Clinical Differences Between Nonarteritic Anterior Ischemic Optic Neuropathy and Optic Neuritis in Chinese Patients: A Retrospective Comparative Case Series Study

Jun Chen

doi:10.11648/j.ijovs.20190401.12

Abstract

The aim of this study is to compare the clinical features between nonarteritic anterior ischemic optic neuropathy (NAION) and optic neuritis (ON) in Chinese patients. The clinical features of 23 cases (23 eyes) of NAION and 62 cases (80 eyes) of ON, including their general conditions, manifestations, auxiliary examinations were retrospectively compared. Simultaneous onset of bilateral eye (29.03% vs. 0%, p=0.009) and pain on movement of the eyes (23.75% vs. 0%, p=0.022) were more common in ON patients in comparison to NAION patients. Ocular pain (32.5% vs. 4.35%, p=0.007) was higher in ON patients than that in NAION patients. Optic disc edema (100% vs. 62.5%, p<0.001), peripapillary hemorrhage (47.83% vs. 10%, p<0.001) and peripapillary hard exudates (17.39% vs. 1.25%, p=0.009) in NAION patients were more common compared to ON patients,. During fluorescein angiography, the rates of the partial or whole papillary hypofluorescent in early phase (65.21% vs. 22.86%, p<0.001), peripapillary choroidal filling delay (73.91% vs. 14.29%, p<0.001) and partial papillary hyperfluorescent in later phase (52.17% vs. 25.71%, p=0.019) were higher in NAION patients than those in ON patients. The clinical features of NAION and ON in Chinese patients reveal a surprising overlap and they still have some characteristic clinical features that can be utilized to differentiate the two diseases.

Highlights

Nonarteritic anterior ischemic optic neuropathy (NAION) and optic neuritis (ON), two of the most common neuro-ophthalmic diseases in adults, share many symptoms and signs, but with a rather different prognostic implication [1].Their pathogenesis, treatment and prognosis are great different
Inclusion Criteria The criteria required for diagnosis of ON included the following [8]: (1) Optic nerve damage correlated with visual field abnormalities; (2) A history of acute pain or painless vision loss and optic disc edema; (3) Existence of relative afferent papillary defect and/or visual evoked potential anomalies; (4) no clinical evidence of ischemic, traumatic, compressive, metabolic, hereditary or toxic optic neuropathy, or other causative ocular diseases; (5) Exclusion of diseases involving the optic chiasm, posterior to the chiasm or occipital cortex; (6) Exclusion of patients with retinopathy, maculopathy, ametropia, glaucoma or other anterior segment diseases; (7) Exclusion of nonorganic vision loss
The rates of hypertension (6.45% vs. 30.43%, p=0.010) were lower in ON patients compared to NAION patients

Summary

Introduction

Nonarteritic anterior ischemic optic neuropathy (NAION) and optic neuritis (ON), two of the most common neuro-ophthalmic diseases in adults, share many symptoms and signs, but with a rather different prognostic implication [1]. Their pathogenesis, treatment and prognosis are great different. NAION, on the other hand, presents with sudden painless visual loss associated with optic disc edema, resulting in visual field loss. NAION represents an acute ischemic disorder of the optic nerve head, which is supplied in blood vessels by the posterior ciliary arteries [3]. NAION has been historically associated with a small, crowded appearing, and cupless optic disc, termed the disc at risk [4]

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