Anterior Ischemic Optic Neuropathy Research Articles

Predictive effect of nonarteritic anterior ischemic optic neuropathy on the development of cerebral small vessel disease: a retrospective study

ObjectiveThe study aims to determine the correlation between cerebral small vessel diseases (SVDs) and nonarteritic anterior ischemic optic neuropathy (NAION). Additionally, investigate whether NAION raises the risk of an increased total cerebral small vessel disease score (CSVD score) compared to control group without ocular conditions.Methods101 controls without any retinal illness and 61 individuals with NAION were enrolled for this retrospective case control study. Ophthalmic examinations and brain magnetic resonance imaging (MRI) scans were performed on all participants. Data on demographics and clinical characteristics were obtained from hospital medical records. We evaluated and compared the distribution of SVDs and rated the total CSVD score based on SVD indications observed on MRI scans.ResultsSVDs were more frequently in NAION individuals than in control group (82%, p < 0.001), and their odds ratio was 4.11 (95%CI: 1.93–8.79, p < 0.001). The ordinal logistic regression showed patients in NAION group had 3.08-, 5.66- and 2.90-times higher risk than in control group, at each point of the white matter hyperintensity (WMH) score (95%CI: 1.43–6.79, p = 0.003), perivascular spaces (PVS) score (95%CI: 2.31–14.9, p < 0.001) and CSVD score (95%CI: 1.32–6.51, p = 0.005) respectively. Dyslipidemia presented a higher risk in the presence of SVDs (p = 0.008, OR = 2.31, 95%CI: 1.20–4.44) and WHM score (p = 0.018, OR = 2.22, 95%CI: 1.07–4.70). There was no significant difference between NAION group and controls in sex, age, or other past medical characteristics.ConclusionThe predictive effect of NAION on SVDs is possible as NAION patients have an increased risk with SVDs. Brain MRI scans and the control of risk factors associated with SVDs should be recommended for individuals who develop NAION.

Stroke Risk Following Nonarteritic Anterior Ischemic Optic Neuropathy.

The association between nonarteritic anterior ischemic optic neuropathy (NAION) and an increased risk of stroke has been a subject of debate. However, multinational studies on this topic are scarce. To evaluate the short-term and long-term stroke risk after NAION compared with a matched control group. This global, retrospective, population-based cohort study used aggregated electronic health records from January 1, 2004, through March 19, 2024, sourced from the Global Collaborative Network of TriNetX, which includes data from over 152 million patients across 17 countries. Patients in the study were followed up for a maximum duration of 10 years. Patients with NAION and age-related cataract were included in the analysis. Those with stroke before the diagnosis of NAION and age-related cataract were excluded. Propensity score matching was applied to balance age, sex, race, ethnicity, comorbidities, and medication use. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code for NAION or age-related cataract. The primary outcome was the relative risk (RR) of stroke (ICD-10 code I60-63) in the NAION cohort vs the matched controls. Multivariable logistic regression analyses were applied to identify potential clinical factors associated with stroke within the NAION cohort. A total of 89 811 patients were identified in both the NAION (mean [SD] age, 57.2 [18.5] years; 38 678 men [43.1%]) and control (mean [SD] age, 57.0 [17.9] years; 40 014 men [44.6%]) cohorts after matching. The NAION cohort demonstrated a significantly higher all-stroke risk at all time points: 1 month (RR, 5.04; 95% CI, 4.41-5.78), 3 months (RR, 3.79; 95% CI, 3.40-4.21), 1 year (RR, 2.50; 95% CI, 2.32-2.70), 5 years (RR, 1.54; 95% CI, 1.45-1.63), and 10 years (RR, 1.33; 95% CI, 1.23-1.43). Sensitivity analysis in patients without comorbidities similarly revealed a significantly increased all-stroke risk across all intervals: 1 month (RR, 7.55; 95% CI, 4.74-12.03), 3 months (RR, 6.70; 95% CI, 4.48-10.04), 1 year (RR, 3.96; 95% CI, 2.94-5.34), 5 years (RR, 2.85; 95% CI, 2.18-3.72), and 10 years (RR, 1.68; 95% CI, 1.25-2.26). Among all the clinical factors of interest, only hypertension was consistently associated with all subtypes of stroke following NAION. This cohort study of patients with NAION found a significantly elevated risk of stroke compared with matched controls, independently of comorbidities. These findings underscore the importance of regular stroke workups following the onset of NAION.

THE IMPACT OF AI ON TEACHERS: SUPPORT OR REPLACEMENT?

The article explores the growing role of AI in education, analyzing whether it serves as a supportive tool for teachers or poses a threat to their jobs. AI can automate routine tasks such as grading and administrative work, freeing up teachers’ time for more meaningful activities like personalized student interaction and lesson planning. Additionally, AI-powered tools enhance data-driven teaching, providing teachers with valuable insights to improve student performance and offer individualized support. While AI offers significant advantages, the article emphasizes that it cannot replace the human qualities essential to teaching, such as emotional intelligence, empathy, and creativity. These are areas where AI falls short, making it unlikely to fully replace teachers. Instead, AI allows teachers to evolve their roles from traditional instruction to mentorship and guidance, focusing on fostering critical thinking and creativity in students. However, there are concerns that AI could reduce teaching jobs or fundamentally change the role of educators. Teachers may also resist AI due to fears of job displacement or lack of sufficient training to use these technologies effectively. The article concludes that AI, when used responsibly, acts as a valuable partner rather than a replacement. By taking over repetitive tasks, AI enables teachers to concentrate on more impactful educational activities, ensuring that the human element remains at the heart of learning.

Association between Semaglutide and Non-Arteritic Anterior Ischemic Optic Neuropathy: A Multinational Population-Based Real-World Study

ObjectiveTo investigate whether semaglutide increases the risk of non-arteritic anterior ischemic optic neuropathy (NAION) in the general population. DesignThis retrospective cohort study utilized a de-identified global electronic medical records database. The enrollment period was extended from January 2017 to August 2023, with observations concluding in August 2024. ParticipantsThis study included individuals with type 2 diabetes mellitus (T2DM) or obesity. They were further categorized into T2DM-only, obesity-only, and T2DM with obesity groups to assess the differences among these subgroups. The effects of semaglutide were compared with those of glucose-lowering or weight loss medications other than glucagon-like peptide receptor agonists. MethodsPatient data were obtained from 160 healthcare organizations across 21 countries. Outcomes were evaluated at one, two, and three years of follow-up. A 1:1 propensity score matching was performed to balance age, sex, body mass index, hemoglobin A1C, medications, and underlying comorbidities. Cox regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI). Main Outcome MeasuresThe occurrence of NAION. ResultsThe final analysis included 37,245 participants with T2DM-only, 33,537 participants with obesity-only, and 64,989 participants with both T2DM and obesity. The results indicated that the administration of semaglutide was not associated with the development of NAION in the T2DM-only group (1 year follow-up: HR, 2.32; 95% CI, 0.60–8.97; 2 years: HR, 2.31; 95% CI, 0.86–6.17; 3 years: HR, 1.51; 95% CI, 0.71–3.25), the obesity-only group (1 year follow-up: HR, 0.25; 95% CI, 0.03–2.28; 2 years: HR, 0.44; 95% CI, 0.09–2.21; 3 years: HR, 0.44; 95% CI, 0.09–2.21), and the T2DM with obesity group (1 year follow-up: HR, 0.81; 95% CI, 0.42–1.57; 2 years: HR, 1.2; 95% CI, 0.74–1.94; 3 years: HR, 1.19; 95% CI, 0.78–1.82). ConclusionsThe findings suggest that semaglutide may not be associated with an increased risk of NAION in the general population. Therefore, avoidance of semaglutide based solely on concerns regarding the risk of NAION may not be warranted, as its potential benefits for blood glucose control and cardiovascular health likely outweigh its potential risks.

Optical coherence tomography angiography of peripapillary vessel density in non-arteritic anterior ischemic optic neuropathy and demyelinating optic neuritis.

In cases of optic disc edema or a pale optic disc, distinguishing an episode of optic neuritis (ON) from that of non-arteritic anterior ischemic optic neuropathy (NAION) during a clinical examination is challenging. Optical coherence tomography angiography (OCTA) can reveal differences in peripapillary vascular network structures and provide biomarkers for differential diagnosis. A total of 23 eyes with NAION, 22 eyes with demyelinating ON (DON), and 27 eyes from healthy participants were imaged using OCTA to observe the radial peripapillary capillaries (RPCs). Optical coherence tomography was used to measure peripapillary retinal nerve fiber layer (RNFL) thickness and the macular ganglion cell complex (mGCC). Data for all patients were recorded at 2-3 weeks and more than 3 months after the symptom onset. A total of 23 affected eyes from 23 patients with NAION (average age 52.17 ± 7.92 years), 22 eyes from 22 patients with demyelinating optic neuritis (DON) (average age 47.88 ± 19.24 years), and 27 eyes from 27 healthy individuals (average age 46.43 ± 14.08 years) were included in the study. There were no significant differences in sex, age, and eye laterality between any two groups (F = 0.968, 0.475, 0.870; p > 0.05). Throughout the course of NAION and DON, the superior RPC, superior mGCC, and peripapillary RNFL decreased with time (p < 0.05). In contrast, the inferotemporal RPC and inferior mGCC did not decrease from the acute to chronic stage in NAION (t = 1.639, 0.834, p = 0.117, 0.413). Compared with the normal group, patients with NAION and DON exhibited a sharp reduction in the average RPC, RNFL, and GCC from the acute to the chronic stage (p < 0.05). Patients with DON exhibited a significant decrease in the inferotemporal RPC and inferior mGCC compared with the patients with NAION (p < 0.05). In contrast, there were no significant differences in the inferior mGCC at the chronic stage between the patients with NAION and those with ON (t = 2.547, p = 0.093). Various structural and microvascular changes were observed in patients with NAION and ON, indicating distinct features of the optic nerve during the different stages of NAION and ON. Peripapillary vascular density, measured using spectral domain OCT (SD-OCT), may be a biomarker to distinguish NAION from ON.

Anterior ischemic optic neuropathy (AION) : S1guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 30.08.2024

Anterior ischemic optic neuropathy (AION) : S1guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 30.08.2024

Posterior short ciliary arteries ischemia following embolization of anterior ethmoid artery to treat dural arteriovenous fistulas: a case report

BackgroundThe Onyx™ Liquid Embolic System is a non-adhesive liquid embolic agent, which has been proved by the US FDA for embolization of lesions in the peripheral and neurovasculature since 2005. We reported a case of ischemic optic neuropathy after using Onyx-18 to embolize the anterior ethmoid arteries that feeding dural arteriovenous fistulas (DAVF).Case presentationA 57-year-old Asian male presented with anterior cranial fossa DAVF underwent embolotherapy by delivering Onyx-18 through a microcatheter into the anterior ethmoid arteries under angiography guidance. The interventional procedure was successful and no clear evidence was found pointing to untargeted occlusive embolus. But after the surgery the patient experienced delayed painless vision loss in the right eye (RE). The fundoscopy showed unilateral papilledema with pale optic disc in RE, accompanied by significant edema and thickening in the retinal nerve fiber layer (RNFL) of macula. The fundus fluorescence angiography showed that most of the optic disc in RE had postponed or absent fluorescence filling. Visual evoked potential (VEP) confirmed that the amplitude of the P100 component was decreased in RE without significant prolongation of the latency. The patient was diagnosed with anterior ischemic optic neuropathy, but immediate pulse steroid therapy failed to rescue his vision.ConclusionPreoperative evaluation of the patient’s hemodynamic status and fundus examination are essential for assessing the risk of ischemic ocular complications, and the non-adhesive liquid embolic agent Onyx-18 should be used cautiously during endovascular embolization of intracranial artery.

Characteristics associated with anterior ischemic optic neuropathy (AION) in giant cell arteritis (GCA).

Giant cell arteritis (GCA) is the most common vasculitis and can result in blindness due to anterior ischemic optic neuropathy (AION). Little is known about which patients with GCA are at higher risk of AION.We did a retrospective chart review to compare demographics, past medical history, labs and imaging of GCA patients with and without AION. All patients at the University of Washington who were diagnosed with GCA by a rheumatologist, had a vascular ultrasound and met classification criteria for GCA were included. AION was diagnosed by an ophthalmologist. To compare demographics, symptoms, presentation imaging and lab findings, we used Pearson Chi-square, Fisher's exact test and t-tests to compare GCA patients with and without AION. 91 patients with GCA without vision loss were compared to 15 patients with GCA and AION.The AION group had significantly more men (p=0.03) and elevated C-reactive protein (CRP) as compared to the non-AION group (p = 0.04). Rates of hypertension, smoking, erythrocyte sedimentation rate (ESR) and classification scores were similar. Vascular ultrasound showed similar rates of small and large vessel vasculitis, but the AION group had higher halo scores, with the AION group having a mean score of 5 and patients with GCA and without AION having a mean score of 3 (p < 0.01). Older men with GCA and more than three halos on vascular ultrasound imaging of GC may be at higher risk of AION. Key Points • This is the first paper to incorporate the use of vascular ultrasound in comparing patients with anterior ischemic optic neuropathy (AION) to those without giant cell arteritis (GCA). • Male sex is associated with AION despite GCA being more common in women. • Older age and higher CRP are associated with AION. • GCA patients with AION had a higher halo score than GCA patients without AION.

Differential diagnosis of optic neuritis and anterior ischemic optic neuropathy

Background. Acute anterior ischemic neuropathy and optic neuritis are among the most common diseases that are the most frequent cause of both reversible and persistent visual acuity reduction. There is a sudden loss of vision, the clinical picture is often similar, and the restoration of visual functions and the prevention of complications in the form of optic nerve atrophy and disease relapses depend on a correct diagnosis and timely prescribed therapy. A significant level of medico-social and economic losses for society in all regions of the world is related to complications, namely the occurrence of optic nerve atrophy due to both optic nerve inflammation (neuritis) and ischemic optic neuropathy. The purpose was to determine the differential signs of optic neuritis and anterior ischemic optic neuropathy. Materials and methods. Eighty-five patients were examined, 52 (61.2 %) women and 33 (38.8 %) men. Seventy-one (83.5 %) participants were employed. The patients were divided into two groups: the first one — 38 patients with optic neuritis (papillitis); the second one — 47 people with ischemic optic neuropathy. General ophthalmological examinations were carried out. Results. Computed perimetry showed the presence of scotoma and quadrantanopia, both in anterior optic neuropathy (typical altitudinal scotomas) and optic neuritis (peripheral and central scotomas). The difference in the indicators of the electrical activity of the visual analyzer according to phosphene between the groups was 15.8 % (p &lt; 0.05), which indicates a more significant increase in the functional activity of the visual analyzer in the group with anterior optic vascular neuropathy. Thinning of the peripapillar nerve fiber layer and partial atrophy of the optic nerve were noted 2 times less often in patients with anterior vascular ischemic neuropathy — 7 (16.3 %) vs. 14 (33.3 %) in those with partial atrophy of the optic nerve (Pearson’s χ2 = 22.59, p = 0.00001). Conclusions. The issue of early differential diagnosis of anterior optic ischemic neuropathy and optic neuritis is relevant, which determines the prognosis of the disease, allows increasing the effectiveness of treatment and preventing irreversible consequences. The therapeutic effect of treating the consequences of damage to the optic nerve is not stable and is weak, and success is not always achieved. First of all, the treatment of the underlying disease is indicated. Computed perimetry showed the presence of scotoma and quadrantanopia in both anterior optic neuropathy (typical altitudinal scotomas) and optic neuritis (peripheral and central scotomas).

Deep Learning to Discriminate Arteritic From Nonarteritic Ischemic Optic Neuropathy on Color Images

Prompt and accurate diagnosis of arteritic anterior ischemic optic neuropathy (AAION) from giant cell arteritis and other systemic vasculitis can contribute to preventing irreversible vision loss from these conditions. Its clinical distinction from nonarteritic anterior ischemic optic neuropathy (NAION) can be challenging, especially when systemic symptoms are lacking or laboratory markers of the disease are not reliable. To develop, train, and test a deep learning system (DLS) to discriminate AAION from NAION on color fundus images during the acute phase. This was an international study including color fundus images of 961 eyes of 802 patients with confirmed AAION and NAION. Training was performed using images from 21 expert neuro-ophthalmology centers in 16 countries, while external testing was performed in a cohort from 5 expert neuro-ophthalmology centers in the US and Europe. Data for training and external testing were collected from August 2018 to January 2023. A mix of deidentified images of 2 fields of view (optic disc centered and macula centered) were used. For training and internal validation, images were from 16 fundus camera models with fields of 30° to 55°. For external testing, images were from 5 fundus cameras with fields of 30° to 50°. Data were analyzed from January 2023 to January 2024. The performance of the DLS was measured using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. In the training and validation sets, 374 (54.9%) of patients were female, 301 (44.2%) were male, and 6 (0.9%) were of unknown sex; the median (range) age was 66 (23-96) years. When tested on the external dataset including 121 patients (35 [28.9%] female, 44 [36.4%] male, and 42 [34.7%] of unknown sex; median [range] age, 69 [37-89] years), the DLS achieved an AUC of 0.97 (95% CI, 0.95-0.99), a sensitivity of 91.1% (95% CI, 85.2-96.9), a specificity of 93.4% (95% CI, 91.1-98.2), and an accuracy of 92.6% (95% CI, 90.5-96.6). The accuracy of the 2 experts for classification of the same dataset was 74.3% (95% CI, 66.7-81.9) and 81.6% (95% CI, 74.8-88.4), respectively. A DLS showing disease-specific averaged class-activation maps had greater than 90% accuracy at discriminating between acute AAION from NAION on color fundus images, at the eye level, without any clinical or biomarker information. A DLS that identifies AAION could improve clinical decision-making, potentially reducing the risk of misdiagnosis and improving patient outcomes.

Intraretinal hyperreflective line: potential biomarker in various retinal disorders.

The intraretinal hyperreflective line (IHL) is a novel posterior segment finding demonstrable using careful optical coherence tomography (OCT) examination. It likely indicates a reaction against photoreceptor, Muller cell, and/or retinal pigment epithelial damage. This study analyzed the spectral-domain OCT characteristics of IHLs to disclose their presence in various retinal conditions. A retrospective review of the charted and imaging records of participants with IHL was conducted at Dokuz Eylul University Department of Ophthalmology between January 2019 and August 2023. The inclusion criterion was the detection of an IHL on good-quality B-scan spectral-domain OCT. An IHL was defined as a vertical line extending from the ellipsoid zone band (or lower) through the outer nuclear layer to the internal limiting membrane in the central fovea. Associated retinal conditions were recorded as potential causative factors for the presence of IHL. IHL was observed on spectral-domain OCT in 40 eyes of 38 participants with several retinal diseases assessment. Fourteen eyes (35%) underwent vitreoretinal surgery pre-IHL detection (12 were operated for full-thickness macular hole [FTMH], one for epiretinal membrane [ERM], and one for rhegmatogenous retinal detachment). In six eyes (15%) a microhole coexisted. Four eyes (10%) had a concurrent lamellar macular hole. The IHL preceded the occurrence of FTMH in three eyes (7.5%), and diabetic macular edema and type 2 idiopathic macular telangiectasia (MacTel-2) were present in three eyes (7.5%) each. The remaining conditions included vitreomacular traction (VMT), nonarteritic anterior ischemic optic neuropathy with central retinal artery occlusion, commotio retinae, exudative age-related macular degeneration, ERM, non-infectious idiopathic posterior uveitis, and Coats' disease, each affecting one eye (2.5%). Of the two participants with bilateral involvement, one was diagnosed with MacTel-2 and the other had IHL with VMT in the right eye that was detected post-vitreoretinal surgery for FTMH in the left eye. Although IHLs are mostly identified in eyes with vitreomacular surface diseases, clinicians may encounter IHLs in other types of retinal pathology. Further large-scale, multicenter, long-term studies on the presence of IHLs in OCT imaging are required to provide more substantial insight on this biomarker.

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide

Background: Non-arteritic anterior ischemic optic neuropathy is the most common acute optic neuropathy in patients older than 50 years. Risk factors for NAION are structural crowding of disc, diabetes, systemic hypertension, hyperlipidaemia, smoking. Patients present with sudden monocular vision loss, dyschromatopsia, visual field defect, disc edema diffuse or segmental. Objectives: To evaluate risk of non arteritic anterior ischemic optic neuropathy after routine treatment. Method: This Longitudinal observational study was carried out from January 2016 to June 2016 at Department of Neuro-Ophthalmology, National Institute of Ophthalmology &amp; Hospital, Sher -E-Bangla Nagar, Dhaka among Sixty cases. Detailed information were obtained in each cases according to protocol. A complete history was taken from the patient. Relevant investigation reports were collected. Selected patients were undergone detailed ophthalmological and systemic evaluation. They were treated at NIO&amp;H with following measure like proper counseling, controlling of risk factors like diabetes, hypertension, hyperlipidaemia and were advised to take tablet vitamin B1, B6 &amp; B12. They were followed up at 1st week, 4th week &amp; 8th week. In each visit visual acuity, color vision, field of vision, RAPD &amp; optic disc changes were recorded in a pre- designed data collection sheet. All the information’s were recorded according to fixed protocol. Results: Among the 60 cases, mean age was 55.67 (±4.89) years, minimum age was 51 and maximum age 69 years. Majority 32(53.3%) were male and 28(46.67%) were female. Associated risk factor like diabetes, hypertension, hyperlipidaemia and sleep apnea which were 53.3%, 36.67%, 30% and 13.3% respectively. Different disc changes of the study population were segmental disc swelling 36(60%) and diffuse disc swelling 24(40%) respectively. Regarding distant visual acuity patients were grouped into 6/6 to 6/12 group, 6/18-6/36 group, 6/60- 1/60 group and counting finger to hand movement group. At presentation most of the patient belongs to 6/6- 6/12 group which was 26(43.33%) followed by 6/18-6/36 group, it was 18(30%), 10(16.67%) were included in (6/60-1/60) group and the rest 06(10%) were included in counting finger to hand movement group. At final visit on 8th week 20(35.7%) patients remain in 6/6-6/12 group and also 6/18-6/36 group includes 20(35.7%) patients, 10(16.67%) were included in (6/60-1/60) group and the rest 06(10%) were included in counting finger to hand movement group. RAPD present in pretreatment 52(86.7%) and in post treatment were 46(82.14%). (p&gt;0.05) that was not statistically significant. Color vision dyschromatopsia in pretreatment 46(76.7%) and in post treatment were 37(60%). In post treatment 06(10.71%) were normal color vision. (p&lt;0.5) that was statistically significant. ocular involvement 52(86.67%) were 1st eye and 08(13.3%) were 2nd eye. Comparison of pre-treatment and post treatment visual field were Arcuate scotoma 12(20%) vs 09(16.07%), Inferior Altitudinal field defect 32(53.33%) vs 31(57.14%), Superior Altitudinal field defect 02(3.3%) vs 02(3.57%) respectively. Conclusion: In study no significant change found on visual acuity, colour vision and field of vision after treatment of non-arteritic anterior ischemic optic neuropathy.

RFMiD: Retinal Image Analysis for multi-Disease Detection challenge

In the last decades, many publicly available large fundus image datasets have been collected for diabetic retinopathy, glaucoma, and age-related macular degeneration, and a few other frequent pathologies. These publicly available datasets were used to develop a computer-aided disease diagnosis system by training deep learning models to detect these frequent pathologies. One challenge limiting the adoption of a such system by the ophthalmologist is, computer-aided disease diagnosis system ignores sight-threatening rare pathologies such as central retinal artery occlusion or anterior ischemic optic neuropathy and others that ophthalmologists currently detect. Aiming to advance the state-of-the-art in automatic ocular disease classification of frequent diseases along with the rare pathologies, a grand challenge on “Retinal Image Analysis for multi-Disease Detection” was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI - 2021). This paper, reports the challenge organization, dataset, top-performing participants solutions, evaluation measures, and results based on a new “Retinal Fundus Multi-disease Image Dataset” (RFMiD). There were two principal sub-challenges: disease screening (i.e. presence versus absence of pathology — a binary classification problem) and disease/pathology classification (a 28-class multi-label classification problem). It received a positive response from the scientific community with 74 submissions by individuals/teams that effectively entered in this challenge. The top-performing methodologies utilized a blend of data-preprocessing, data augmentation, pre-trained model, and model ensembling. This multi-disease (frequent and rare pathologies) detection will enable the development of generalizable models for screening the retina, unlike the previous efforts that focused on the detection of specific diseases.

Accuracy of Diagnosing Optic Neuritis Using DANTE T1-SPACE Imaging.

To evaluate the use of delay alternating with nutation for tailored excitation-prepared T1-weighted turbo spin echo (DANTE T1-SPACE) imaging for diagnosing optic neuritis and to analyze its correlation with clinical findings before and after treatment. Patients diagnosed with optic neuritis or non-arteritic anterior ischemic optic neuropathy (NA-AION) were evaluated at the Ophthalmology Department of Kyoto University Hospital. All patients underwent magnetic resonance (MR) studies before treatment initiation and ophthalmic examinations before and after treatment. Three ophthalmologists independently reviewed the MR scans for abnormalities. The magnetic resonance imaging (MRI) assessments included post-contrast DANTE T1-SPACE, post-contrast volumetric interpolated breath-hold examination (VIBE), and short T1 inversion recovery (STIR) scans. The presence of abnormalities in each sequence was determined. Of 36 eyes from 30 patients, 21 eyes from 17 patients were diagnosed with optic neuritis, and 15 eyes from 13 patients were diagnosed with NA-AION. DANTE T1-SPACE sequences showed better sensitivity for detecting optic neuritis than STIR sequences (100% vs 67%, p = 0.009). VIBE images did not confirm enhancement of lesions in some cases with optic neuritis. No differences were observed among the sequences for NA-AION. Lesion length evaluated by DANTE T1-SPACE sequences was associated with circumpapillary retinal nerve fiber layer thickness at the initial visit, eye pain, and the time interval from symptom onset to MRI scan. Contrast-enhanced DANTE T1-SPACE was better than other sequences of MRI for diagnosing optic neuritis.

Anterior ischemic optic neuropathy: A complication of hemodialysis

Non-arteritic anterior ischemic optic neuropathy (NA-AION) is a rare complication of chronic hemodialysis in patients with end-stage renal disease. We present an interesting case of a 50-year-old patient on hemodialysis who presented with diminution of vision in the left eye (LE). The pupil showed a relative afferent pupillary defect in LE, and the rest of the anterior segment was within normal limits. A fundus revealed pallid disc edema. LE had color vision defect. Spectral-domain optical coherence tomography showed increased retinal nerve fiber layer thickness at the superior edge of the disc, confirming the diagnosis of NA-AION.

Non-arteritic anterior ischemic optic neuropathy in Black patients

Prior studies have shown that non-arteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared to those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black NAION patients compared to White patients. Retrospective cross-sectional study METHODS: Self-reported race was collected from all NAION patients seen between 2014-2022 from a single US neuro-ophthalmology service. All Black NAION patients and a randomly selected sample of White NAION patients were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures. We included 32 Black NAION patients (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: OR 4.07, P = 0.03; 6 to <12 months: OR 6.05, P = 0.007). Chronic kidney disease (OR 7.53, P = 0.003) and hemodialysis (OR 13.69, P = 0.02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR 2.83, P = 0.09; 0.25 to <0.35: OR 0.56, P = 0.46; ≥0.35: OR 0.66, P = 0.44). Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black NAION patients were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White NAION patients, suggesting that the underlying proposed compartment mechanism is the same between races.

Ischemic Optic Neuropathy: A Review of Current and Potential Future Pharmacotherapies.

The treatment of arteritic anterior ischemic optic neuropathy (AAION), non-arteritic ischemic optic neuropathy (NAAION), and posterior ischemic optic neuropathy (PION) is a topic of ongoing research with mixed evidence on some pharmacotherapies and a need for more consensus. This manuscript provides an overview of these conditions' current, potential future, and attempted pharmacotherapies. AAION's current treatment regimen consists of high-dose steroids, with methotrexate, tocilizumab, and abatacept, being the most viable steroid-sparing therapy candidates. As for NAAION, the treatments being tried are vast, with mixed evidence supporting each modality. Similarly, despite the various treatment options explored, there still needs to be a universally effective therapy for PION. More research is needed to formulate an agreed-upon treatment regimen for these conditions.

Longitudinal evaluation of circumpapillary structure-function and vasculature-function relationships in acute and sub-acute nonarteritic anterior ischemic optic neuropathy

PurposeTo investigate the global and regional correlations between longitudinal structure-function (S-F) and vasculature-function (V-F) using circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements, circumpapillary vessel density (cpVD) and the corresponding/final visual outcomes at different stages of nonarteritic anterior ischemic optic neuropathy (NAION). MethodsThirty eyes of 30 patients with acute NAION were included. LogMAR best-corrected visual acuity(BCVA), mean deviation (MD) and visual field index (VFI), cpRNFL thickness and cpVD across different retinal layers were examined at baseline, 2 weeks and 1 month after diagnosis. Potential correlations between the Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters and visual outcomes were investigated in both acute and sub-acute NAION. ResultsSignificant global and regional correlations in S-F relationship were identified exclusively in sub-acute stage (p < 0.05). However, among the OCTA parameters for the acute NAION, the temporal cpVD in superficial vessel complex (SVC) and inner retinal layer (IRL) exhibited positive correlations with corresponding and final visual acuity and visual field outcomes. In the sub-acute stage of NAION, the cpVD of global or temporal section in radial peripapillary capillary (RPC), SVC and IRL were positively correlated with visual outcomes. ConclusionSignificant longitudinal V-F relationships exist both globally and regionally, in acute and sub-acute NAION. The cpVD parameters of the SVC and IRL are potentially valuable for evaluating corresponding and final visual outcomes and highlights the importance of monitoring cpVD over cpRNFL thickness in acute NAION.

Efficacy of compound xueshuantong capsule in reducing cardiovascular diseases and associated ophthalmic complications: a multi-centre retrospective study

IntroductionThis study aims to explore the effectiveness and value of compound xueshuantong capsule (CXC) in the treatment of diseases by evaluating its potential to reduce cardiovascular diseases (CVDs) and ophthalmic complications. MethodsA total of 5104 patients with fundus vascular diseases including retinal artery occlusion (RAO), retinal vein occlusion (RVO), diabetic retinopathy (DR), hypertensive retinopathy, periphlebitis of retina, age-related macular degeneration (AMD), central serous chorioretinopathy (CSC), and anterior ischaemic optic neuropathy (AION) were enroled across seven hospitals from 2002 to 2022. All participants were randomised categorised into two groups: CXC combination group (CXC alone or combined with hypoglycemic, lipid-lowering, or anti-hypertensive drugs, and other microcirculation and fundus angiopathy medications), and non-CXC group (only taking the above-mentioned medicines). ResultsKaplan-Meier curves illustrated a lower incidence of cardio-cerebrovascular events and ophthalmic complications in CXC group compared with other group at a significant difference observed. Further stratification revealed a decreased risk of ophthalmic complications in CXC group, and supported by multivariate analysis through adjusting for baseline confounding factors. Discussion/ConclusionsOur findings further confirmed the potential value of CXC in treating cardio-cerebrovascular diseases and associated ophthalmic complications, and accompanying with less side effects at the same time.

Arteritic Ischemic Optic Neuropathy

Ischemic optic neuropathy is an important cause of blindness. There are two types of ischemic optic neuropathy: posterior and anterior ischemic optic neuropathy (AION). The arteritic type of AION (AAION) is usually due to giant cell arteritis. Giant cell arteritis can present with visual loss alone in up to 25% of cases. AAION is considered a neuro-ophthalmologic emergency. Early recognition and treatment of AAION is crucial to prevent severe visual loss. The gold standard of treatment is corticosteroids. There is no consensus in the literature on the optimal treatment approach in steroid-resistant or steroid-contraindicated cases. Biologic agents, especially tocilizumab, show promise in resistant cases.