Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

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Overview

Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common optic nerve disease in patients over age 50 years.[1] It's characterized by a lack of blood flow to the optic disc which is the head of the optic nerve. Since the optic nerve is the nerve that carries visual information from the eye to the brain, patients present with vision loss that is usually unilateral. Anterior ischemic optic neuropathy (AION) involves the 1mm segment of the optic nerve head (optic disc), and damages the nerve fibers causing optic disc swelling and ischemia around the area.

Causes

NAION is idiopathic. But strong risk factors are:

  • Sleep apnea[2]
  • Hypertensive drugs taken at night[3]
  • Small optic disc and cup[4]
  • Hypertension[5]
  • Diabetes[5]
  • Optic disc drusen[6]
  • Interferon alpha[7]
  • Phophodiesterase type 5 inhibitor (Sildenafil)[8]

Treatment

At this moment there is no treatment for NAION. Observation and management of sleep apnea, hypertension, and diabetes are recommended as well as prevention of taking sildenafil and hypertensive drugs at night.[9]

Prognosis

Depending on the lifestyle modifications the patient can regain vision or permanently lose vision. NAION can worsen during the first days but it usually stabilizes by 2 months.[10]

  1. ↑ Rucker JC, Biousse V, Newman NJ (2004). "Ischemic optic neuropathies". Curr Opin Neurol. 17 (1): 27–35. doi:10.1097/00019052-200402000-00006. PMID 15090874.
  2. ↑ Mojon DS, Hedges TR, Ehrenberg B, Karam EZ, Goldblum D, Abou-Chebl A; et al. (2002). "Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy". Arch Ophthalmol. 120 (5): 601–5. doi:10.1001/archopht.120.5.601. PMID 12003609.
  3. ↑ Hayreh SS, Podhajsky P, Zimmerman MB (1999). "Role of nocturnal arterial hypotension in optic nerve head ischemic disorders". Ophthalmologica. 213 (2): 76–96. doi:10.1159/000027399. PMID 9885384.
  4. ↑ Preechawat P, Bruce BB, Newman NJ, Biousse V (2007). "Anterior ischemic optic neuropathy in patients younger than 50 years". Am J Ophthalmol. 144 (6): 953–60. doi:10.1016/j.ajo.2007.07.031. PMID 17854756.
  5. ↑ 5.0 5.1 "Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial". Arch Ophthalmol. 114 (11): 1366–74. 1996. doi:10.1001/archopht.1996.01100140566007. PMID 8906027.
  6. ↑ Cohen DN (1971). "Drusen of the optic disc and the development of field defects". Arch Ophthalmol. 85 (2): 224–6. doi:10.1001/archopht.1971.00990050226018. PMID 4100520.
  7. ↑ Purvin VA (1995). "Anterior ischemic optic neuropathy secondary to interferon alfa". Arch Ophthalmol. 113 (8): 1041–4. doi:10.1001/archopht.1995.01100080093034. PMID 7639655.
  8. ↑ Pomeranz HD, Bhavsar AR (2005). "Nonarteritic ischemic optic neuropathy developing soon after use of sildenafil (viagra): a report of seven new cases". J Neuroophthalmol. 25 (1): 9–13. doi:10.1097/00041327-200503000-00003. PMID 15756125.
  9. ↑ Atkins EJ, Bruce BB, Newman NJ, Biousse V (2010). "Treatment of nonarteritic anterior ischemic optic neuropathy". Surv Ophthalmol. 55 (1): 47–63. doi:10.1016/j.survophthal.2009.06.008. PMC 3721361. PMID 20006051.
  10. ↑ Hayreh SS, Zimmerman MB (2007). "Optic disc edema in non-arteritic anterior ischemic optic neuropathy". Graefes Arch Clin Exp Ophthalmol. 245 (8): 1107–21. doi:10.1007/s00417-006-0494-0. PMID 17219123.
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