Risk Factors For Nonarteritic Anterior Ischemic Optic Neuropathy Research Articles

Study of nycthemeral variations in blood pressure in patients with non-arteritic anterior ischemic optic neuropathy.

The objective of this study was to analyze the nycthemeral variations in blood pressure (BP) in individuals who presented with non-arteritic anterior ischemic optic neuropathy (NAION). BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.-6 a.m.; definition 2, 10 p.m.-7 a.m.; and definition 3, 10 p.m.-8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10-20%), mild dippers (0-10%), reverse dippers (< 0%), and extreme dippers (> 20%). The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.-6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension after ABPM. No risk factor for NAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). In our population of patients who had an episode of NAION, the proportion of extreme dippers was higher than that usually found in the literature. However, extreme dipping is not a frequent feature of patients with NAION as compared to patients with systemic hypertension. ABPM is recommended for all patients with NAION and unknown history of systemic hypertension.

STUDY OF NYCTHEMERAL VARIATIONS IN BLOOD PRESSURE IN PATIENTS WITH NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY

Objective: Non-arteritic anterior ischemic optic neuropathy (NAAION) is the most common acute pathology of the optic nerve in patients over 50 years of age and loss of vision is irreversible in the vast majority of cases. The role of nocturnal arterial hypotension in the occurrence of NAAION remains a topic of debate. Indeed, studies on this subject are rare and the results contradictory. In this study, we ubject the nychthemeral variations in blood pressure (BP) in a large cohort of patients with acute NAAION to determine the presence and extent of nocturnal arterial hypotension in this population, and thus determine whether nocturnal arterial hypotension could be involved in the pathophysiology of NAAION Design and method: BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.–6 a.m.; definition 2, 10 p.m.–7 a.m.; and definition 3, 10 p.m.–8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10–20%), mild dippers (0–10%), reverse dippers (&lt; 0%), and extreme dippers (&gt; 20%). Results: The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.–6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension (systolic and/or diastolic hypertension) after ABPM. No risk factor for NAAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). Conclusions: In our population of patients who had an episode of NAAION, the proportion of extreme dippers was higher than that usually found in the literature. The definition of the nighttime period used in this study had an impact on the proportion of extreme dippers and might probably explain the contradictory results from the few studies on this ubject.

Laterality condition analysis on non-arteritic anterior ischemic optic neuropathy patient in one of the hospital in Jakarta with medical data mining

Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) is a disease caused by blood shortages in the artery that supplies the optic disc. Risk factors for NAION are hypertension, obesity, diabetes, dislipidemia, smoking, hypercoagulable state, cardiovascular disease, and stroke. NAION can result from unilateral or bilateral conditions. This study will focus on the identification of important factors that could distinguish characteristics between unilateral and bilateral patients. Random forest method is applied to obtain factors that can consistently distinguish characteristic between each laterality condition. Decision trees and the logistic regression method are added to obtain the visualization of the role of each important factors in the form of classification tree and the risk comparison of patients for experiencing a certain laterality condition by using odds ratios. The important factors based on random forest model are onset, fasting blood glucose levels, high density lipoprotein levels, age, two-hour postprandial glucose levels, and low density lipoprotein levels. Based on the odds ratio, advancing age and high density lipoprotein levels will decrease the risk of patients experiencing bilateral condition; on the other hand, the risk of bilateral condition will increase if other important factors are also increased.

Optic Disc Drusen Associated Anterior Ischemic Optic Neuropathy: Prevalence of Comorbidities and Vascular Risk Factors.

Nonarteritic anterior ischemic optic neuropathy (NA-AION) associated with optic disc drusen (ODD) is termed ODD-AION, where NA-AION with no evidence of ODD is simply termed NA-AION. Patients with ODD-AION have been found to be younger than those with NA-AION but with similar vascular risk factors. This study compares the known risk factors for NA-AION between a group with ODD-AION and a similarly aged group with NA-AION. A case-control study of 13 patients with ODD-AION and 14 patients with NA-AION diagnosed in the period 2008-2017. All patients underwent an interview designed to evaluate history of vascular risk factors and comorbidities and re-examination including enhanced depth imaging optical coherence tomography to confirm the presence or absence of ODD. No significant differences were found in demographic or clinical characteristics between the ODD-AION and the NA-AION group. Significantly more ODD-AION patients than NA-AION patients had no vascular risk factors (smoking, arterial hypertension, diabetes mellitus, and dyslipidemia) present (P = 0.047). Significantly fewer patients in the ODD-AION group were diagnosed with arterial hypertension or dyslipidemia than in the NA-AION group. In this cross-sectional study, the ODD-AION patients more often had no vascular risk factors as compared to NA-AION patients, which supports the hypothesis that ODD are an independent risk factor for AION.

Disc Configuration as a Risk and Prognostic Factor in NAION: The Impact of Cup to Disc Ratio, Disc Diameter, and Crowding Index

ABSTRACTPurpose: The presence of the so called disc at risk (a small disc with no cupping) has been considered the main risk factor for the development of non-arteritic anterior ischemic optic neuropathy (NAION). However its role as a prognostic factor has not been studied. Our aim was to determine the weight of disc configuration as a risk and a prognostic factor for NAION.Methods: Case control study. Forty eyes of 40 patients who were diagnosed with NAION between 2008 and 2017, and 120 controls (3 controls for each patient) were included in the study. Disc diameter (DD), cup to disc ratio (CDR), and peripapillar retinal nerve fiber layer thickness (RNFLT) of the non-affected eye were measured using optic coherence tomography (3D OCT 2000, Topcon). Crowding index (CI) was defined as the quotient of average RNFLT and disc area. Mean deviation (MD) at the time of diagnosis and at least three months later was determined using a Humphrey Visual Field Analyzer (SITA standard 24-2 strategy). Visual acuity (VA) was measured using Snellen charts and transformed into LogMAR values.Results: Only CDR was found to be a risk factor for NAION. No correlationship was found between CI and visual loss.Conclusions: DD and CI did not show value as either prognostic or risk factors. Glial tissue may be a part of the content of the optic disc as important as axons. Our results are in line with the latest studies about NAION pathophysiology. Contrary to classic thinking, these papers have not found smaller disc diameters, but smaller values of lamina cribosa depth in NAION patients.

Prospective Case-crossover Study Investigating the Possible Association Between Nonarteritic Anterior Ischemic Optic Neuropathy and Phosphodiesterase Type 5 Inhibitor Exposure

To evaluate the association between intermittent phosphodiesterase type 5 inhibitor (PDE5i) exposure and risk of acute nonarteritic anterior ischemic optic neuropathy (NAION) using a case-crossover design. Male adults with suspected NAION were enrolled at 41 US ophthalmology sites from 2010 to 2015 and were interviewed regarding risk factors for NAION, medical history, and PDE5i use before NAION onset (index date of onset [IDO]). An adjudication committee confirmed the NAION cases. The primary analysis, using the person-time method, examined the rate of PDE5i exposure within 5 half-lives of NAION onset relative to PDE5i exposure over a 30-day study period preceding the IDO in men exposed to PDE5i intermittently as a measure of NAION risk associated with PDE5i exposure. Rate ratios were estimated using the Mantel-Haenszel estimator. Secondary analyses included person-time analyses over the 12-months preceding the IDO and matched-interval analyses over 42 days preceding the IDO. Of 279 men with confirmed NAION, 22 were exposed to PDE5i intermittently within 30 days of IDO. The Mantel-Haenszel rate ratio for risk of NAION associated with PDE5i exposure within 5 half-lives of IDO was 2.27 (95% confidence interval [CI]: 0.99-5.20) over the 30-day period (n = 22) and 3.52 (95% CI: 1.59-7.79) over the 12-month period (n = 26). Sensitivity analyses showed similar results and were statistically significant. The matched-interval method found no association (hazard ratio = 1.64 [95% CI: 0.60-4.51]). Overall, the study suggests an increased risk of NAION associated with PDE5i use. Patients and health-care providers should continue to weigh the risks and benefits of PDE5i use, including the potential for NAION.

The relationship of high density lipoprotein cholesterol and cholesterol ester transfer protein TaqIB mutation in non-arteritic anterior ischemic optic neuropathy

Objective To investigate the association of high density lipoprotein cholesterol (HDL-C) and cholesterol ester transfer protein (CETP) TaqIB mutation with non-arteritic anterior ischemic optic neuropathy (NA-AION) in the Shaanxi Han ethnic population. Methods The study cohort consisted of 45 individuals that had been diagnosed with NA-AION and 45 healthy controls (matched for age, gender). None of the cases or controls had a history of diabetes, serious cardio-cerebral vascular diseases, liver and kidney dysfunction that might influence plasma lipid levels. Plasma HDL-C was detected by enzyme-linked immunosorbent one-step, through the Toshiba TBA-40FR automatic biochemical analyzer. CETP TaqIB gene polymorphism was determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques for analysis. B2B2 genotype was only a fluorescence band with 535 bp; B1B1 genotype was 2 fluorescence bands with 361, 174 bp; B1B2 genotype was 3 fluorescence bands with 535, 361, 174 bp. The relative risk of genotype, HDL-C and disease occurrence was analyzed by logistics regression analysis. Results There have no significant difference between NA-AION patients and controls about plasma total cholesterol level and triglyceride level (t=1.907, 1.877; P>0.05). The plasma HDL-C levels were significantly lower in NA-AION patients than in controls (t=2.367, P=0.022). Compared with controls, the prevalence of B1B1 genotype and B1 allele was higher (χ2=17.289, P=0.001), the prevalence of B2 allele (χ2=15.648, P=0.000) was lower in NA-AION patients. The lower concentration of HDL-C was risk factor of NA-AION (odds ratio=6.143, 95% confidence interval 1.262 - 29.895, χ2=27.676; P=0.013). The proportion of B1B1 genotype was significantly higher in NA-AION patients than in controls (odds ratio=2.24, 95% confidence interval 2.427- 36.323, χ2=10.526; P=0.001). Conclusions The low plasma HDL-C is independent risk factor for NA-AION and is associated with the development of NA-AION in the Shaanxi Han ethnic population. CETP TaqIB mutation is associated with low plasma HDL-C in NA-AION in the Shaanxi Han ethnic population. Key words: Optic neuropathy, ischemic/etiology; Cholesterol, HDL/genetics; Cholesterol ester transfer proteins/genetics; Alleles; Gene frequency; Polymorphism, genetic/genetics

The Relationship Between Phosphodiesterase-5 Inhibitors and Nonarteritic Anterior Ischemic Optic Neuropathy

A cause and effect relationship between phosphodiesterase-5 inhibitor (PDE5I) use and nonarteritic anterior ischemic optic neuropathy (NAION) has been hypothesized based on case reports. Review of literature. Thirty-nine case reports in the peer-reviewed medical literature have documented a possible relationship between PDE5I consumption and NAION. However, pertinent details, such as the dose and frequency of PDE5I use, and elapsed time between ingestion and onset of vision loss, are lacking from many of these reports. Investigations regarding alterations in ocular perfusion in research subjects who ingested sildenafil have been inconclusive because they have not been performed on subjects with "disc at risk" or risk factors for NAION. One case-crossover study demonstrated a 2-fold increase in risk of NAION after ingestion of PDE5I. When a diagnosis of NAION is made, an inquiry should be made as to whether any PDE5I was ingested before the onset of vision loss. If so, the patient should be counseled regarding the possibility that continued PDE5I use may increase the risk of NAION in the fellow eye. Patients with a known history of previous NAION should be cautioned regarding the use of PDE5I for erectile dysfunction or pulmonary hypertension because of the potential increased risk of fellow eye involvement.

Anterior Ischemic Optic Neuropathy After Strabismus Surgery

We report a case of nonarteritic anterior ischemic optic neuropathy (NAION) in a healthy young woman after strabismus surgery. A 26-year-old woman with no medical history underwent uneventful left medial rectus recession and lateral rectus resection for a long-standing esotropia under general anesthesia. Preoperatively, visual acuity had been 20/20 in the right eye and 20/200 in the left eye (amblyopia). Thirteen days postoperatively, she noticed loss of vision superiorly in the left eye on awakening without any other symptoms. On our examination the next day, visual acuity was 20/20 in the right eye and 20/400 in the left eye. She had a superior nerve fiber bundle (altitudinal) visual field defect on confrontation, a left relative afferent pupillary defect, and mild left optic disc swelling, mainly inferiorly (Fig. 1). The right optic disc had a normal appearance. Both discs had a cup-to-disc ratio of 0.1. All other aspects of the ophthalmic examination were normal.FIG. 1: Fundus photography performed 1 day after onset of visual field loss shows left optic disc swelling.Results of standard laboratory tests, including a full blood cell count, serum electrolytes, erythrocyte sedimentation rate, C-reactive protein, thyroid function, blood glucose, and anti-nuclear, anti-mitochondrial, anti-smooth muscle, and anti-parietal cell antibodies, were normal. MRI of the brain and orbits was unremarkable. Four weeks later, visual acuity in the left eye had returned to its baseline level of 20/200, but the altitudinal field defect persisted (Fig. 2). A diagnosis of left NAION was made. Six months later, field testing showed a persistent defect with some improvement (Fig. 3).FIG. 2: Late-phase fluorescein angiography demonstrates areas of pinpoint hyperfluorescence without marked optic disc hyperfluorescence.FIG. 3: Visual field examination performed 7 months after the onset of field loss shows minimal improvement.NAION has been reported after anterior segment (mainly cataract) surgery (1), vitrectomy (2), scleral buckling surgery (3), and post-LASIK (4). We have found no reports of NAION occurring either immediately or after an interval following strabismus surgery, although a case of posterior ischemic optic neuropathy has been reported (5). Our patient had no risk factors for NAION apart from a low cup-to-disc ratio, and her youth makes her an unlikely candidate for spontaneous NAION. The ages of patients reported with NAION occurring at an interval after ocular surgery range from 48 to 94 (2,4). A case has been reported after intraocular lens implantation in a 33-year-old woman, but this occurred immediately after surgery rather than after an interval (6). The delayed onset of symptoms in our young patient raises the possibility of an inflammatory etiology. However, the lack of pain and normal MRI scan suggest that optic neuritis was unlikely. Given our patient's left amblyopia, we cannot exclude preexisting structural anomalies that might have increased her susceptibility to NAION. Also, from one case, we cannot conclude that the optic neuropathy and strabismus surgery were necessarily related. O. A. R. Mahroo, MB, BChir, PhD C. J. Hammond, MB, BChir, MD, FRCOphth West Kent Eye Centre Princess Royal University Hospital Farnborough Common Orpington, UK [email protected]

Mitochondrial DNA nucleotide changes in non-arteritic ischemic optic neuropathy.

The authors sequenced the entire mitochondrial DNA coding region in a group of 19 patients with non-arteritic anterior ischemic optic neuropathy (NAION) and in 100 controls. Synonymous and nonsynonymous nucleotide changes were more common in NAION patients (p < 0.001). Twelve of these (11 novel) were potentially pathologic, nine of which altered moderately or highly conserved amino acids in the functional domain of the affected protein. Mitochondrial malfunction may be a risk factor for NAION.

Hyperhomocystinemia in patients with nonarteritic anterior ischemic optic neuropathy, central retinal artery occlusion, and central retinal vein occlusion

Objective This study aimed to determine the prevalence of hyperhomocystinemia among patients with nonarteritic anterior ischemic optic neuropathy (NAION), central retinal artery occlusion (CRAO), or central retinal vein occlusion (CRVO). Design Retrospective, case-control study. Participants The study cohort consisted of 74 consecutive patients with NAION, CRAO, or CRVO who were examined at the Retina or Neuro-ophthalmological Unit of the Tel-Aviv Sourasky Medical Center from 1998 through 1999. The control group consisted of 81 consecutive patients of similar gender and age with no history of these pathologic conditions. Main outcome measures Plasma homocystine levels of all study participants were obtained. Results Eighteen of 40 patients (45%) with NAION and eight of 13 patients (61.5%) with CRAO had hyperhomocystinemia compared with three of 21 (14.3%) in the CRVO group ( P < 0.001) and eight (9.8%) in the control group ( P < 0.0001). Hypertension and ischemic heart disease were significantly more prevalent in the NAION patients with elevated plasma homocystine. Conclusions Our findings suggest that hyperhomocystinemia is a risk factor for NAION and CRAO.