Nonarteritic Anterior Ischemic Optic Neuropathy Patients Research Articles

Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion.

To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy (NAION) and central retinal artery occlusion (CRAO) and develop a predictive diagnostic nomogram. The study included 37 patients with monocular NAION, 20 with monocular CRAO, and 24 with hypertension. Gender, age, and systemic diseases were recorded. Blood routine, lipids, hemorheology, carotid and brachial artery doppler ultrasound, and echocardiography were collected. The optic disc area, cup area, and cup-to-disc ratio (C/D) of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured. The carotid artery intimal medial thickness (C-IMT) of the affected side of the CRAO group was thicker (P=0.039) and its flow-mediated dilation (FMD) was lower (P=0.049) than the NAION group. Compared with hypertension patients, NAION patients had higher whole blood reduced viscosity low-shear (WBRV-L) and erythrocyte aggregation index (EAI; P=0.045, 0.037), and CRAO patients had higher index of rigidity of erythrocyte (IR) and erythrocyte deformation index (EDI; P=0.004, 0.001). The optic cup and the C/D of the NAION group were smaller than the other two groups (P<0.0001). The diagnostic prediction model showed high diagnostic specificity (83.7%) and sensitivity (85.6%), which was highly related to hypertension, the C-IMT of the affected side, FMD, platelet (PLT), EAI, and C/D. CRAO patients show thicker C-IMT and worse endothelial function than NAION. NAION and CRAO may be related to abnormal hemorheology. A small cup and small C/D may be involved in NAION. The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

Diffusional kurtosis imaging in differentiating nonarteritic anterior ischemic optic neuropathy from acute optic neuritis.

We aimed to determine the feasibility of using DKI to characterize pathological changes in nonarteritic anterior ischemic optic neuropathy (NAION) and to differentiate it from acute optic neuritis (ON). Orbital DKI was performed with a 3.0T scanner on 75 patients (51 with NAION and 24 with acute ON) and 15 healthy controls. NAION patients were further divided into early and late groups. The mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) were calculated to perform quantitative analyses among groups; and receiver operating characteristic curve analyses were also performed to determine their effectiveness of differential diagnosis. In addition, correlation coefficients were calculated to explore the correlations of the DKI-derived data with duration of disease. The MK, RK, and AK in the affected nerves with NAION were significantly higher than those in the controls, while the trend of FA, RD, and AD was a decline; in acute ON patients, except for RD, which increased, all DKI-derived kurtosis and diffusion parameters were significantly lower than controls (all P < 0.008). Only AK and MD had statistical differences between the early and late groups. Except for MD (early group) and FA, all other DKI-derived parameters were higher in NAION than in acute ON; and parameters in the early group showed better diagnostic efficacy in differentiating NAION from acute ON. Correlation analysis showed that time was negatively correlated with MK, RK, AK, and FA and positively correlated with MD, RD, and AD (all P < 0.05). DKI is helpful for assessing the specific pathologic abnormalities resulting from ischemia in NAION by comparison with acute ON. Early DKI should be performed to aid in the diagnosis and evaluation of NAION.

COMPARISON OF VISUAL ACUITY AFTER A COMBINATION OF CITICHOLINE AND METHYLPREDNISOLONE WITH A SINGLE CITICHOLINE TREATMENT IN NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Non-arteritic anterior ischemic optic neuropathy (NAION) accounts for 90-95% of optic neuropathy in the elderly with symptoms of decreased visual acuity. Posterior ciliary brevis hypoperfusion results in ischemia, triggers oxidative stress, axonal edema as well as compartment syndrome leading to retinal ganglion cell death via apoptosis. There is no gold standard therapy for NAION. Citicholine as a neuroprotector agent has shown satisfactory results in the acute and chronic phases. Methylprednisolone is also a therapeutic consideration that decreases capillary permeability thereby promoting faster resolution of disc edema. This study aimed to compare visual acuity in NAION patients with combination therapy of citicholine and methylprednisolone with single citicholine therapy.&#x0D; Methods : An analytical observational study with retrospective data collection at the National Eye Center of Cicendo Hospital for the period January 2021–February 2022. A total of 59 NAION patients who met the inclusion criteria were then divided into 2 groups, namely receiving a combination of citicholine with corticosteroids and single citicholine treatment.&#x0D; Results : The mean age in the combination group was 52.57±9.035 and the single group was 57.52±10.319. The number of men and women in the combination group were the same while in the single group women was higher. The risk factors obtained were hypertension, diabetes mellitus (DM), dyslipidemia, and smoking. There was a significant mean difference between initial visual acuity and3 months after therapy in the combination therapy group (p=0.0001) and in the single group. (p=0.002)&#x0D; Conclusion : Visual acuity in NAION patients with combination therapy of citicholine and methylprednisolone is better than citicholine alone.

Nonarteritic anterior ischemic optic neuropathy and incidence of Parkinson’s disease based on a nationwide population based study

This study aimed to investigate the association between nonarteritic anterior ischemic optic neuropathy (NAION) and Parkinson's disease (PD) using a retrospective, nationwide, population-based cohort in South Korea. This study utilized data from the Korean National Health Insurance database, including 43,960 NAION patients and 219,800 age- and sex-matched controls. Cox proportional hazards regression models were used to assess the risk of developing PD in the NAION group compared to the control group after adjusting for various confounding factors. Subgroup analyses were conducted based on sex, age, and comorbidities. The incidence rate of PD was higher in the NAION group (1.326 per 1000 person-years) than in the control group (0.859 per 1000 person-years). After adjusting for confounding factors, the risk of developing PD was significantly higher in the NAION group (adjusted hazard ratio [aHR] 1.516, 95% confidence interval [CI] 1.300–1.769). Subgroup analyses did not reveal a significant difference in the risk of PD development based on sex, age, or comorbidities. This retrospective, nationwide, population-based cohort study revealed a significant association between NAION and an increased risk of developing PD in a South Korean population. The incidence rate of PD was observed to be higher in individuals diagnosed with NAION than in age- and sex-matched controls even after adjusting for potential confounding variables, with the risk being approximately 51.6% higher in the NAION group. Further research is necessary to elucidate the underlying pathophysiological mechanisms linking NAION to PD and to determine whether similar associations exist in other ethnic and geographical populations.

Understanding the Etiopathogenesis of Non-Arteritic Anterior Ischemic Optic Neuropathy with Laboratory Findings.

The role of inflammation and hemostasis in non-arteritic anterior ischemic optic neuropathy (NAION) was investigated by examining related blood tests. The predictive values of these laboratory indicators and their effects on prognosis were reviewed. In this study, 48 patients diagnosed with NAION and 50 healthy volunteers were included. All subjects underwent full ophthalmological examination. All patients were treated with oral corticosteroids (methylprednisolone 1 mg/kg/day) for 15 days after that corticosteroid medication was reduced and stopped. Each patient was monitored at least for 12 months. The mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte ratio (NLR), and red cell distribution width (RDW) values were recorded. These findings were compared with control group. The mean MPV, RDW, and NLR values were significantly higher in NAION group (respectively, p<0.001, p=0.006, and p<0.001). There was no statistically significant difference between group 1 and group 2 in PDW values, but the mean PDW value was higher in the patient group compared to the control group (p=0.435). Based on the receiver operating characteristic (ROC) curve, the NLR had the strongest predictive value. This was followed by MPV, RDW, and PDW with lower diagnostic predictive values. MPV, NLR, and RDW were found to be elevated and have diagnostic predictive values in NAION patients. Easily accessible and simple laboratory methods could help us show systemic inflammation and ischemic events in NAION patients. As a result, inflammatory reactions besides ischemic changes may play a role in the etiopathogenesis of NAION. These biomarkers can be evaluated to ensure that patients with risk factors for the development of NAION.

Vessel Density Features of Optical Coherence Tomography Angiography for Classification of Optic Neuropathies Using Machine Learning.

To evaluate the classification performance of machine learning based on the 4 vessel density features of peripapillary optical coherence tomography angiography (OCT-A) for classifying healthy, nonarteritic anterior ischemic optic neuropathy (NAION), and optic neuritis (ON) eyes. Forty-five eyes of 45 NAION patients, 32 eyes of 32 ON patients, and 76 eyes of 76 healthy individuals with optic nerve head OCT-A were included. Four vessel density features of OCT-A images were developed using a threshold-based segmentation method and were integrated in 3 models of machine learning classifiers. Classification performances of support vector machine (SVM), random forest, and Gaussian Naive Bayes (GNB) models were evaluated with the area under the receiver-operating-characteristic curve (AUC) and accuracy. We divided 121 images into a 70% training set and 30% test set. For ON-NAION classification, best results were achieved with 50% threshold, in which 3 classifiers (SVM, RF, and GNB) discriminated ON from NAION with an AUC of 1 and accuracy of 1. For ON-Normal classification, with 100% threshold, SVM and RF classifiers were able to discriminate normal from ON with AUCs of 1 and accuracies of 1. For NAION-normal classification, with 50% threshold, the SVM and RF classified the NAION from normal with AUC and accuracy of 1. ML based on the combined peripapillary vessel density features of total vessels and capillaries in the whole image and ring image could provide excellent performance for NAION and ON distinction.

Structure-function relationship between magnetic resonance imaging lesion areas and visual field defects in initial optic neuritis with altitudinal hemianopsia.

To study the spatial association of magnetic resonance imaging (MRI) contrast enhancement (CE) areas with visual field defect (VFD) asymmetry in initial cases of optic neuritis (ON) with altitudinal hemianopsia (AH) with reference to nonarteritic anterior ischemic optic neuropathy (NAION) with AH. Multicenter, cross-sectional study. The present study comprised 19 ON patients and 20 NAION patients with AH who underwent orbital contrast fat-suppressed MRI. The signal-to-intensity ratio (SIR) was calculated by dividing the maximum CE of the optic nerve by the mean CE of the cerebral white matter in 11 coronal sections at 3-mm intervals from immediately posterior to the eyeball to the optic chiasm. Sections in ON patients with an SIR exceeding the mean plus 2 standard deviations of the SIR at the corresponding section in the NAION group were considered abnormal. The correlation between upper-to-lower CE asymmetry in the maximum SIR section and VFD counterpart was determined. The ON group had significantly higher maximum SIR than that of the NAION group (1.77 ± 0.88 vs. 1.25 ± 0.32; P < .01). Seven of the 19 patients had sections with abnormally high CE extending posteriorly beyond the orbital apex. Significant spatial correspondence was observed between CE and VFD asymmetry (rs = 0.563; P = .015) in the ON group but not in the NAION group (rs = - 0. 048; P = .850). ON patients with AH frequently show CE even in the intracerebral optic nerve, maintaining a moderate structure-function correspondence.

Papillary vitreous detachment as a possible accomplice in non-arteritic anterior ischaemic optic neuropathy

AimTo evaluate the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of vitreopapillary interface between NAION patients and normal...

Race Distribution in Nonarteritic Anterior Ischemic Optic Neuropathy

To describe the racial distribution of patients diagnosed with nonarteritic anterior ischemic optic neuropathy (NAION) in 2 large urban academic centers in the United States. Retrospective cross-sectional study. All patients with NAION evaluated between 2014 and 2022 in tertiary neuro-ophthalmology services in Atlanta, GA, and New York, NY, respectively, were included. In order to assess the racial accessibility to our services, similar numbers of patients with idiopathic intracranial hypertension seen in the same services were included. Self-reported race at the time of neuro-ophthalmologic examination was collected for all patients. Results were compared with data published by the US Bureau of Census for Decennial Census in 2020 for the states of Georgia and New York, and for the total population of the United States. In both locations, the vast majority of patients with NAION reported being White (91.06% in Atlanta and 78.9% in New York). Only 7.27% of patients in Atlanta and 3% in New York reported being Black, and 1.24% of patients in Atlanta and 5.9% in New York reported being Asian. There were a much higher proportion of White people among NAION patients than in the group of patients with idiopathic intracranial hypertension and in each respective state and in the United States. Our results show that the majority of patients with NAION are White, followed by Black and Asian races, respectively, thus confirming the NAION race distribution reported by past clinical trials.

The correlation between non-arteritic anterior ischemic optic neuropathy and cerebral infarction.

The aim of this study was to explore the correlation between non-arteritic anterior ischemic optic neuropathy (NAION) and cerebral infarction (CI). Moreover, the ocular and systemic parameters are also compared between NAION patients with or without CI. Retrospective analysis is performed for NAION patients and the controls. The controls were collected at the eye outpatient with cranial computed tomography (CT), and data of blood triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and apolipoprotein B were drawn. The diagnosed NAION patients with cranial CT are included, and data of clinical history and routine clinical examination were drawn from the medical record. Visual acuity, intraocular pressure (IOP), visual field, and visual evoked potential were also drawn. Eighty-two unilateral and 6 bilateral patients, totally 94 eyes for 88 NAION patients and 69 controls are included. NAION and control patients have matched age, gender, and weight. There is no difference in triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and apolipoprotein B between these two groups. NAION patients (43.18%, 38/88) have a higher ratio of CI than the controls (14.49%, 10/69) (p = 0.000). For NAION, the odds ratio (OR) of CI is 2.691 (p = 0.011). Body mass index, height, and IOP show no significant difference between NAION patients with or without CI. NAION patients with CI have a significant higher ratio of hypertension than those without CI, and the OR of HBP is 2.623 (p = 0.008). The correlation between NAION and CI is possible as NAION patients have a significant higher ratio with CI. In NAION patients, hypertension is a risk factor for those with CI.

A Taiwan Nationwide Population-Based Study of Socio-Demographic Factors and Comorbid Conditions Associated with Non-Arteritic Anterior Ischaemic Optic Neuropathy

Aims: The aim of the study was to investigate the socio-demographic factors and systemic conditions associated with non-arteritic anterior ischaemic optic neuropathy (NAION). Methods: This was a nationwide population-based retrospective case-controlled study that recruited 9,261 NAION patients selected from the Taiwan National Health Insurance Research Database. The control group consisted of 9,261 age-, sex-, and index date-matched non-NAION patients recruited from the Taiwan Longitudinal Health Insurance Database, 2000. NAION was designated in the database by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as “code 377.41: ischaemic optic neuropathy without ICD-9-CM code 446.5: giant cell arteritis.” Associated socio-demographic factors and systemic medical conditions were analysed using the McNemar’s test, and continuous variables were analysed using the paired t test. The odds ratio (OR) and adjusted OR of developing NAION were compared using univariate logistic regression and multivariable logistic regression analyses, respectively. Results: Patients with systemic conditions such as diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease, and hypotension were more likely to develop NAION than controls (adjusted OR = 1.81, 95% confidence interval [CI] = 1.67–1.97, p < 0.0001; adjusted OR = 1.46, 95% CI = 1.36–1.57, p < 0.0001; adjusted OR = 1.44, 95% CI = 1.33–1.57, p < 0.0001; adjusted OR = 3.26, 95% CI = 2.65–4.01, p < 0.0001; adjusted OR = 2.32, 95% CI = 1.31–4.10, p = 0.0039, respectively). Conclusions: NAION is strongly associated with diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease, and hypotension.

Construction and functional enrichment analysis of the competitive endogenous RNA regulatory network for nonarteritic anterior ischemic optic neuropathy based on high-throughput sequencing.

Based on the transcriptome high-throughput sequencing of nonarteritic anterior ischemic optic neuropathy (NAION), this study constructed a competitive endogenous RNA (ceRNA) network, enriched and analyzed it, screened long noncoding (lnc)RNAs and circular (circ)RNAs that may participate in the competitive endogenous mechanism in NAION, and inferred its function. Four milliliters of peripheral blood from NAION patients and the control group was extracted from clinical samples, transcriptome high-throughput sequencing was performed, and the sequencing data were visualized. Based on the principle of the ceRNA network, the lncRNA-micro (mi)RNA-messenger (m)RNA interaction axis and circRNA-miRNA‒mRNA interaction axes were constructed. The differentially expressed genes (DEGs) in the interaction axis were enriched and analyzed by Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG), and the functions and signalling pathways of lncRNAs and circRNAs in the interaction network were speculated. Fifty-one circRNAs were differentially expressed in the sequencing data: 25 were upregulated, and 26 were downregulated. For 996 differentially expressed lncRNAs, 317 were upregulated and 679 were downregulated, and for 1161 differentially expressed mRNAs, 698 were upregulated and 463 were downregulated. Thirty-three differentially expressed miRNAs, upregulated miRNA 18 and downregulated miRNA 15 were identified. After screening, 13 coexpressed mRNAs, 15 lncRNAs, and 3 miRNAs were finally constructed in the lncRNA-miRNA-mRNA network, and the circRNA-miRNA-mRNA network was constructed by 159 mRNAs, 26 miRNAs, and 34 circRNAs. In the lncRNA network, GO enrichment analysis obtained 182 biological processes, 12 cell components and 38 molecular functions, which are related mainly to the regulation of the activity of proteins and enzymes such as cyclic nucleotide-dependent protein kinase activity and magnesium ion-dependent protein serine/threonine phosphatase activity. KEGG analysis involved mainly the forkhead box O (FoxO) signalling pathway, apelin signalling pathway, etc. In the circRNA enrichment results, 353 biological processes, 52 cell components, and 45 molecular functions were obtained, involving mainly calcium channel regulation, neutrophil activation, mRNA transport, and metabolism. KEGG mainly involved the Wnt signalling pathway, apelin signalling pathway, Hippo signalling pathway, oxytocin signalling pathway, etc. This paper provides a new idea for lncRNAs and circRNAs to mediate the occurrence and development of NAION through the ceRNA mechanism. This study lays a foundation for the in-depth study of the pathogenesis of NAION.

Analysis of Systemic Risk Factors and Post-Insult Visual Development in a Danish Cohort of Patients with Nonarteritic Anterior Ischemic Optic Neuropathy.

PurposeNonarteritic 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.MethodsA 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.ResultsThere 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.ConclusionWe 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.

The Efficacy of Glucocorticoids in the Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis.

Background To evaluate the clinical effects and safety of glucocorticoids for patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods The databases MEDLINE, Embase, PubMed, Cochrane Database, and Web of Science were used to search for the relevant studies, and full-text articles that reported on the evaluation of glucocorticoids vs. no-treatment or placebo for patients with NAION. Review Manager 5.4 was used to estimate the pooled effects of the results among selected studies. Forest plots, funnel plots, and Begg's rank correlation were also performed on the included articles. Results A total of 983 patients were contained in the 9 studies that satisfied the eligibility criteria. The meta-analysis showed that, compared with the control group, the glucocorticoid group had significantly improved the VA (MD: -0.25, 95% CI [-0.45, -0.05], P = 0.02), VF (MD: -0.50, 95% CI [-0.94, -0.07], P = 0.02), and RNFL (MD: -14.10, 95% CI [-26.41, -1.79], P = 0.02) in NAION patients and had a high improvement rate of VA (RR 1.31, 95% CI [1.12, 1.52], P = 0.0005). No significant publication bias was observed in our study. Discussion. Our research preliminarily confirmed the effectiveness of glucocorticoids for NAION treatment, but more high-quality RCTs focusing on the hormone adverse reactions should be performed to verify our conclusions.

Citicoline in Non–arteritic Anterior Ischemic Optic Neuropathy: Pattern Electroretinography review

This study aims to assess 1000 mg citicoline each day given for 60 days on chronic phase NAION (non–arteritic anterior ischemic optic neuropathy) patients. Double masked randomized clinical trial divided the patients into 2 groups: citicoline group (C–NAION) and placebo group (P–NAION). Analysis was done in 17 patients in each group. There were increament of ? amplitude P50 30 days in C–NAION group (0,775±2,6 µV) and ? amplitude N95 60 days in C–NAION group (–0,356±2,992 µV) but statistically insignificant compared to P–NAION. Age has a good correlation with ? amplitude P50 (r = –0.517; p = 0.002). Subjects with 1 risk factor experienced a higher ? amplitude of P50 than the subjects with more than 1 risk factor (1.856 ± 2.121 ?V vs –0.26 ± 2.45; p = 0.025). Citicoline did not show any changes in Retinal Ganglion Cell Thickness. There were improvement of ? mean deviation 60 days in C–NAION group (3,13±6,467 dB), but statistically insignificant compared to P–NAION. Citicoline tends to increase the ? amplitude of P50, N95 and mean deviation in chronic phase NAION. Age and the number of risk factors affects the increase of ? amplitude P50.

Genetic polymorphisms of apolipoprotein E in nonarteritic anterior ischemic optic neuropathy.

To elucidate the potential role of genetic polymorphisms of apolipoprotein E (APOE) in nonarteritic anterior ischemic optic neuropathy (NAION) and the association between APOE and NAION-induced ocular impairments. A total of 73 NAION patients and 73 sex- and age-matched healthy controls were recruited for the study. Genomic DNA was isolated from peripheral blood samples. The alleles and genotypes of APOE were explored. The interaction between APOE and medical comorbidities was assessed by the multifactor dimensionality reduction (MDR) method. Among 81 affected eyes of NAION patients, an additional association study of APOE isoforms with visual impairments was carried out. The allele and genotype frequencies for APOE showed significant differences when comparing NAION cases and controls. Multivariate analysis adjusted for age, sex, hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, and cerebrovascular disease revealed that the ε3/ε4 genotype (OR = 3.86, 95% CI = 1.13-13.25, p = 0.032) and ε4 allele (OR = 3.55, 95% CI = 1.05-11.99, p = 0.041) were strong independent risk factors for NAION. Compared to eyes with the ε3/ε3 + ε2/ε4 genotype, individuals with the ε4/ε4 + ε3/ε4 genotype had worse visual field defects (VFDs) and thinner macular ganglion cell complex (mGCC) thicknesses with larger focal loss of volume (FLV) and general loss of volume (GLV). Compared to ε4 noncarriers, ε4 carriers also tended to have more serious VFD and mGCC loss. APOE polymorphisms conferred a significant risk of NAION and were significantly related to ocular impairments caused by NAION.

Quantification of peripapillary vessel density in non-arteritic anterior ischemic optic neuropathy patients with optical coherence tomography angiography.

Quantitative assessments based on optical coherence tomographic angiography (OCTA) may have potential promising value in the early detection of non-arteritic anterior ischemic optic neuropathy (NA-AION), but there is limited information on the ability of OCTA to distinguish eyes with NA-AION. This study was conducted to evaluate the ability of measurements of peripapillary perfusion using OCTA to distinguish healthy eyes from eyes with NA-AION. In this retrospective case-control study, newly diagnosed NA-AION patients and healthy controls matched at a ratio of 1:3 by gender and age (±5 years) were enrolled from 1 September 2020 to 30 June 2021. Peripapillary vessel density (pVD) was examined based on the area of vessels by means of a 4.5 mm OCTA scan. In addition, peripapillary retinal nerve fiber layer (pRNFL) thickness was obtained from structural optical coherence tomography (OCT), as was the area under the receiver operating characteristic (ROC) curve (AUC). A total of 29 eyes from 28 cases with NA-AION and 99 healthy eyes from 68 participants were imaged. All participants were Chinese. The NA-AION group showed a significant reduction of the pVD (P<0.001), while all subregions of pRNFL thickness were prominent in all 8 quadrants (P>0.05). The pVD of the optic disc in the superior temporal (ST) region showed better diagnostic accuracy (AUC =0.86) in discriminating the NA-AION group from healthy controls. After adjusting for confounders, ST was independently associated with the presence of NA-AION [odds ratio (OR) =0.971, 95% confidence interval (CI): 0.943-0.990, P=0.048]. Decreased pVD was detected by non-invasive measurements of OCTA in the eyes of NA-AION patients. This finding may reveal an association between the ST region and the presence of NA-AION. The pVD may have potential diagnostic ability and may serve as an additional biomarker in the management of the disease.

Hypercoagulable States Therapy in Nonarteritic Anterior Ischemic Optic Neuropathy (NAION)

Background Ischemic optic neuropathy is one of the main causes of blindness or visual impairment in middle age or elderly population. Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is the most common type of ischemic optic neuropathy. Systemic risk factors such as hypertension, diabetes mellitus, nocturnal hypotension, sleep apnea, cardiovascular disease and hypercoagulable states are related to NAION. The aim of the study was to evaluate the clinical outcome of hypercoagulable states therapy in NAION patients. Methods This study is a retrospective study conducted at Cipto Mangunkusumo Hospital Jakarta. All NAION patients with age more than 19 y.o were included. Patients were divided into 4 group; group 1: NAION patients treated with hypercoagulable states therapy, group 2: NAION patients treated with anticoagulant therapy, group 3: NAION patients treated with antiplatelet therapy and group 4: NAION patient without anticoagulant, antiplatelet or hypercoagulable states therapy. Results The total sample were 49 patients (49 eyes). Twenty-six patients (56.5%) were diagnosed with hypercoagulable state. In group 1 – 3 half of the patients (50%) had clinical improvements with anticoagulant, antiplatelet and hypercoagulable therapy. Conclusion Hypercoagulable states therapy may improve clinical outcome of NAION.

Dynamic volume-rendered optical coherence tomography pupillometry.

To assess intrapupillary space (IPS) changes in healthy subjects with regard to decreased iris motility in patients with pseudoexfoliation glaucoma (PEXG) or non-arteritic anterior ischaemic optic neuropathy (NAION) in a feasibility study in a clinical environment. Scotopic and photopic IPS measurements using three-dimensionally rendered swept-source optical coherence tomography (SS-OCT) data were obtained and compared for all subjects. Intrapupillary space (IPS) parameters were evaluated such as absolute volumetric differences, relative light response for volumetric ratios and pupillary ejection fraction (PEF) for functional contraction measurements. From a total of 122 IPS from 66 subjects, 106 IPS were eligible for comparison providing values for 72 normal, 30 PEXG and 4 NAION eyes. In healthy, PEXG and NAION subjects, scotopic overall mean IPS was 8.90, 3.45 and 4.16 mm3 , and photopic overall mean IPS was 0.87, 0.74 and 1.13 mm3 , respectively. Three-dimensional contractility showed a mean absolute difference of 8.03 mm3 for normals (defined as 100% contractility), 2.72 mm3 for PEXG (33.88% of normal) and 3.03 mm3 for NAION (38.50% of normal) with a relative light response ratio between scotopic and photopic volumes of 10.26 (100%), 4.69 (45.70%) and 3.67 (35.78%), respectively. Pupillary ejection fraction (PEF) showed a contractile pupillary emptying of 88.11% for normals, 76.92% for PEXG and 70.91% for NAION patients. This 3D pupillometry OCT assessment allows for quantitative measurements of pupil function, contractility and response to light. More specifically, PEF is presented as a potential (neuro)-pupillary outcome measure that could be useful in the monitoring of ophthalmic disorders that affect pupillary function.

Altered Brain Functional Connectivity at Resting-State in Patients With Non-arteritic Anterior Ischemic Optic Neuropathy.

Purpose: To investigate the possible changes in functional connectivity (FC) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) using resting-state functional MRI (fMRI).Methods: Thirty-one NAION patients and 31 healthy controls were recruited and underwent resting-state fMRI scans. Regions of interest (ROIs) were defined as bilateral Brodmann’s area 17 (BA17). FC analysis was performed between the ROIs and the rest of the brain regions, and the between group comparisons of FC were performed. We conducted correlation analysis between the FC changes and the clinical variables in NAION patients.Results: Compared with healthy controls, patients with NAION showed significantly decreased FC between the left BA17 and the right inferior frontal gyrus, left caudate nucleus. As for the right BA17, patients exhibited significantly increased FC with the left olfactory gyrus and decreased FC with the right superior frontal gyrus (SFG), right insula. Moreover, FC values between the right insula and the right BA17 were positively correlated with the right side of mean sensitivity in the central visual field (r = 0.52, P < 0.01) and negatively correlated with the right side of mean defect in the central visual field (r = −0.55, P < 0.01).Conclusion: Our study indicated that patients with NAION showed significantly abnormal functional reorganization between the primary visual cortex and several other brain regions not directly related to visual function, which supports that NAION may not only be an ophthalmic disease but also a neuro-ophthalmological disease.