Nonarteritic Ischemic Optic Neuropathy Patients Research Articles

Macular Edema as Unusual Presentation of Non-Arteritic Ischemic Optic Neuropathy (NAION)

Introduction: Non-arteritic Ischemic Optic Neuropathy is the most common type of ischemic optic neuropathy. Nearly half of NAION patients presented with 20/30 or better visual acuity. Central vision is often preserved relative to the visual field loss. Macular edema in NAION patient is rare, and its occurrence may confuse to other disease and lead to unnecessary treatment.
 Case Report: We identified three NAION patients presented with macular edema. The patients' age was above 40 and had diabetes mellitus (DM). Our patients had clinical findings consistent with NAION with poor visual acuity at the early presentation. Optical coherence tomography examination was performed, and all patients had prominent subretinal fluid. Intravitreal anti-VEGF injection was done on our first patient and no treatment was given to our second and third patient. All patients showed a significant improvement of macular edema.
 Discussion: Macular edema is a rare clinical manifestation that may contribute a visual deterioration in NAION. The incidence of macular edema in NAION patients is difficult to measure since OCT of macula is not routinely performed. In our report, we encountered three cases of NAION complicated by macular edema that underwent a different approach in therapy. Spontaneous regression of subretinal fluid was seen during observation without any treatment given. Our patients achieved a stable visual acuity and visual field defect. This finding is under the literature that spontaneous recovery will be observed during the natural course of acute NAION.
 Conclusion: Macular edema is an unusual but self-limiting presentation of NAION. Therefore, a comprehensive examination is needed to prevent any unnecessary treatment.

Factors Associated With Visual Acuity in Non-arteritic Ischemic Optic Neuropathy Patients: A Five-Year Cross-Sectional Study.

Background and objectiveNon-arteritic ischemic optic neuropathy (NAION) is a common cause of optic neuropathy in elderly patients. Currently, there is no definitive treatment for this condition, and the factors influencing visual outcomes have not yet been conclusively identified. In this study, we aimed to evaluate factors that affect visual outcomes and those that are predictors of the development of NAION in a Thai population.MethodsAll patients diagnosed with NAION at the Rajavithi Hospital between January 1, 2016, and December 31, 2020, were retrospectively reviewed to evaluate the improvement in their best-corrected visual acuity (BCVA) and determine the factors that are predictive of visual outcomes.ResultsThe 80 patients reviewed were predominantly male (55%) with a mean age of 55.8 ±9.89 years. Their most common comorbidities were dyslipidemia (DLP) (67.5%), diabetes mellitus (DM) (61.3%), and hypertension (HT) (48.8%). At the 12-week follow-up visit, there was a significant improvement of at least 0.2 logarithm of the minimum angle of resolution (logMAR) in BCVA (p=0.001). A significantly greater percentage of patients with higher age, DM, and HT was observed in the unfavorable visual recovery (UVR) group (p=0.002, p=0.001, and p=0.005 respectively). In contrast, neither baseline visual acuity nor cup-to-disc ratio (CDR) affected the result of visual recovery (p=0.275 and p=0.076, respectively). In multivariate logistic analysis, older age increased the odds of worse visual recovery [odds ratio (OR): 4.014; 95% CI: 1.038-15.515; p=0.044], as did having DM (OR: 3.809; 95% CI: 1.168-12.421; p=0.027), and HT (OR: 4.577; 95% CI: 1.491-14.049; p=0.008).ConclusionsNone of the baseline visual status parameters (visual acuity, CDR, or visual field defect) was able to determine the outcome of visual recovery at 12 weeks in our NAION patients. Regarding systemic vascular diseases, diabetes and HT are significant risk factors and also predictors of poor visual improvement in Thai populations. NAION patients who are elderly or have vascular diseases such as DM or HT should be closely followed up and advised about the likelihood of having inferior visual recovery.

Objectives & background: Drug-induced hepatotoxicity (DIH) is a common side effect of anti-TB drugs. Acute viral hepatitis (AVH) may be confounded with chronic alcoholic hepatitis clinically, biochemically, and histologically (CAH). Place of Study: Rashid Latif Medical College Lahore Duration of Study: March 2019 to January 2021 Methods: This prospective research examined the effect of acute viral hepatitis as a contributing

Background: Diabetes, low nighttime blood pressure, and nonarteritic ischemic optic neuropathy may be associated. Not too many studies present whether this relationship applies to patients. Objective: Diabetes mellitus, low blood pressure at night, and nonarteritic ischemic optic neuropathy were studied in a group of individuals. Methods: The ophthalmology clinic will conduct a cross-sectional research on patients with nonarteritic ischemic optic neuropathy from March 2019 to December 2021. Nonarteritic ischemic optic neuropathy patients were tested for diabetes. Some participants wore ambulatory blood pressure monitors during the trial. Nighttime blood pressure drops are typical, muted, severe, and reverse. Results: Nonarteritic ischemic optic neuropathy was identified in 67 individuals. 587 of 67 patients were selected. 34 patients (50.7%) had diabetes, while 39 (58.2%) had hypertension. 32 people's blood pressure dropped during sleep. Only four (5.9%) saw substantial drops. Conclusions: Diabetes may be linked to nonarteritic ischemic optic neuropathy, but not nocturnal blood pressure declines. Keywords: Optic Neuropathy, Diabetes Mellitus, Hypertension

Atherogenic indices in non-arteritic ischemic optic neuropathy.

To evaluate the atherogenic indices and the relationship with visual acuity and bilateral sequential involvement in patients with non-arteritic ischemic optic neuropathy (NAION). A total of 65 patients with NAION and 48 age-sex matched healthy individuals were included in this retrospective study. The demographic characteristics and laboratory findings of the patients and control subjects were obtained from the electronic medical records. The atherogenic indices were calculated using the lipid parameters. The association between visual acuity, bilateral sequential involvement, and atherogenic indices was investigated. The mean age was 63.8±12.5y in the NAION group and 64.7±10.1y in control group (P=0.707). Although there were no significant differences in terms of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) between two groups (P=0.089, 0.091), all the non-traditional serum lipid ratios were significantly higher in NAION group (P<0.05). In the NAION subgroup analysis, with visual acuity≤20/200 had higher TC/high-density lipoprotein cholesterol (HDL-c), LDL-c/HDL-c, and non-HDL-c/HDL-c values than the patients in the NAION group with visual acuity >20/200 (P=0.032, 0.025, 0.032, respectively). The values for the atherogenic indices were higher in NAION patients with bilateral sequential involvement in comparison to those with unilateral involvement (P=0.271, 0.127, 0.197, 0.128, 0.127, respectively). The study reveals a relationship between NAION and the non-traditional lipid ratios. Atherogenic indices may predict the visual loss severity and second eye involvement in patients with NAION.

Risk factors and visual outcome of Non-Arteritic Ischemic Optic Neuropathy (NAION): Experience of a tertiary center in Kuwait

Non-arteritic ischemic optic neuropathy (NAION) is the most common acute optic neuropathy over the age of 50 years. NAION is commonly associated with systemic vascular risk factors (diabetes, hypertension, hyperlipidemia) and small cup-to-disc-ratio. We have assessed the prevalence risk factors of NAION and the visual outcome in patients referred to a tertiary ophthalmology center in Kuwait. A retrospective review of new cases of NAION presenting within 2 weeks of onset were included and baseline clinical and demographics characteristic were determined. The prevalence of risk factors and the visual outcome (change in logMAR visual acuity, mean deviation of visual field) was compared between young NAION patients (below 50 years of age) and older NAION patients (over 50 years of age). The odds ratio of a final favorable visual outcome (visual acuity 20/40 or better) by age category was determined. Seventy-eight eyes of 78 patients with recent onset NAION were included in the study. The most prevalent risk factors for NAION in our subjects were diabetes (64.1%), small cup-to-disc ratio (61.5%), hyperlipidemia (51.3%) and hypertension (38.5%). Young NAION patients had better final logMAR visual acuity (0.55 +- 0.57) then older NAION patients (0.9 +- 0.73), (p = 0.03). Furthermore, young NAION patients were 2.8 times more likely to have a final visual acuity of 20/40 or better than older NAION patients, odds ratio (OR), 2.87; 95% confidence interval (CI), 1.12-7.40, Chi-square p-value = 0.03). There is a high prevalence of systemic vascular risk factors and small cup-to-disc ratio in NAION patients referred to our center across different age groups (below and above 50 years). Patients below the age of 50 years with NAION are more likely to have a final visual acuity of 20/40 or better than NAION patients above the age of 50 years.

Neuroenhancement and neuroprotection by oral solution citicoline in non-arteritic ischemic optic neuropathy as a model of neurodegeneration: A randomized pilot study.

PurposeTo evaluate whether treatment with Citicoline in oral solution (OS-Citicoline) would increase visual function, retinal ganglion cells (RGCs) function, and neural conduction along visual pathways (neuroenhancement), and/or induce preservation of RGCs fibers’ loss (neuroprotection) in non-arteritic ischemic optic neuropathy (NAION), a human model of neurodegeneration.MethodsThirty-six patients with NAION and 20 age-matched controls were enrolled. Nineteen NAION patients received 500 mg/day of OS-Citicoline for a 6-month period followed by 3-month of wash-out (NC Group); 17 NAION patients were not treated (NN Group) from baseline to 9 months. In all subjects at baseline, and in NC and NN eyes at 6 and 9 months of follow-up, we assessed Visual Acuity (VA), Pattern Electroretinogram (PERG), Visual Evoked Potentials (VEP), retinal nerve fiber layer thickness (RNFL-T), and Humphrey 24–2 visual field mean deviation (HFA MD). Mean differences were statistically evaluated with ANOVA between Groups, and linear correlations were analysed with Pearson’s test.ResultsAt 6 months, significant differences between groups for all parameters were observed (ANOVA, p<0.01). In NC eyes, VA increased, PERG responses increased, VEP recordings improved and were significantly correlated with increases in HFA MD (p<0.01), and RNFL-T was unmodified or improved. In contrast, in NN eyes, VA, PERG, VEP responses, RNFL-T, and HFA MD were further worsened. Significant differences were still present at 9-month follow-up in the NN Group and after 3 months of OS-Citicoline wash-out in NC eyes.ConclusionsOS-Citicoline treatment induced neuroenhancement (improvement in RGCs function and neural conduction along visual pathways related to improvement of visual field defects) and neuroprotection (unmodified or improved RNFL morphological condition) in a human model of NAION involving fast RGCs degeneration.Trial registrationClinicalTrials.gov NCT03758118.

The status of the application of optical coherence tomography angiography in nonarteritic ischemic optic neuropathy

Optical coherence tomography angiography (OCTA) is a new technology of angiography which features multiple advantages over the traditional ones. It can provide a rapid and noninvasive approach to observing the vascular morphology and blood vessel density of the optic disc, peripapillary and macular area. Nonarteritic ischemic optic neuropathy (NAION) is an acute optic neuropathy characterized by a sudden, painless decrease in vision and a typical visual field defect. It has been widely accepted that the circulatory insufficiency of the optic nerve head (ONH) mainly supplied by the posterior ciliary arteries (PCA) results in ischemic damage. Relevant researches are necessary for exploring the pathogenesis, diagnosis and treatment of NAION, and this review summarizes the results of recent studies on application of OCTA in analyzing the blood flow in the optic and macular area in NAION patients. (Chin J Ophthalmol, 2019, 55:306-310).

COMPARISON OF mfERG WITH VEP IN NAION PATIENTS AND HEALTHY PEOPLE

Purpose : Comparison of mfERG (multifocal electroretinography )with VEP( vizual evoked potential )in NAION( Nonarteritic ischemic optic neuropathy ) patients and healthy people Materials and methods: 44 NAION patients were included in the study.The patients were 23 woman, 21 male. The average age was 60-83 in NAION group.The patients underwent mfERG and VEP. 35 healthy people formed the control group. In the control group was 19 woman, 17 male. The average age was 57-89 in control group. Results : Mean VEP amplitude 1.89 * 0, 95mV and latency 123,6 * 18,70 msec in NAION group . In healthy group VEP amplitude was 4.92 * 1, 02mV and latency was 103,01 * 7.02 msec. There was no obvious pathology in mfERG in patients with NAION and in the control group . Conclusion: In NAION patients, significant changes can be seen in VEP amplitude and VEP latency. This was also found in our work. Ganglion cell and optic disc damage does not change in the mfERG , so abnormal mfERG is probably a reporter of an external retinal lesion. Key words: mfERG, VEP , NAION

Stem Cell Ophthalmology Treatment Study: bone marrow derived stem cells in the treatment of non-arteritic ischemic optic neuropathy (NAION).

Ten patients with bilateral visual loss due to sequential non-arteritic ischemic optic neuropathy (NAION) underwent autologous Bone Marrow Derived Stem Cell (BMSC) therapy within the Stem Cell Ophthalmology Treatment Study (SCOTS). SCOTS is an Institutional Review Board approved clinical study utilizing autologous BMSC in the treatment of optic nerve and retinal diseases that meet inclusion criteria. The average age of the patients treated was 69.8 years. The average duration of visual loss in eyes treated was 9.8 years and ranged from 1 to 35 years. Affected eyes were treated with either retrobulbar, subtenons and intravenous BMSC or, following vitrectomy, intra-optic nerve, subtenons and intravenous BMSC. The primary outcome was visual acuity as measured by Snellen or converted to LogMAR. Following therapy in SCOTS, 80% of patients experienced improvement in Snellen binocular vision (P=0.029) with 20% remaining stable; 73.6% of eyes treated gained vision (P=0.019) and 15.9% remained stable in the post-operative period. There was an average of 3.53 Snellen lines of vision improvement per eye with an average 22.74% and maximum 83.3% improvement in LogMAR acuity per eye. The average LogMAR change in treated eyes was a gain of 0.364 (P=0.0089). Improvements typically manifested no later than 6 months post procedure. The use of BMSC in the Stem Cell Ophthalmology Treatment Study achieved meaningful visual improvements in a significant percentage of the NAION patients reported. Improvements typically manifested no later than 6 months post-procedure. Duration of visual loss did not appear to affect the ability of the eyes to respond to treatment. Possible mechanisms by which visual improvement occurred may include BMSC paracrine secretion of proteins and hormones, transfer of mitochondria, release of messenger RNA or other compounds via exosomes or microvesicles and neuronal transdifferentiation of the stem cells.

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy.

To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes. The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (P<0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t=3.65, P<0.01, R2=0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t=4.32, P<0.01, R2=0.4957). The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.

Visual field defects of the contralateral eye of non-arteritic ischemic anterior optic neuropathy: are they related to sleep apnea?

To evaluate whether obstructive sleep apnea (OSA) is responsible for the visual field defects found in the fellow eyes of patients with non-arteritic ischemic optic neuropathy (NAION). Prospective cross-sectional study. The visual fields of the fellow eyes of NAION subjects with OSA were compared to the visual fields of control OSA patients matched for OSA severity. All patients underwent comprehensive ophthalmological and general examination including Humphrey 24.2 SITA-Standard visual field and polysomnography. Visual field defects were classified according the Ischemic Optic Neuropathy Decompression Trial (IONDT) classification. From a cohort of 78 consecutive subjects with NAION, 34 unaffected fellow eyes were compared to 34 control eyes of subjects matched for OSA severity (apnea-hypopnea index [AHI] 35.5 ± 11.6 vs 35.4 ± 9.4 events per hour, respectively, p = 0.63). After adjustment for age and body mass index, all visual field parameters were significantly different between the NAION fellow eyes and those of the control OSA groups, including mean deviation (-4.5 ± 3.7 vs -1.3 ± 1.8 dB, respectively, p < 0.05), visual field index (91.6 ± 10 vs 97.4 ± 3.5%, respectively, p = 0.002), pattern standard deviation (3.7 ± 2.3 vs 2.5 ± 2 dB, respectively, p = 0.015), and number of subjects with at least one defect on the IONDT classification (20 vs 10, respectively, p < 0.05). OSA alone does not explain the visual field defects frequently found in the fellow eyes of NAION patients.

Distinguishing ischaemic optic neuropathy from optic neuritis by ganglion cell analysis.

To determine whether a pattern of altitudinal ganglion cell loss, as detected and measured by optical coherence tomography (OCT), can be used to distinguish non-arteritic ischaemic optic neuropathy (NAION) from optic neuritis (ON) during the acute phase, and whether the rate or severity of ganglion cell loss differs between the two diseases. We performed a retrospective, case-control study of 44 patients (50 eyes) with ON or NAION and 44 age-matched controls. Non-arteritic ischaemic optic neuropathy and ON patients had OCT at presentation and four consecutive follow-up visits. Controls had OCT at one point in time. The ganglion cell complex (GCC) was evaluated in the macula, and the retinal nerve fibre layer (RNFL) was evaluated in the peripapillary region. Ganglion cell complex thickness, RNFL thickness and GCC mean superior and inferior hemispheric difference were compared between NAION and ON patients at each time-point using unpaired t-tests and between disease and control subjects at first measurement using paired t-tests. Mean time from onset of symptoms to initial presentation was 10.7±6.6days in NAION and 11.7±8.6days in ON (p=0.67). There was a significantly greater vertical hemispheric difference in GCC thickness in NAION patients than ON patients at all time-points (5.5-10.7μm versus 3.1-3.6μm, p=0.01-0.049). Mean GCC thickness was significantly decreased at less than 2weeks after onset in NAION compared to age-matched controls (72.1μm versus 82.1μm, p<0.001), as well as in ON compared to age-matched controls (74.3μm versus 84.5μm, p<0.001). Progression and severity of GCC and RNFL loss did not differ significantly between NAION and ON. A quantitative comparison of mean superior and inferior hemispheric GCC thickness with OCT may be used to distinguish NAION from ON.

Pilot Study of Optical Coherence Tomography Measurement of Retinal Blood Flow in Retinal and Optic Nerve Diseases

To investigate blood flow changes in retinal and optic nerve diseases with Doppler Fourier domain optical coherence tomography (OCT). Sixty-two participants were divided into five groups: normal, glaucoma, nonarteritic ischemic optic neuropathy (NAION), treated proliferative diabetic retinopathy (PDR), and branch retinal vein occlusion (BRVO). Doppler OCT was used to scan concentric circles of 3.4- and 3.75-mm diameters around the optic nerve head. Flow in retinal veins was calculated from the OCT velocity profiles. Arterial and venous diameters were measured from OCT Doppler and reflectance images. Total retinal blood flow in normal subjects averaged 47.6 μL/min. The coefficient of variation of repeated measurements was 11% in normal eyes and 14% in diseased eyes. Eyes with glaucoma, NAION, treated PDR, and BRVO had significantly decreased retinal blood flow compared with normal eyes (P < 0.001). In glaucoma patients, the decrease in blood flow was highly correlated with the severity of visual field loss (P = 0.003). In NAION and BRVO patients, the hemisphere with more severe disease also had lower blood flow. Doppler OCT retinal blood flow measurements showed good repeatability and excellent correlation with visual field and clinical presentations. This approach could enhance our understanding of retinal and optic nerve diseases and facilitate the development of new therapies.

Intravitreal Ranibizumab Injection for Nonarteritic Ischemic Optic Neuropathy

The aim of this study was to evaluate the functional and morphological outcomes of intravitreal ranibizumab injection (IVR) in the treatment of nonarteritic ischemic optic neuropathy (NAION). Three patients with NAION of 1–2 days onset underwent IVR. A complete ophthalmologic examination was performed at baseline (before IVR) and at 1 day, 1 week, 1 month, 6 months, and 1 year following IVR. In all patients, we found an early resolution of optic disk swelling, as soon as 1 week after IVR; however, such a morphological improvement was not accompanied by a corresponding functional (visual acuity and perimetric) improvement. The first treated patient presented a good visual acuity and a relative central visual field defect at baseline, and at the 12-month follow-up, we found an overall functional stabilization, with no further visual acuity and visual field deterioration. The second and third treated patients presented a lower visual acuity and an absolute center-involving visual field defect at baseline. In these patients, despite early papillary edema resolution, late optic nerve atrophy occurred, and visual acuity and visual field did not improve at the 12-month follow-up. The results from our study suggest that even if IVR is effective in reducing optic nerve swelling in NAION patients, no functional improvement may be observed. Further studies are necessary to definitively establish the efficacy and safety of IVR in the treatment of NAION.

Thrombophile Gerinnungsstörungen bei unter 60-jährigen Patienten mit nichtarteriitischer anteriorer ischämischer Optikusneuropathie

The potential impact of coagulation abnormalities on non-arteritic ischaemic optic neuropathy (NAION), individually and in combination with cardiovascular risk factors, remains unclear. In a prospective case-control study a cohort of 26 NAION patients < 60 years at the time of the NAION or a previous thromboembolic event and 50 subjects matched for age and sex were prospectively screened for thrombophilic risk factors. Overall, thrombophilic defects were found to be present in 12 of 26 patients (46.2 %) and in 9 of 50 (18 %) controls (p = 0.01). The most frequent coagulation disorders were high levels of factor VIII (p = 0.04) and lipoprotein (a) (p = 0.03). Moreover, we identified two patients with homozygous resistance to activated protein C, which is the first description of this coagulation disorder associated with NAION. Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (p = 0.038). Our results indicate that thrombophilic disorders are associated with the development of non-arteriitic ischaemic optic neuropathy in patients < 60 years of age at the time of a first thromboembolic event. Selective screening of young patients and patients without cardiovascular risk factors may be helpful in identifying NAION patients with thrombophilic defects.

Selective thrombophilia screening of patients with nonarteritic anterior ischemic optic neuropathy

To date, the question whether there is a relationship between thrombophilic disorders and the development of nonarteritic ischemic optic neuropathy (NAION) remains controversial. We sought to investigate the prevalence of various coagulation defects among NAION patients <65 years of age, and to provide clinical guidelines for a selective thrombophilia screening. A cohort of 35 patients <65 years of age with NAION and 70 controls matched for age and sex were prospectively screened for thrombophilic risk factors. Overall, thrombophilic defects were found to be present in 18 of 35 patients (51.4%) and in 12 of 70 (17.1%) controls (P = 0.0005). The most frequent coagulation disorders were increased levels of factor VIII (P = 0.015) and lipoprotein (a) (P = 0.005). Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (P = 0.0059). There was a strong association of coagulation disorders and a personal or family history of thromboembolism (P = 0.028). Moreover, we determined the age of <or=55 years at the time of the first thromboembolic event or NAION as a strong predictor of underlying thrombophilia (P = 0.0002). Our results indicate that thrombophilic disorders are associated with the development of NAION in specific subgroups of patients. Selective screening of young patients, subjects with a personal or family history of thromboembolism, and patients without cardiovascular risk factors may be helpful in identifying NAION patients with thrombophilic defects.

Electrophysiological assessment of visual function in patients with non‐arteritic ischaemic optic neuropathy

Our study aims to evaluate retinal function and neural conduction in post-retinal visual pathways of patients with non-arteritic ischaemic optic neuropathy (NION). Twenty patients (mean age: 63.7 +/- 5.96 year) with NION and 20 age-similar control subjects were enrolled. Simultaneous recording of pattern electroretinograms (PERGs) and visual evoked potentials (VEPs), and Log of minimum angle resolution (MAR) visual acuity (VA) were assessed in NION patients and controls. Significantly (ANOVA, P < 0.01) abnormal PERG and VEP responses, delayed retinocortical time (RCT, difference between VEP P100 and PERG P50 implicit times), and reduced VA were found in NION patients with respect to control subjects. The delay in RCT was not significantly (Pearson's test, P > 0.01) correlated with the PERG impairment. The reduction in VA was significantly (Pearson's test, P < 0.01) correlated to the increase in VEP P100 implicit time and RCT, whereas no correlations (P > 0.01) were found with PERG abnormalities. Non-arteritic ischaemic optic neuropathy patients with a reduction in VA may present two different, unrelated impairments: a dysfunction of the inner retinal layer (abnormal PERG) and abnormal post-retinal neural conduction (abnormal VEP and RCT). The reduction in VA seems to be related to the post-retinal impairment and seems to be independent from the retinal dysfunction.

Visual Fields at Follow-up in the Ischemic Optic Neuropathy Decompression Trial: Evaluation of Change in Pattern Defect and Severity Over Time

Purpose To evaluate change from baseline to 12 months follow-up in study and nonstudy (fellow) eye visual fields from the Ischemic Optic Neuropathy Decompression Trial (IONDT). Design Randomized controlled trial and observational study. Participants The IONDT enrolled patients ≥50 years with acute nonarteritic ischemic optic neuropathy (NAION). Randomized patients (n = 258) had visual acuity ≤20/64; nonrandomized patients (n = 160) had visual acuity >20/64 or refused randomization. Interventions Optic nerve decompression surgery (n = 127) or careful follow-up (n = 131). Main Outcome Measures We measured visual fields at baseline and at 6 and 12 months follow-up. Using a computerized system, we classified visual field defects by pattern, location, and severity. We examined changes over time by treatment group, age, baseline comorbidities, and change in visual acuity. In fellow (nonstudy) eyes, we assessed change by whether NAION was present at baseline and also incidence of NAION by whether a visual field defect was present at baseline. Results We analyzed 245 study eye visual field pairs (179 and 66, randomized and nonrandomized, respectively) for change from baseline to 12 months. We observed significant changes in defect distribution within the central field (P = 0.02) for randomized eyes. Superior and inferior altitudinal defects were less severe at follow-up in both randomized and nonrandomized eyes. We observed an association between change in central field severity and change in visual acuity from baseline (P<0.001 at 6 months; P = 0.01 at 12 months; Kendall's tau-b), but no association between visual field change and treatment group, age, or baseline comorbidities. Superior and inferior visual field defects present at baseline in nonstudy eyes improved at follow-up. Fellow (nonstudy) eyes with normal fields did not have an increased risk of developing NAION compared with eyes with ≥1 defects. Conclusions Visual fields of NAION patients enrolled in the IONDT were relatively stable from baseline to follow-up. A visual field defect in the nonstudy eye at baseline was not associated with development of NAION during follow-up compared with eyes with normal fields. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article. To evaluate change from baseline to 12 months follow-up in study and nonstudy (fellow) eye visual fields from the Ischemic Optic Neuropathy Decompression Trial (IONDT). Randomized controlled trial and observational study. The IONDT enrolled patients ≥50 years with acute nonarteritic ischemic optic neuropathy (NAION). Randomized patients (n = 258) had visual acuity ≤20/64; nonrandomized patients (n = 160) had visual acuity >20/64 or refused randomization. Optic nerve decompression surgery (n = 127) or careful follow-up (n = 131). We measured visual fields at baseline and at 6 and 12 months follow-up. Using a computerized system, we classified visual field defects by pattern, location, and severity. We examined changes over time by treatment group, age, baseline comorbidities, and change in visual acuity. In fellow (nonstudy) eyes, we assessed change by whether NAION was present at baseline and also incidence of NAION by whether a visual field defect was present at baseline. We analyzed 245 study eye visual field pairs (179 and 66, randomized and nonrandomized, respectively) for change from baseline to 12 months. We observed significant changes in defect distribution within the central field (P = 0.02) for randomized eyes. Superior and inferior altitudinal defects were less severe at follow-up in both randomized and nonrandomized eyes. We observed an association between change in central field severity and change in visual acuity from baseline (P<0.001 at 6 months; P = 0.01 at 12 months; Kendall's tau-b), but no association between visual field change and treatment group, age, or baseline comorbidities. Superior and inferior visual field defects present at baseline in nonstudy eyes improved at follow-up. Fellow (nonstudy) eyes with normal fields did not have an increased risk of developing NAION compared with eyes with ≥1 defects. Visual fields of NAION patients enrolled in the IONDT were relatively stable from baseline to follow-up. A visual field defect in the nonstudy eye at baseline was not associated with development of NAION during follow-up compared with eyes with normal fields.

Mitochondrial DNA abnormalities in NAION

We reported that a group of 19 patients with non-arteritic ischaemic optic neuropathy (NAION) had an increased number of mitochondrial (mt) DNA nucleotide changes1 and significantly increased relative mtDNA content...

Electrophysiological findings in patients with nonarteritic anterior ischemic optic neuropathy

Objective Nonarteritic ischemic optic neuropathy (NAION) is one of the most frequent causes of sudden visual loss in middle-aged or elderly patients. Although several electrophysiological methods are available for an objective evaluation of the visual deficits, these are not generally used in the assessment of the clinical condition of NAION patients. To evaluate the severity of the optic nerve and retinal damage, electrophysiological tests were performed on 8 patients with NAION. Methods Visual evoked potentials (VEPs), scotopic, photopic and flicker electroretinograms (ERGs), multifocal ERGs and pattern ERGs were recorded. Results The results demonstrated that the VEPs fairly reliably reflected the visual loss caused by NAION. The VEPs were extinguished in cases with a serious visual acuity loss, while a decrease in amplitude and a lengthening of the P100 latency were observed in cases with good visual acuity and a severe visual field loss and in the nonattacked fellow eye of the patients with monocular involvement. The pattern ERGs failed to show signs of retrograde degeneration. The photopic, scotopic and flicker ERGs, and the oscillatory potentials (OPs) were close to normal in these NAION patients. Conclusions Our observations permit the conclusion that electrophysiological methods can provide an objective indication of the clinical condition of these patients. The new data obtained promote an understanding of the pathomechanism of the disease. Significance Electrophysiological tests are suitable for monitoring of the progression of the disease in NAION patients.