Abstract Details

Title Short-term Deterioration of Visual Acuity and Visual Fields in Nonarteritic Anterior Ischemic Optic Neuropathy

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-015

Objective To determine the frequency and severity of further visual loss experienced by patients within ten weeks from diagnosis of acute nonarteritic anterior ischemic optic neuropathy (NAION).

Background

NAION is the most common cause of optic neuropathy in patients over 50 years of age. Typical presentation involves sudden onset painless vision loss, often altitudinal, with clinical findings of a swollen optic disc and contralateral “disc at risk”. Unfortunately, there is no treatment for NAION and the visual loss can be devastating.

Design/Methods Electronic medical records (EMR) at an academic neuro-ophthalmology practice were searched for diagnosis of “NAION” and all identified charts were reviewed to determine eligibility. Patients diagnosed with acute NAION between February 2014-December 2023 who presented within four weeks of symptom onset and were seen in follow-up within ten weeks were included. Clinically significant decline in best corrected visual acuity (BCVA) and peripheral VF were defined as decline of BCVA ≥2 Snellen lines and decrease of ≥2 decibels (dB) in mean deviation (MD) on perimetric testing.

Results Forty-nine eyes met inclusion and exclusion criteria. Sixty-seven percent of patients were male and average age at presentation was 66 years. Twenty-two percent of eyes demonstrated worsening of BCVA by ≥2 lines. Of these, 55% worsened by ≥4 lines and 27% by ≥8 lines. In 27% of eyes MD on perimetry worsened by ≥2 dB and in 18% by ≥4 dB. In total, 41% of eyes demonstrated clinically significant worsening of BCVA or VF.

Conclusions Subacute deterioration of BCVA and/or VF following acute NAION is not uncommon while optic disc edema is present, with sizeable proportion of patients experiencing dramatic visual decline. Deterioration in visual function within the first 10 weeks of presentation does not exclude the diagnosis of NAION and further investigations should only be performed if additional clinical features are discordant with this diagnosis.

Authors/Disclosures
Angela T. Kwan, MSc PRESENTER	Miss Kwan has nothing to disclose.
Moiz Lakhani, BHSc, MD (C)	Mr. Lakhani has nothing to disclose.
Heather McDonald, MD	Dr. McDonald has nothing to disclose.
Armin Handzic, MD	Mr. Handzic has nothing to disclose.
Edward Margolin, MD	Dr. Margolin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for J and J.

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