Non-Arteritic Ischemic Optic Neuropathy

Abstract

Non-arteritic ischemic optic neuropathy (NAION); it is an optic neuropathy that can cause acute unilateral painless vision loss, optic disc edema, relative afferent pupillary defect, peripapillary hemorrhage and visual field defects in individuals over 50 years of age. Although its pathophysiology has not been fully elucidated today; It is widely accepted that it results from hypoperfusion in the short posterior ciliary arteries that supply the optic nerve head. The diagnosis of NAION is made primarily clinically. While there is no vision loss in approximately one-third of the cases, severe vision loss develops in 40-50%. It is thought that there is always a visual field defect from the beginning of NAION, therefore perimetry is the most important diagnostic test. In the differential diagnosis of NAION, vision- and life-threatening diseases, especially arteritic ischemic optic neuropathy, demyelinating, infiltrative and compressive optic neuropathies, should be considered. Perimetry, blood tests, fluorescein angiography, optical coherence tomography (OCT), OCT angiography, brain and orbital MRI provide very useful information in the differential diagnosis. Although many medical and surgical treatments have been tried, unfortunately there is no effective treatment or prophylactic prevention method for NAION today; However, neuroprotective agents, stem cell and gene therapy treatments aimed at stopping or reducing optic nerve damage appear promising in the near future. The purpose of this review is to provide a comprehensive, up-to-date overview of NAION.