The correlation between non-arteritic anterior ischemic optic neuropathy and cerebral infarction

Abstract

Background The aim of this study was to explore the correlation between non-arteritic anterior ischemic optic neuropathy (NAION) and cerebral infarction (CI). Moreover, the ocular and systemic parameters are also compared between NAION patients with or without CI. Methods Retrospective analysis is performed for NAION patients and the controls. The controls were collected at the eye outpatient with cranial computed tomography (CT), and data of blood triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and apolipoprotein B were drawn. The diagnosed NAION patients with cranial CT are included, and data of clinical history and routine clinical examination were drawn from the medical record. Visual acuity, intraocular pressure (IOP), visual field, and visual evoked potential were also drawn. Results Eighty-two unilateral and 6 bilateral patients, totally 94 eyes for 88 NAION patients and 69 controls are included. NAION and control patients have matched age, gender, and weight. There is no difference in triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and apolipoprotein B between these two groups. NAION patients (43.18%, 38/88) have a higher ratio of CI than the controls (14.49%, 10/69) (p = 0.000). For NAION, the odds ratio (OR) of CI is 2.691 (p = 0.011). Body mass index, height, and IOP show no significant difference between NAION patients with or without CI. NAION patients with CI have a significant higher ratio of hypertension than those without CI, and the OR of HBP is 2.623 (p = 0.008). Conclusions The correlation between NAION and CI is possible as NAION patients have a significant higher ratio with CI. In NAION patients, hypertension is a risk factor for those with CI.

An overview of neuro-ophthalmic disorders at Jenna Ophthalmic Center, Baghdad, Iraq (2021-2022)

“…The etiology of blindness showed variability. While the incidence of non-arteritic anterior ischemic optic neuropathy was very high, it is worth noting that just one participant in the research mentioned above had complete vision loss [ 39 ]. Multiple investigations have shown that NAION often manifests with a Snellen visual acuity superior to 6/60 [ 40 ].…”

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

“…NA-AION has been demonstrated to be significantly associated with systemic arterial hypertension, found in 35-50% of patients [14,58]; diabetes mellitus, present in 5-25% of cases [14,34,58,59]; hyperlipidemia, hypercholesterolemia and hypertriglyceridemia, atherosclerosis, and arteriosclerosis [60]. Undetected or untreated systemic hypertension and diabetes mellitus are the most important underlying disease amongst NA-AION patients (cardio); -Cardiovascular and cerebrovascular diseases: in comparison with a matched population, patients developing NA-AION have been demonstrated to be at higher risk of acute cerebrovascular and cardiovascular events, such as stroke, transient ischemic events, hearts attacks, and are also at a higher risk of dying from vascular events [14,58,61,62]. A recent retrospective study found that patients with NA-AION have a 3.35 times increased risk of developing an ischemic stroke when compared with patients with similar comorbidities but without NA-AION [61].…”

“…In this regard, ophthalmologists should remember the following important points: -a complete anamnesis should include [14,44]: past medical history (e.g., vasculopathy risk factors); recent surgical history; social history (e.g., smoking); medications (e.g., amiodarone, PDE-5i); and the presence of symptoms of OSAS and giant cell arteritis, such as daytime sleepiness, pain, mandibular claudication, etc. ; -invite all NA-AION patients to undergo a complete multidisciplinary evaluation by an inter-professional team, including internists, endocrinologists, neurologists, and pulmonologists to identify and likely control modifiable risk factors such as systemic hypertension, diabetes mellitus, hyperlipidemia, and OSAS; -request all NA-AION patients to stop smoking, reduce weight, and do physical exercise to reduce the risk of vascular diseases that are linked to NA-AION development [14,58,62]; -avoid nocturnal arterial hypotension, which has been demonstrated to be an important predisposing risk factor for NA-AION. In this regard, avoidance of the assumption of anti-hypertensive drugs in the evening or at bedtime could be important [11]; -ask NA-AION patients to avoid sleeping in the lateral decubitus position, in particular from the site of the affected eye [51]; -suggest ocular hypotensive treatments in the presence of borderline or high IOP values to improve ONH blood flow; -use caution in prescribing treatment with intravitreal injections in NA-AION patients, because the sudden IOP increase after the intravitreal injection could impair OD circulation and predispose to progressive VA loss in the affected eye, or the development of NA-AION in the fellow eye [79]; -ask all male patients developing an NA-AION about the use of phosphodiesterase-5 inhibitors (PDI5i); moreover, before the prescription of PDI5i, patients should undergo an ophthalmological examination and, especially in the presence of a crowded OD, be informed about the risk of developing an NA-AION by using the drugs and eventually discouraged to take PDE5i.…”