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Mark J Kupersmith, Neil Miller, Leonard A Levin, Sharon Klier; Presentation Features for a Multinational Treatment Trial of Nonarteritic Anterior Ischemic Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2261.
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Awareness of presenting features and systemic factors associated with acute non-arteritic anterior ischemic optic neuropathy (NAION) is based on data from one prospective treatment trial, with 258 participants and cases series. The Quark / NORDIC NAION treatment trial will recruit approximately 800 participants and the attributes for the first 400 subjects, enrolled from multiple sites in 8 countries, provides the largest prospective uniformly-collected dataset on this disorder.
We describe presentation data, for participants with acute symptomatic NAION enrolled in a double-masked randomized clinical trial, including comprehensive medical history, laboratory studies, EKG, ophthalmic evaluation including optical coherence tomography (OCT) and 24-2 threshold perimetry, using spot size III and spot size V.
Of the first 400 enrollees (121 women, 279 men), with average age 61 years, 46% had hypertension, 24% diabetes, 46% hyperlipidemia, 25% cardiac disease, 2.5% ischemic brain disease (with wide variability by country). The fellow eye had prior NAION in 18%. Vision evaluations at screening and day 1 (mean separation 1.9 days) were similar, as visual acuity (r = 0.90) and the average fovea threshold of the visual field (r = 0.89) for each correlated (p = 0.01). OCT-measured retinal nerve fiber layer (RNFL) thickening mildly correlated with the average visual field threshold for spot III (r= 0.24) and spot V (r=0.27) but not with visual acuity.
These results confirm prior accounts showing the relevance of systemic disorders in NAION, but it appears that hyperlipidemia is more frequent and cerebrovascular disease less common than previously reported. Optic disc swelling, determined by RNFL thickening, correlates with visual field deficit but not loss of visual acuity.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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