June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Very Poor Visual Acuity in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)
Author Affiliations & Notes
  • Michael Dattilo
    Ophthalmology, Emory University, Atlanta, Georgia, United States
  • Tian Tian
    Ophthalmology, Emory University, Atlanta, Georgia, United States
  • Beau B Bruce
    Ophthalmology, Neurology, and Epidemiology, Emory University, Atlanta, Georgia, United States
  • Kannan Narayana
    Ophthalmology, Emory University, Atlanta, Georgia, United States
  • Jason Peragallo
    Ophthalmology and Pediatrics, Emory University, Atlanta, Georgia, United States
  • Nancy J Newman
    Ophthalmology, Neurology, and Neurological Surgery, Emory University, Atlanta, Georgia, United States
  • Valerie Biousse
    Ophthalmology and Neurology, Emory University, Atlanta, Georgia, United States
  • Footnotes
    Commercial Relationships   Michael Dattilo, None; Tian Tian, None; Beau Bruce, None; Kannan Narayana, None; Jason Peragallo, None; Nancy Newman, None; Valerie Biousse, None
  • Footnotes
    Support  Unrestricted Departmental Research to Prevent Blindness Grant (Department of Ophthalmology, Emory University), NIH/NEI Core grant P30-EY06360 (Department of Ophthalmology, Emory University)
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3857. doi:
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    • Get Citation

      Michael Dattilo, Tian Tian, Beau B Bruce, Kannan Narayana, Jason Peragallo, Nancy J Newman, Valerie Biousse; Very Poor Visual Acuity in Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). Invest. Ophthalmol. Vis. Sci. 2017;58(8):3857.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Very poor visual acuity (VA) at presentation is unusual in NAION, and is usually suggestive of arteritic AION. In the IONDT, 34/420 (8%) had HM or worse VA (21 HM, 13 LP, and 0 NLP). In Hayreh’s cohort, 34/237 (14%) had VA of CF or worse. Our goal was to report the frequency of very poor VA in NAION patients and to describe patient characteristics.

Methods : Retrospective review of 151 consecutive NAION patients with detailed neuro-ophthalmologic evaluation seen at our institution between 07/14/2014-04/27/2016. Patients with HM or worse initial VA were included. Temporal arteritis and other causes of optic neuropathies were excluded in all patients.

Results : In 17/151 (11%) NAION patients, very poor VA (2 NLP, 6 LP, 10 HM (one had HM VA OU from bilateral sequential NAION)) was documented (11 (65%) men; average age 63yo (<29-86yo); 14 (82%) white, 2 (12%) African-American, 1 (6%) Indian). All patients had a disc-at-risk and at least one vascular risk factor; 14 (82%) had ≥2 vascular risk factors. Eight had fundus photographs obtained within 30 days of onset; all had severe, pallorous optic disc edema. Ten (59%) had bilateral sequential NAION (3/10 with incidentally discovered previous NAION at the time of presentation) and 2 (12%) had recurrent NAION. Seven (41%) had a temporal artery biopsy. Oral or IV steroids were given to 3/7 patients with unilateral NAION, to 4/10 with bilateral sequential NAION after the first NAION and to 7/10 patients after the second NAION. Visual acuity at last follow-up ranged from 20/50 to light perception (LP) with VA 20/400 or better in 4/17 patients.

Conclusions : 11% of NAION patients had profound visual impairment, similar to previous large studies. The 8 patients with photographs had unusually severe disc edema at presentation. Bilateral sequential NAION was more common than in the IONDT.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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