidental findings.
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20
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Maass J, Matthé E. Bilateral vision loss due to Leber's hereditary optic neuropathy after long-term alcohol, nicotine and drug abuse. Doc Ophthalmol 2018; 136:145-153. [PMID: 29372350 DOI: 10.1007/s10633-018-9622-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Leber's hereditary optic neuropathy is relatively rare, and no clinical pathognomonic signs exist. We present a rare case of bilateral vision loss of a patient with multiple drug abuse in the history. OBSERVATION A 31-year-old man presented with a history of progressive, decreased vision in both eyes for 6 month. On examination, his visual acuity was hand motion in both eyes. Funduscopy demonstrated a temporal pallor of the optic disc. Goldmann visual field perimetry showed a crescent visual field in the right eye and a circular decrease to less than 50 ° in the left eye. Electroretinogram showed a scotopic b-wave amplitude reduction. Optical coherence tomographies, Heidelberg Retina tomography, visual evoked potentials, and magnetic resonance imaging with contrast as well as blood tests were normal. The patient reported to consume various kinds of drugs as well as recreational drug use and alcohol consumption since he was 16 years old. We started a hemodilution therapy, believing the patient suffered from a bilateral, toxic optic neuropathy due to his lifestyle. Laboratory results later on showed Leber's hereditary optic neuropathy. CONCLUSION AND IMPORTANCE Leber's hereditary optic neuropathy is a rare disease without a typical, pathognomonic presentation. Even though the patient gave good reasons for a toxic optic neuropathy, one should never stop to test for other diseases.
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Affiliation(s)
- Johanna Maass
- Department of Ophthalmology, Carl Gustav Carus University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Saxony, Germany.
| | - Egbert Matthé
- Department of Ophthalmology, Carl Gustav Carus University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Saxony, Germany
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21
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Newman A, Andrew N, Casson R. Review of the association between retinal microvascular characteristics and eye disease. Clin Exp Ophthalmol 2017; 46:531-552. [PMID: 29193621 DOI: 10.1111/ceo.13119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/29/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Computerized retinal imaging technologies enable the static and dynamic measurement of a range of retinal microvascular parameters. Large population-based studies have reported associations between these microvascular indices and various ophthalmic diseases including diabetes, age-related macular degeneration, retinal artery embolism, retinal vein occlusion, glaucoma and non-glaucomatous optic neuropathies. Increasingly, sophisticated imaging and analysis techniques have the potential to provide relevant clinical information regarding disease risk and progression; however, further studies are required to verify associations and strengthen the predictive power of these techniques. We summarize the current state of knowledge regarding retinal microvascular characteristics and eye disease.
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Affiliation(s)
- Alexander Newman
- Department of Ophthalmology, Gold Coast University Hospital, Queensland, Australia.,Griffith University School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicholas Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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22
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Kosekahya P, Caglayan M, Unal O, Yuzbasioglu S, Koc M, Ucgul Atilgan C, Yulek F. Optic Nerve Head Elastometry in Both Eyes of Patients with Unilateral Non-arteritic Anterior Ischaemic Optic Neuropathy - May It Be a Novel Aspect of the Pathogenesis? Neuroophthalmology 2017; 42:222-228. [PMID: 30042792 DOI: 10.1080/01658107.2017.1397702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
In this prospective study, the biomechanical properties of optic nerve head (ONH) and cornea in both eyes of patients with non-arteritic anterior ischaemic optic neuropathy and healthy control eyes were investigated. ONH elastometry was measured with real-time elastography, and corneal elastometry was measured with ocular response analyser. Elastometry of cornea and ONH was lower in both eyes of patients with unilateral non-arteritic ischaemic optic neuropathy than in healthy control eyes. The role of these biomechanical differences in the pathogenesis of non-arteritic ischaemic optic neuropathy should be investigated further.
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Affiliation(s)
- Pinar Kosekahya
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Department of Ophthalmology, Mardin State Hospital, Mardin, Turkey
| | - Ozlem Unal
- Department of Radiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Sema Yuzbasioglu
- Department of Ophthalmology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mustafa Koc
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | - Fatma Yulek
- Department of Ophthalmology, Yildirim Beyazit University Ataturk Research and Training Hospital, Ankara, Turkey
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23
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Khan A, Petropoulos IN, Ponirakis G, Malik RA. Visual complications in diabetes mellitus: beyond retinopathy. Diabet Med 2017; 34:478-484. [PMID: 27917530 DOI: 10.1111/dme.13296] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
Diabetic retinopathy is the most common cause of vision loss in people with diabetes mellitus; however, other causes of visual impairment/loss include other retinal and non-retinal visual problems, including glaucoma, age-related macular degeneration, non-arteritic anterior ischaemic optic neuropathy and cataracts. Additionally, when a person with diabetes complains of visual disturbance despite a visual acuity of 6/6, abnormalities in refraction, contrast sensitivity, straylight and amplitude of accommodation should be considered. We review and highlight these visual problems for physicians who manage people with diabetes to ensure timely referral and treatment to limit visual disability, which can have a significant impact on daily living, especially for those participating in sports and driving.
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Affiliation(s)
- A Khan
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - R A Malik
- Weill Cornell Medicine-Qatar, Doha, Qatar
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24
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The enigma of nonarteritic anterior ischemic optic neuropathy: an update for the comprehensive ophthalmologist. Curr Opin Ophthalmol 2016; 27:498-504. [PMID: 27585212 DOI: 10.1097/icu.0000000000000318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury, and frequently presents to comprehensive ophthalmologists. We review the typical and atypical clinical features and current literature on various treatment modalities for NAION. RECENT FINDINGS The epidemiology and clinical presentation of this disease can be variable, making a definitive diagnosis difficult in many cases. In addition, the differential diagnoses for this disorder, although comprising much less prevalent entities, are quite broad and can have substantial systemic implications if these alternatives go unrecognized. NAION has many systemic associations and comorbidities that deserve inquiry when the diagnosis is made. There are currently no widely accepted, evidence-based treatments for NAION. All recommendations made to patients to reduce their risk of sequential eye involvement, including avoidance of potential nocturnal hypotension, erectile dysfunction medication, and treatment of obstructive sleep apnea, have theoretical bases. SUMMARY NAION is a common cause of acute vision loss in adult and older patients, and thus, comprehensive ophthalmologists need to be able to diagnose and appropriately manage this disorder. We anticipate fruitful results from current and future trials aimed at neuroprotection in the affected eye and prevention of sequential eye involvement.
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25
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Cestari DM, Gaier ED, Bouzika P, Blachley TS, De Lott LB, Rizzo JF, Wiggs JL, Kang JH, Pasquale LR, Stein JD. Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy. Ophthalmology 2016; 123:2446-2455. [PMID: 27659545 DOI: 10.1016/j.ophtha.2016.08.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating ocular condition causing permanent vision loss. Little is known about risk factors for developing this disease. We assessed demographic, systemic, and ocular factors associated with NAION. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS Beneficiaries between 40 and 75 years old without NAION at baseline enrolled in a large U.S. managed care network. METHODS Enrollees were monitored continuously for ≥2 years between 2001 and 2014 to identify those newly diagnosed with NAION (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 377.41). All persons were under ophthalmic surveillance and all cases had ≥1 confirmatory ICD-9-CM code for NAION during follow-up. MAIN OUTCOME MEASURES Multivariable Cox regression modeling was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs) to describe the statistical relationship between selected demographic characteristics, systemic and ocular conditions, and the hazard of developing NAION. RESULTS Of 1 381 477 eligible enrollees, 977 (0.1%) developed NAION during a mean ± standard deviation (SD) follow-up of 7.8±3.1 years. The mean ± SD age for NAION cases at the index date was 64.0±9.2 years vs. 58.4±9.4 years for the remainder of the beneficiaries. After adjustment for confounding factors, each additional year older was associated with a 2% increased hazard of NAION (HR = 1.02; 95% CI: 1.01-1.03). Female subjects had a 36% decreased hazard of developing NAION (HR = 0.64; 95% CI: 0.55-0.74) compared with male subjects. Compared with whites, Latinos had a 46% decreased hazard of developing NAION (HR = 0.54; 95% CI: 0.36-0.82), whereas African ancestry was not significantly associated with NAION (HR = 0.91; 95% CI: 0.72-1.15). Systemic diseases associated with NAION included hypertension (HR = 1.62; 95% CI: 1.26-2.07) and hypercoagulable states (HR = 2.46; 95% CI: 1.51-4.00). Although diabetes mellitus (DM) was not significantly associated with NAION compared with those without DM (P = 0.45), patients with end-organ involvement from DM had a 27% increased hazard of NAION relative to those with uncomplicated DM (HR = 1.27; 95% CI: 1.01-1.59). Ocular diseases associated with NAION were age-related macular degeneration (HR = 1.29; 95% CI: 1.08-1.54) and retinal vein occlusion (HR = 3.94; 95% CI: 3.11-4.99). CONCLUSIONS Our study identified several modifiable risk factors that may be associated with NAION. Should future studies confirm these findings, they may offer opportunities to prevent or treat this debilitating condition.
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Affiliation(s)
- Dean M Cestari
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Eric D Gaier
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Peggy Bouzika
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Taylor S Blachley
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jae H Kang
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Louis R Pasquale
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
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26
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Subramanian PS, Gordon LK, Bonelli L, Arnold AC. Progression of asymptomatic optic disc swelling to non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2016; 101:671-675. [PMID: 27565987 DOI: 10.1136/bjophthalmol-2016-309250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The time of onset of optic disc swelling in non-arteritic anterior ischaemic optic neuropathy (NAION) is not known, and it is commonly assumed to arise simultaneously with vision loss. Our goal is to report the presence and persistence of optic disc swelling without initial vision loss and its subsequent evolution to typical, symptomatic NAION. METHODS Clinical case series of patients with optic disc swelling and normal visual acuity and visual fields at initial presentation who progressed to have vision loss typical of NAION. All subjects underwent automated perimetry, disc photography and optic coherence tomography and/or fluorescein angiography to evaluate optic nerve function and perfusion. RESULTS Four patients were found to have sectoral or diffuse optic disc swelling without visual acuity or visual field loss; the fellow eye of all four had either current or prior NAION or a 'disc at risk' configuration. Over several weeks of clinical surveillance, each patient experienced sudden onset of visual field and/or visual acuity loss typical for NAION. CONCLUSIONS Current treatment options for NAION once vision loss occurs are limited and may not alter the natural history of the disorder. Subjects with NAION may have disc swelling for 2-10 weeks prior to the occurrence of visual loss, and with the development of new therapeutic agents, treatment at the time of observed disc swelling could prevent vision loss from NAION.
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Affiliation(s)
- Prem S Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lynn K Gordon
- Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - Laura Bonelli
- Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - Anthony C Arnold
- Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
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27
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Han M, Zhao C, Han QH, Xie S, Li Y. Change of Retinal Nerve Layer Thickness in Non-Arteritic Anterior Ischemic Optic Neuropathy Revealed by Fourier Domain Optical Coherence Tomography. Curr Eye Res 2015; 41:1076-1081. [PMID: 26580572 DOI: 10.3109/02713683.2015.1084640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To examine the changes of non-arteritic anterior ischemic optic neuropathy (NAION) by serial morphometry using Fourier domain optical coherence tomography (FD-OCT). MATERIALS AND METHODS Retrospective study in patients with newly diagnosed NAION (n=33, all unilateral) and controls (n=75 unilateral NAION patients with full contralateral eye vision) who underwent FD-OCT of the optic disk, optic nerve head (ONH), and macula within 1 week of onset and again 1, 3, 6, and 12 months later. The patients showed no improvement in vision during follow-up. RESULTS Within 1 week of onset, all NAION eyes exhibited severe ONH fiber crowding and peripapillary retinal nerve fiber layer (RNFL) edema. Four had subretinal fluid accumulation and 12 had posterior vitreous detachment (PVD) at the optic disc surface. Ganglion cell complex (GCC) and RNFL thicknesses were reduced at 1 and 3 months (p < 0.05), with no deterioration thereafter. Initial RNFL/GCC contraction magnitude in the superior hemisphere correlated with the severity of inferior visual field deficits. CONCLUSIONS NAION progression is characterized by an initial phase of accelerated RNFL and GCC deterioration. These results reveal that the kinetic change of neural retina in NAION and may have implication on the time window for treatment of NAION. FD-OCT is useful in the evaluation of NAION.
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Affiliation(s)
- Mei Han
- a Clinical College of Ophthalmology , Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute , Tianjin , China
| | - Chen Zhao
- a Clinical College of Ophthalmology , Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute , Tianjin , China
| | - Quan-Hong Han
- a Clinical College of Ophthalmology , Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute , Tianjin , China
| | - Shiyong Xie
- a Clinical College of Ophthalmology , Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute , Tianjin , China
| | - Yan Li
- a Clinical College of Ophthalmology , Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute , Tianjin , China
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Wu F, Mao S, Yu T, Jiang H, Ding Q, Xu G. Elevated plasma aldosterone is an independent risk factor for erectile dysfunction in men. World J Urol 2015; 34:999-1007. [DOI: 10.1007/s00345-015-1723-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022] Open
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Lipoprotein(a) als wichtiger Risikofaktor für Gefäßverschlüsse. Bericht über eine beidseitige nicht-entzündliche anteriore ischämische Optikusneuropathie mit erfolgreicher Behandlung eines Auges und Langzeitbeobachtung. SPEKTRUM DER AUGENHEILKUNDE 2014. [DOI: 10.1007/s00717-014-0215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Measurement of retinal function with flash-electroretinography in Chinese patients with hyperlipidemia. Graefes Arch Clin Exp Ophthalmol 2014; 252:1385-92. [PMID: 25030239 DOI: 10.1007/s00417-014-2726-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 05/26/2014] [Accepted: 06/30/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We used flash electroretinography (F-ERG) to determine if retinal function was impaired in patients with hyperlipidemia, including visual acuity and fundus morphological changes, and to identify predictors of impaired retinal function in hyperlipidemia patients. METHODS This was a prospective case-control study (Shanghai, China; February 2011 to January 2012) in 696 hyperlipidemia patients and 136 healthy controls. Exclusion criteria included best-corrected visual acuity <0.6, previous intraocular surgery, and chronic comorbidities. Each participant underwent a comprehensive series of ophthalmologic examinations, and standard F-ERG examination. Data were analyzed using t-tests and multivariate analysis. RESULTS Six hundred and twenty-six hyperlipidemia patients (57.69 ± 14.01 years; 59.58% female) and 120 healthy controls (55.13 ± 14.03 years; 60% female) were included in the final analysis. After adjustment for age and gender using multivariate covariance analysis, F-ERG result revealed significantly lower response amplitudes in the hyperlipidemia group (P < 0.05), and longer implicit times (P < 0.05) than the control group. F-ERG parameters were significantly different between the two groups. Stepwise multiple linear regression analysis showed that serum LDL levels (P < 0.001), BMI (P < 0.001), duration of hyperlipidemia (P < 0.001), and serum HDL levels (P = 0.03) were negatively correlated with ΣOps. CONCLUSION The present study suggests that the retinal function of hyperlipidemia patients was significantly lower than in healthy controls, even before the occurrence of pathological changes in the fundus.
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Nicholson JD, Leiba H, Goldenberg-Cohen N. Translational Preclinical Research may Lead to Improved Medical Management of Non-Arteritic Anterior Ischemic Optic Neuropathy. Front Neurol 2014; 5:122. [PMID: 25071709 PMCID: PMC4092366 DOI: 10.3389/fneur.2014.00122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/25/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- James D Nicholson
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center , Petach Tikva , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Hana Leiba
- Department of Ophthalmology, Kaplan Medical Center , Rehovot , Israel ; Hebrew University Hadassah Medical Center , Jerusalem , Israel
| | - Nitza Goldenberg-Cohen
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center , Petach Tikva , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel ; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel , Petach Tikva , Israel
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Chen T, Song D, Shan G, Wang K, Wang Y, Ma J, Zhong Y. The association between diabetes mellitus and nonarteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis. PLoS One 2013; 8:e76653. [PMID: 24098798 PMCID: PMC3786911 DOI: 10.1371/journal.pone.0076653] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/25/2013] [Indexed: 11/20/2022] Open
Abstract
Background The association of diabetes mellitus (DM) with nonarteritic anterior ischemic optic neuropathy (NAION) has been inconclusive. Purpose To determine whether DM is associated with an increased risk of NAION. Methods A comprehensive literature search was performed for published studies reporting both DM and NAION based on PubMed and EMBASE. After reviewing characteristics of all the included studies systematically, meta-analytical method was employed to calculate the pooled odds ratio (OR) and associated 95% confidence interval (CI) from random-effects models. Heterogeneity was assessed by Q-statistic test. Funnel Plot, Begg's and Egger's linear regression test were applied to evaluate publication bias. A sensitivity analysis and meta-regression analysis were also performed to assess the robustness of results. Results 2,096 participants from 12 case-control studies were pooled for a meta-analysis. The result of meta-analysis of these studies indicated that DM is associated with increased risk of NAION (pooled OR = 1.64, 95% CI = 1.17–2.30; P = 0.004). Sensitivity analysis indicated our findings are robust, and meta-regression analysis revealed no significant effect in terms of geographical area, gender, age of patients with NAION, the year of the publication, source of the controls, and sample size (all p>0.05). Evidence of publication bias was not observed in our study. Conclusion Meta-analysis suggests that DM might be associated with increased risk of NAION.
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Affiliation(s)
- Ting Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Delu Song
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwei Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (JM); (YZ)
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (JM); (YZ)
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Papageorgiou E, Karamagkiolis S, Dimera V. Nonarteritic anterior ischemic optic neuropathy and double thrombophilic defect: a new observation. Case Rep Ophthalmol 2012; 3:61-4. [PMID: 22529804 PMCID: PMC3331875 DOI: 10.1159/000336779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report the first case of nonarteritic anterior ischemic neuropathy (NAION) associated with double thrombophilia: protein S deficiency and prothrombin G20210A mutation. A 58-year-old man is presented including the clinical and laboratory findings, cardiovascular profile and thrombophilia screening. The patient presented with 3/10 vision and an inferior altitudinal defect in the right eye. Funduscopic examination of the right eye revealed a hyperemic optic disk with blurred superior optic disk border and sectoral nerve fiber layer edema. Complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal, suggesting a NAION. A workup of cardiovascular risk factors revealed hyperlipidemia, arterial hypertension and high-risk asymptomatic coronary artery disease. Due to the family history of deep vein thrombosis in the patient's daughter, a thrombophilia screening was additionally performed. The results revealed a double thrombophilic defect, namely congenital protein S deficiency and heterozygosity for prothrombin G20210A mutation, which were also identified in the patient's daughter. Anticoagulant warfarin therapy was initiated and the patient underwent a triple bypass surgery. At three-month follow-up, the right optic disk edema had resolved, leaving a pale superior optic nerve head. Visual acuity in the right eye had slightly improved to 4/10; however, the dense inferior altitudinal field defect had remained unchanged. The patient is currently treated with warfarin, atorvastatin, irbesartan and metoprolol. This case suggests that the first line of investigation in all patients with NAION involves assessment of cardiovascular risk factors. However, careful history taking will identify NAION patients who are eligible for additional thrombophilia screening: young patients without vasculopathic risk factors, bilateral or recurrent NAION, idiopathic or recurrent venous thromboembolism (VTE), positive family history of VTE, and VTE in young age or in unusual sites (e.g. cerebral, hepatic, mesenteric, or renal vein).
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Affiliation(s)
- Eleni Papageorgiou
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
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Lee MS, Grossman D, Arnold AC, Sloan FA. Incidence of nonarteritic anterior ischemic optic neuropathy: increased risk among diabetic patients. Ophthalmology 2011; 118:959-63. [PMID: 21439645 DOI: 10.1016/j.ophtha.2011.01.054] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Previous studies have identified a higher prevalence of diabetes mellitus (DM) among patient cohorts with nonarteritic anterior ischemic optic neuropathy (NAION). We sought to determine the development of incident NAION among a group of newly diagnosed patients with DM and to estimate the incidence of NAION among the elderly. DESIGN Medicare 5% database study. PARTICIPANTS A total of 25 515 patients with DM and an equal number of age- and gender-matched nondiabetic patients. METHODS Query of Medicare 5% claims files identified patients with a new diagnosis of DM in 1994. A randomly selected control group was created using 1-to-1 propensity score matching. Patients with a diagnosis of giant cell arteritis, preexisting DM, and age 68 years or older or >95 years were excluded. Patients with DM and controls were followed for the development of NAION over the following 4745 days. MAIN OUTCOME MEASURES Incidence of NAION among patients with and without DM. RESULTS In each group, 85% were white, 11% were black, and 4% were other race. Patients were aged 76.4 years, and 40% were male. Mean follow-up was 7.6 years. In the diabetes group, 188 individuals developed NAION (0.7%) compared with 131 individuals (0.5%; P < 0.01) in the control group. In unadjusted Cox regression analysis, having DM was associated with a 43% increased risk (hazard ratio [HR]: 1.431; 95% confidence interval [CI], 1.145-1.789) of developing NAION. After adjusting for other covariates, the risk of developing NAION among individuals with DM was reduced to 40% (HR 1.397; 95% CI, 1.115-1.750). Male gender increased an individual's risk of developing NAION by 32% (HR 1.319; 95% CI, 1.052-1.654). No other covariate was statistically significantly associated with developing NAION. The annual incidence of NAION was 82 per 100 000 persons. CONCLUSIONS Diabetes mellitus significantly increased the risk of the diagnosis NAION. The incidence of NAION among patients aged more than 67 years may be higher than previously reported.
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Affiliation(s)
- Michael S Lee
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA.
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Pepple KL, Bhatti MT, Foroozan R. Not again! Surv Ophthalmol 2010; 56:86-93. [PMID: 20709344 DOI: 10.1016/j.survophthal.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 05/07/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
A 58-year-old white man presented with a second episode of vision loss in the same eye. Diagnostic evaluations conducted at each episode were unrevealing for an underlying etiology, and a presumptive diagnosis of recurrent non-arteritic anterior ischemic optic neuropathy (NAION) was made. The evaluation of recurrent NAION is discussed.
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Affiliation(s)
- Kathryn L Pepple
- Department of Ophthalmology, Duke University Eye Center, Duke University Medical Center, Durham, North Carolina, USA
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Fontenla García JR, Figueras Roca M. [Importance of vascular risk factors for retinal microvascular obstructive pathology]. Med Clin (Barc) 2010; 134:111-3. [PMID: 19896149 DOI: 10.1016/j.medcli.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 11/25/2022]
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Non-arteritic anterior ischemic optic neuropathy and thrombophilia. Graefes Arch Clin Exp Ophthalmol 2008; 247:577-81. [PMID: 18958485 DOI: 10.1007/s00417-008-0979-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022] Open
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