Progression of asymptomatic optic disc swelling to non-arteritic anterior ischaemic optic neuropathy

Subramanian, Prem S.; Gordon, Lynn K.; Bonelli, Laura; Arnold, Anthony C.

doi:10.1136/bjophthalmol-2016-309250

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…Moreover, if increased choroidal thickness was a compensatory factor, it must be decreased after the acute phase, but as mentioned earlier, the result of previous studies in the chronic phase also showed thicker choroid. [8,9] The NAION progresses through asymptomatic "incipient NAION" to full blown ischemic neuropathy with characteristic clinical presentation in more than two-third of cases [18,19] . By further contributing to "compartment syndrome" in already constricted scleral canal, increased choroidal thickness may have a role in the development of symptomatic axonal damage.…”

Section: Discussionmentioning

confidence: 99%

Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy

Nikkhah

Feizi

Abedi

et al. 2020

JOVR

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Purpose: To compare the choroidal thickness in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION) with healthy contralateral eye and normal controls. Methods: Thirty-eight eyes with NAION, thirty-eight unaffected fellow eyes, and seventy four eyes from 37 healthy, age- and sex-matched subjects were included in this prospective comparative case-control study. Choroidal thickness was measured by enhanced depth imaging (EDI) of spectral domain optical coherence tomography (SDOCT). Peripapillary choroidal thickness (PCT) was measured at 1000 and 1500 μm from Bruch's membrane opening (BMO). Subfoveal choroidal thickness (SFCT) was measured in central subfoveal area, and 500 microns apart in temporal and nasal sides. Choroidal thickness among NAION eyes, uninvolved fellow eyes, and control eyes were compared. Results: The mean of PCT at 1000 μm was significantly thicker in NAION and fellow eyes compared to control eyes (169.7 ± 47, 154.4 ± 42.1, and 127.7 ± 49.9 μm, respectively, P < 0.001 and P = 0.42). The mean PCT at 1500 μm was also significantly thicker in NAION and fellow eyes compared to control eyes (178.6 ± 52.8, 162.6 ± 46.1, and 135.1 ± 59 μm, respectively, P = 0.007 and P = 0.048). The mean PCT at 1000 and 1500 μm was significantly greater in NAION compared to fellow eyes (P = 0.027 and P = 0.035, respectively). The mean of SFCT was significantly thicker in NAION compared to control eyes (P = 0.032); however, there was no significant difference between uninvolved fellow and control eyes (P = 0.248). Conclusion: Thicker choroidal thickness in acute NAION and uninvolved fellow eyes compared to normal eyes suggests a primary choroidal role in NAION pathophysiology.

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Section: Discussionmentioning

confidence: 99%

Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy

Nikkhah

Feizi

Abedi

et al. 2020

JOVR

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“…First, the time course is rapid for the onset and then swelling reduction in NAION (notwithstanding case reports suggesting ONH swelling can be present for weeks before vision loss 18 . 19 ), and slower and insidious, typically over weeks to months before diagnosis and to time of improvement in many patients with papilledema. Second, the increased pressure in the intracranial or subarachnoid perioptic space, and at the scleral flange, which typically occurs with papilledema, is absent in patients with NAION and is likely the explanation for not having CF or radial-oriented RF in NAION eyes.…”

Section: Discussionmentioning

confidence: 99%

Nonarteritic Anterior Ischemic Optic Neuropathy Induced Retinal Folds and Deformations

Kupersmith

Sibony

Dave

2017

Invest. Ophthalmol. Vis. Sci.

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PurposeWe hypothesized that the edema/swelling in the retina due to acute nonarteritic anterior ischemic optic neuropathy (NAION) can induce retinal folds (RF). We determined the pattern and frequency of folds in NAION at presentation and in follow-up, and the relationship between folds and a number of functional and structural parameters over time.MethodsWe prospectively studied eyes with acute NAION by spectral-domain optic coherence tomography (SD-OCT). We used transaxial and en face views to evaluate the presence of peripapillary fluid (PPF), peripapillary wrinkles (PPW), RF, choroidal folds (CF), creases, macular edema, and vitreous traction on the optic disc. Retinal deformations were correlated with the retinal nerve fiber layer (RNFL) thickness, logMAR visual acuity (VA) and mean deviation (MD).ResultsAt presentation, 60 eyes had mean RNFL = 224 ± 75 μm, no vitreous traction, and similar VA and MD regardless of the retinal deformation or macular edema. There was PPF in 73%, PPW in 57%, RF in 38%, creases in 20%, and macular edema in 18% of eyes, and no CF. Eyes with retinal deformations had significantly greater RNFL thickness (P < 0.026). At 1 to 2 months, 49 eyes had reduction of the RNFL (112 ± 40 μm, P = 0.001) and unchanged VA and MD that did not correlate with fewer eyes having PPF (15%, P = 0.001), PPW (10%, P = 0.001), RF (10%, P = 0.001), creases (17%), and macular edema (0%, P = 0.007).ConclusionsRF in NAION reflect stresses and strains due to extracellular fluid without increased pressure in the retrolaminar tissue and subarachnoid space, seen with papilledema. In NAION, the deformations and their resolution do not correlate with vision loss.

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“…Several previous authors have described the so-called "incipient NA-AION": it is an asymptomatic OD edema that can spontaneously resolve, which is explained as reversible ONH ischemia without infarction, and, in 25-45% of cases, can progress to an overt NA-AION within a few weeks [32]. This clinical entity has been also described in the fellow eye of NA-AION patients [105]. A pre-symptomatic phase of NA-AION with impaired perfusion of the ONH has been confirmed with fluorescein angiography [15].…”

Section: Clinical Signs and Symptomsmentioning

confidence: 96%

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Salvetat,

Pellegrini,

Spadea

et al. 2023

Vision

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Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.

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Progression of asymptomatic optic disc swelling to non-arteritic anterior ischaemic optic neuropathy

Cited by 10 publications

References 15 publications

Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy

Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy

Nonarteritic Anterior Ischemic Optic Neuropathy Induced Retinal Folds and Deformations

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

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