Purchase this article with an account.
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.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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.
This PDF is available to Subscribers Only