Comparison of Arteritis and Nonarteritic Anterior Ischemic Optic Neuropathies with the Heidelberg Retina Tomograph

Danesh‐Meyer, Helen V.; Savino, Peter J.; Spaeth, George L.; Gamble, Greg

doi:10.1016/j.ophtha.2004.12.041

Cited by 57 publications

(33 citation statements)

References 48 publications

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“…To facilitate early diagnosis, researchers have focused on objective morphological analysis of the retrobulbar tract and the head of the optic nerve, in order to reduce the bias caused by subjective medical interpretations [20]. Optic nerve analysis by means of magnetic resonance imaging, digital stereoscopy and Heidelberg retina tomography are some examples of how recent technologies can quantitatively document peculiar clinical findings in ON, NAION and other optic nerve diseases [21][22][23]. We can also recall the laserbased blood flow measuring technique applied to the study of optic nerve head microcirculation that has been able to quantitatively demonstrate optic nerve head circulatory abnormalities in patients with ON and NAION [24].…”

Section: Discussionmentioning

confidence: 99%

Mass Dimension Evaluation of the Optic Nerve Head Microvascularity in Non-Glaucomatous Optic Neuropathies

Bianciardi¹

2016

Int J Oral Craniofac Sci

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In several diseases, fractal analysis has been proven useful to give contribution in diagnosis and prognosis of the patient and to improve treatments. In the present work we have evaluated the mass dimension of the vascular pattern of optic nerve head in non-glaucomatous optic neuropathic patients and healthy controls. Static fluorescein angiogram was performed and the images of the early venous phase were saved. A manual outline of the trajectories of the two-dimensional vascular network was performed down to vessels of 20 micron diameter, processed to threshold the vessel network without background interference and converted into an outline of single pixels and then the fractal analysis was performed. Mass dimension evaluation of the optic nerve head microvascularity was able to differentiate health condition vs. non-glaucomatous neuropathies (p<0.01), as well optic neuritis vs. nonarteritic anterior ischemic optic neuropathy (p<0.01), with high sensitivity and specificity (p<0.0001; p<0.0001). Mass dimension index shows a significantly increased vascular complexity of the optic nerve head in cases compared with controls, also permitting to distinguish between patients affected by optic neuritis vs. nonarteritic anterior ischemic optic neuropathy. This new, fast, unexpensive, methodology may be used in helping the clinician to perform the differential diagnosis between the pathologies and to study the effect of therapies during the follow up of the patient.(NAION) is difficult to be performed on clinical grounds, both giving overlapping clinical profiles [15]. However, it is fundamental to establish an early differential diagnosis, having the ON patient a clear tendency to develop multiple sclerosis, a disease where therapies should be performed as early as possible [16]. In order to verify whether the fractal analysis of the optic nerve head microvascularity could help in the differential diagnosis between ON and NAION, we have evaluated the mass dimension of the optic nerve head vascular pattern, as revealed by fluorescein angiography. SubjectsPatients with unilateral NAION or unilateral idiopathic ON were recruited from the Department of Ophthalmology of the University of Siena. Each patient underwent a complete neuro-ophthalmic examination, including assessment of visual acuity, colour vision, papillary reaction, slit-lamp examination, applanation tonometry, Goldman visual field testing, visual evoked potentials, dilated fundoscopy and fluorescein angiogram.The criteria for patients' admittance with NAION to the study were: unilateral disc swelling with clinical features consistent with NAION [16], no recovery of visual function in the first month of follow up, exclusion of arteritic anterior ischemic optic neuropathy either on clinical grounds or following a negative temporal artery biopsy, negative magnetic resonance imaging of the brain and orbits, no other ocular pathology, no neurological diseases that might influence or explain the patient's visual symptoms. The patient admittance criteria wi...

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Section: Discussionmentioning

confidence: 99%

Mass Dimension Evaluation of the Optic Nerve Head Microvascularity in Non-Glaucomatous Optic Neuropathies

Bianciardi¹

2016

Int J Oral Craniofac Sci

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“…(4) The eye had optic disc-related visual field defects. (5) There was no neurologic, systemic, or ocular disorder, which could be responsible for ODE and visual impairment.…”

Section: Methodsmentioning

confidence: 96%

“…Evidence of the latter is that at least 73% of NA-AION patients discovered visual loss on waking in the morning or at their first opportunity to use vision critically after sleep, while the remaining 27% were not sure when they first discovered visual loss [33]. (b) Moreover, after the ODE has resolved, in arteritic AION the disc mostly develops cupping (because of severe acute ischemic damage), similar to that seen in glaucomatous optic neuropathy, but not in NA-AION [5,13,15,16,23,28].…”

Section: Evolution Of Ode In Na-aionmentioning

confidence: 99%

Optic disc edema in non-arteritic anterior ischemic optic neuropathy

Hayreh

Zimmerman

2007

Graefes Arch Clin Exp Ophthalmol

115

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We investigated the clinical characteristics, time to resolution and the factors that influence it, and evolutionary pattern of optic disc edema (ODE) in non-arteritic anterior ischemic optic neuropathy (NA-AION). Our study was conducted in 591 consecutive patients (749 eyes) with NA-AION who fulfilled our inclusion criteria. On their first visit to our clinic, all patients had a detailed ophthalmic and medical history, a comprehensive ophthalmic evaluation, and stereoscopic color fundus photography and fluorescein fundus angiography. On each follow-up visit, the same ophthalmic evaluation was performed, except for fluorescein fundus angiography. The effect of steroid therapy on ODE was evaluated in a "patient choice study" in 723 eyes, i.e., patients who voluntarily opted to have (343 eyes) or not have (380 eyes) this therapy. To identify the factors that influence time to ODE resolution, parametric regression models for interval-censored data were fitted by maximum likelihood estimation using an SAS procedure. Our results indicate that the overall median time (25-75th percentile) to spontaneous resolution of ODE from the onset of visual loss was 7.9 (5.8-11.4) weeks. The ODE resolution time was longer in diabetics than in non-diabetics (p = 0.003) in the single factor model. Multi-factor analysis showed that worse initial visual field defects (p < 0.0001) and worse visual acuity (p = 0.04) were associated with a faster resolution of ODE. Those treated with steroid therapy within 2 weeks after onset of NA-AION had significantly (p = 0.0006) faster ODE resolution than untreated cases. Severity of initial visual loss and systemic diseases were identical in steroid treated and untreated patients. A characteristic evolutionary pattern of ODE in NA-AION was observed. In conclusion, our study showed that in NA-AION the time course for resolution of ODE is shorter with greater severity of initial visual field and visual acuity loss, which may relate to the number of axons permanently damaged during the acute stage. Steroid therapy was associated with shorter time to resolution of ODE. Resolution of ODE goes through a characteristic evolutionary process.

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“…38 Serial examination of the optic nerve head reveals significant excavation and enlargement of the optic cup following AAION secondary to GCA. 39 The end-stage optic disc appearance is a pale and cupped optic nerve head. AAION is at times difficult to distinguish from non-arteritic anterior ischemic optic neuropathy (NAION).…”

Section: Permanent Visual Lossmentioning

confidence: 99%