Abstract
Purpose :
Optic disc edema (ODE) may be caused by a multitude of causes and is one of the most common reasons for referral to neuro-ophthalmology. The goal of this study was to evaluate the most common causes of ODE in patients with significantly compromised vision (initial best-corrected visual acuity (BCVA) of 20/400 or worse) at presentation.
Methods :
This was a retrospective chart review over a 5-year period of consecutive patients presenting to tertiary neuro-ophthalmology clinics at the University of Toronto.
Results :
A total of 656 patients with ODE were included and 51 patients (7.77%) had an initial BCVA of 20/400 or worse. There were 57 eyes (35 female, 22 male) included at baseline and 50 eyes at final follow-up. The mean age at first visit across patients was 56 ± 20.3 years. Female (n=31) patients were significantly older than male (n=20) patients (p < 0.05). The causes of ODE were optic neuritis (ON) (38.6%), non-arteritic anterior ischemic optic neuropathy (NAION) (38.6%), arteritic anterior ischemic optic neuropathy (AAION) (8.8%), uveitis-related (7%), papilledema from idiopathic intracranial hypertension (IIH) (5.3%), and Vogt-Koyanagi-Harada disease (1.8%). The initial BCVA was not significantly different between ON and NAION groups (p = 0.52); however, final BCVA was significantly better in the ON group (p < 0.0001). The mean initial BCVA was worst in the AAION group (2.62 ± 0.54 logMAR). There were significantly more female patients with NAION and VA of 20/400 or worse compared to male patients (p < 0.05). The most common cause in patients <40 was ON (76.9%) whereas the two most common causes in patients >80 were NAION (60%) and AAION (40%). In patients between the ages of 60-80, NAION (100%) was the only cause.
Conclusions :
Patients with ODE and poor vision represent a minority of cases seen in neuro-ophthalmology clinics (<10%). Optic neuritis and NAION are the two most common causes of ODE with poor vision at presentation. Improvement over time is an effective way to differentiate these two causes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.