Abstract
Purpose :
The spectrum of diseases responsible for Ischemic Optic Neuropathies varies, yet the vast majority of these conditions stem from a relatively limited set of underlying causes.
The main objectives of this study were to examine the distribution of various causes of ischemic optic neuropathy and the prevalence of cases where the cause of optic neuropathy could not be determined.
Methods :
This cross-sectional study examined patients who underwent evaluation at the Neuro-Ophthalmology service at a tertiary care center in the U.S. from January 2016 to February 2023 with queries of the electronic health record (EHR) for encounters with ICD-10 code for “ischemic optic neuropathy” (right, left, bilateral, or unspecified). The prevalence of etiologies was determined, including special cases and those where the cause of optic neuropathy could not be determined. This selection of cases of ischemic optic neuropathy was compared to data presented at the 2016 NANOS meeting that described the distribution of all causes of optic neuropathy throughout one year within the same office.
Results :
A total of 1197 records were reviewed. The most common cause of ischemic optic neuropathy was NAION in 721 (72%) of cases, of which 221(30.6%) were sequential NAION. Recurrent NAION and NAION with quasi-simultaneous bilateral optic nerve edema were identified in 8 (1.1%) and 10 (1.3%) cases, respectively. Incipient NAION (nerve head swelling without visual loss) was identified in 23 (3.2%) patients. Giant cell arteritis accounted for 69 (7%) of cases. Optic disk drusen and shock-induced ischemic optic neuropathy were observed in 19 (2%) and 28 (3%) cases, respectively. We diagnosed posterior ischemic optic neuropathy in only 16 (2%) patients. A substantial proportion of the cases (131, 13%) were classified as idiopathic.
Conclusions :
The findings underscore the varied nature of optic neuropathies, ischemic and otherwise. Notably, 10% of our optic neuropathies were of unknown etiology, which offers insight into the magnitude of the diagnostic vacuum and provides some perspective of direction for future research.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.