Abstract
Purpose :
Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in adults older than 50 and the most common cause of vision loss in patients with optic disc drusen (ODD). In this study, we compared adults with NAION and analyzed clinical differences between those with ODD-AION (ODD-associated NAION) and those without ODD (nODD-AION).
Methods :
We used STAnford Research Repository (STARR) to generate a database of 971 patients with ODD who were seen at Stanford Byers Eye Institute using International Classification of Diseases codes and natural language processing-enabled searching. Of these, 15 patients (22 eyes) had confirmed diagnoses of ODD-AION. For comparison, we prospectively included the first AION eye of 22 nODD-AION patients. We compared their general and optical characteristics 1 to 18 months after the onset of NAION event (“onset”), and longitudinal records in 6 ophthalmic assessments, including best correct visual acuity (BCVA), intraocular pressure (IOP), cup-to-disk ratio (C/D), peripapillary retinal nerve fiber layer thickness (pRNFL), macular ganglion cell complex thickness (mGCC), and static perimetry mean deviation (note the most severely affected patients could not perform static perimetry). We used linear regression and generalized estimating equation (GEE) to evaluate the association between ODD and onset and longitudinal characteristics.
Results :
A comparison of 22 ODD-AION eyes and 22 nODD-AION eyes revealed no difference in onset age, sex, and race. Compared to nODD-AION group, the ODD-AION eyes had better BCVA by 3.4 lines at event onset ([LogMAR], β=-0.341, 95%CI [-0.602, -0.081], P=0.012) and by 3.5 lines at follow-up (β=-0.35, 95%CI [-0.57, -0.13], P=0.002) but no difference in mean deviation. Optical coherence tomography (OCT) measurements of C/D, pRNFL or mGCC at onset show no significant difference, but GEE showed that ODD-AION eyes had relatively thicker mGCC (β=7.18, 95%CI [1.63, 12.7], P=0.011) at follow-up. Compared with patients with nODD-AION, those with ODD-AION had significantly lower systolic blood pressure (SBP) in the most recent measurements (123.8± 2.4 vs. 136.1±17.8, P=0.017) and IOP at the onset (14.1±0.50 vs. 15.9 ±0.65, P=0.033).
Conclusions :
Compared with nODD-AION eyes, ODD-AION eyes have better functional and structural outcomes. Patients with ODD-AION had lower IOP and SBP compared to those without ODD, two known risk factors of NAION.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.