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Purpose: To analyze the data and retinal microvasculature for nonarteritic anterior ischemic optic neuropathy (NAİON) patients referred to have carotid Doppler ultrasound from 2016 to 2020. Methods: In this case-control observational study, 30 NAİON patients evaulated with carotid doppler sonography. 22 NAION patients (at least 3 months after onset of symptoms) and 9 normal subjects underwent a complete ophthalmic examination including optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A). NAİON eyes and fellow eyes were further divided into the groups according to presence of carotid stenosis (CS). NAION patients with CS were termed "CS-NAION"; those without were termed "NCS-NAION". Measurements of radial peripapillary capillary vessel density (RPC VD) and ganglion cell complex (GCC), disk retinal nerve fiber layer (RNFL) thickness were compared among groups. Results: Fourteen of 30 NAİON patients referred for carotid Doppler were positive for CS with all of such referrals having less than 50% stenosis. RNLF, GCC and RPC VDs were reduced in NAION eyes, when compared to controls and the fellow eyes. RPC VD was significantly lower in the temporal-superior (P=0.037) and the superior-temporal (P=0.012) sectors of the NCS-NAION patients than in the CS-NAION patients. No significant differences were found between CS-fellow eyes and NCS-fellow eyes in terms of RPC VDs, RNLF or GCC. Conclusion: Results of the study highlight the effect of carotid artery stenosis on ocular perfusion pressure in the pathogenesis of NAİON. More extensive studies are necessary.

Purpose To show alterations of retinal arteriolar caliber (RAC), retinal venular caliber (RVC), retinal nerve fiber layer thickness (RNFLT), peripapillary choroidal thickness (ppCT), and central macular thickness (CMT) in acute and chronic phases of nonarteritic anterior ischemic optic neuropathy (NAION). Methods Forty-one eyes of 41 patients with NAION were included in this retrospective study. RAC, RVC, RNFLT, ppCT, and CMT measurements were performed via spectral-domain optical coherence tomography in the acute and chronic phases of NAION. Results RVC, RNFLT, ppCT, and CMT were significantly thinner in the chronic phase compared to the acute phase (p < 0.001), whereas RAC remained similar throughout the visits (p = 0.26). The visual acuity difference between the acute and chronic phases was not correlated with the changes of RAC, RVC, RNFLT, ppCT, or CMT. Conclusions RVC, RNFLT, ppCT, and CMT decreases in the chronic phase when compared to the acute phase of NAION, whereas RAC does not change significantly.

To investigate the natural course, visual outcome, and risk factors for visual loss after nonarteritic anterior ischemic optic neuropathy (NAION) attack in Chinese patients from a tertiary medical center in Southern Taiwan. This is a longitudinal observational study that included sixty NAION patients, who were seen in our neuro-ophthalmology clinic from 2007 to 2016. Records of their ophthalmic history, medical history, best-corrected visual acuity (BCVA), visual field (VF) testing, and optical coherence tomography (OCT) were obtained for analysis. When the first visit was within two weeks after NAION onset, 62% of patients had BCVA of less than 0.1 (logMAR BCVA ≥ 1) and 38% had at least moderate–severe depression (VF grade ≥ 3) on VF on the initial visit. VA stabilized at three months after onset and was predictive of VA at 12 months. Diabetes mellitus was a risk factor associated with VA worsening. Sixty-one percent of patients had BCVA of less than 0.1 at 12 months after onset. VF remained relatively unchanged during the disease, with 41% eyes having VF grade ≥ 3 at 12 months after onset. On OCT, all quadrants of retinal nerve fiber layer thickened initially, returned to the level of the fellow eye at one month, and continued thinning up to 12 months slowly. In Southern Taiwan, a higher proportion of Chinese patients (over half) presented with severe visual loss during the first two weeks of NAION attack and at 12 months after the onset of NAION as compared to the findings previously reported in Caucasians. Understanding the natural course of NAION in Chinese patients may provide insights toward a possible therapeutic window for NAION treatments in this group of patients.

Optic disc drusen (ODD) are acellular deposits in the prelaminar optic nerve head. The most accredited theory is that they are secondary to abnormalities in axonal metabolism and degeneration, but the pathogenesis is not clear to date. Although ODD are often considered a benign condition, the great majority of patients with ODD show visual field defects and are at higher risk for developing anterior ischemic optic neuropathy. ODD are classified as superficial or buried, with the latter being often misdiagnosed as papilledema with optic nerve head swelling, leading to an unnecessary investigation for causes of increased intracranial pressure. The recent technological improvements in OCT imaging which allowed an earlier and more certain diagnosis even of the smallest ODD, renovated the interest around this pathology. However, an updated systematic review is still missing. Therefore, the aim of this work is to provide a concise yet comprehensive overview of the current state of art, focusing on pathophysiology, clinical presentation, diagnostic methods, treatment modalities and potential future perspectives of this condition.

To assess the peripapillary perfusion in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA). Twenty-five patients with unilateral acute NAION were included in this observational cross-sectional study. They were divided into two groups: group I (25 eyes) included eyes with acute NAION, and group II (25 eyes) included fellow normal eyes. Diagnosis of NAION was based on clinical examination and fluorescein angiography. OCTA (AngioVue, Optovue) was used to evaluate the optic nerve head perfusion and measure the peripapillary vessel density in all eyes included in the study. Fourteen male and 11 female patients with a mean age of 60.2 ± 3.5 years were included in this study. The mean duration of presentation was 4.3 ± 0.6 days. Mean BCVA was 0.13 ± 0.06 and 0.69 ± 0.18 in eyes with NAION and normal eyes, respectively (p

To report the youngest female carrier of Fabry disease, complicated by cilioretinal artery occlusion and anterior ischemic optic neuropathy (AION).Case report.An 11-year-old girl was referred to our clinic with painless, acute loss of vision in her right eye. Posterior segment examination and fluorescein angiography revealed cilioretinal artery occlusion and AION. Systemic evaluations were unremarkable, except for a low blood α-galactosidase A enzyme level of 242.27 pmol/spot*20 h (reference range: 450-2000 pmol/spot*20 h). The patient was diagnosed with female carrier of Fabry disease.Retinal vascular occlusions are rare in childhood, and Fabry disease may present with retinal vascular occlusion. Ophthalmological examinations may be contributing for early detection of the disease. To the best of our knowledge, this is the first report of a child female carrier of Fabry disease, complicated by cilioretinal artery occlusion and AION.

The aim was to assess the ganglion cell complex (GCC) thickness, retinal nerve fiber layer (RNFL) thickness and optic disk features in the affected eyes (AE) and unaffected fellow eyes (FE) of subjects with unilateral nonarteritic anterior ischemic optic neuropathy (NAION) and to compare with healthy control eyes (CE) using spectral domain-optical coherence tomography (SD-OCT). This study included 28 patients and age, sex and refraction-matched 28 control subjects. Mean GCC thickness and peripapillary RNFL thickness in four quadrants measured by cirrus SD-OCT were evaluated in both AE and FE of patients and CE. In addition, optic disk measurements obtained with OCT were evaluated. Mean GCC thickness was significantly lower in AE compared with both FE and CE (P

Critical flicker fusion (CFF) frequency is a well-studied test for evaluating demyelinating optic neuritis (ON). Its use in evaluating other optic neuropathies is not well established. The purpose of this study was to compare CFF in ON and non-arteritic anterior ischemic optic neuropathy (NAION). We performed a retrospective review to compare multiple variables for eyes with ON or NAION using two-sided T tests and Chi-square tests. A multivariate linear regression was performed for the dependent variable CFF. A receiver operating characteristic (ROC) curve was used to define a CFF threshold for distinguishing these entities. Unaffected eyes had an average CFF value of 31.5 Hz. CFF values for ON (20.7 Hz ± 7.36) and NAION (24.3 Hz ± 9.03) were not significantly different from each other (P = 0.06). However, the CFF for ON, 18.27 Hz ± 9.29, was significantly lower than for NAION, 23.92 Hz ± 7.02, P = 0.02 when limiting the comparison to moderate and severe disease. An ROC curve demonstrates that a CFF value of ≤24 Hz is 71% sensitive for ON and that a value >24 Hz is 74% specific for excluding ON. A multivariate linear regression model demonstrated that ON contributed to approximately an 8 Hz decrease in CFF compared to NAION. Patients with a CFF of ≤24 Hz have a 2.89 odds ratio (95% CI 1.76–4.01) of having ON. CFF values in eyes with ON were significantly lower compared to eyes with NAION when evaluating moderate and severe disease. Twenty-four hertz may be a useful CFF threshold value when trying to distinguish between these two entities.

The aim of this study was to evaluate the usefulness of the RTVue-100 Fourier-domain optical coherence tomograph (RTVue-100 OCT) in screening for glaucoma and non-arteritic anterior ischemic optic neuropathy (NA-AION). In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma and NA-AION using the RTVue-100 OCT, and also by independent clinical examination. For the RTVue-100 OCT measurements, the optic nerve head (ONH) scan and the macular ganglion cell complex (GCC) scan were applied. Subjects with possible optic neuropathy (as indicated by any of the scans and/or by the clinical examination) underwent a detailed clinical investigation to verify or exclude the disease. Of the 146 attendees, 133 participants (256 eyes) successfully underwent the RTVue-100 OCT measurements. Of these, six eyes (2.3%) had glaucoma and three eyes (1.2%) had partial optic atrophy due to earlier NA-AION. The retinal nerve fibre layer (RNFL) parameters (provided by the instrument software) had 99.2-99.6% specificity, 96.5-96.9% accuracy, and positive likelihood ratio (PLR) of 27.3-54.7, but only 11.1-22.2% sensitivity. Accuracy and PLR for the ONH parameters were95% and8.3, respectively. The GCC scan of the macula provided up to 95.9% specificity, 94.0% accuracy, 10.7 PLR and 44.4% sensitivity. During the screening of this Caucasian population with 3.5% prevalence of optic neuropathy due to glaucoma and NA-AION, the RTVue-100 OCT was found to be useful for screening, with both RNFL and GCC parameters providing high accuracy and PLR values10.

Purpose: There is considerable overlap in the clinical profile of patients with idiopathic optic neuritis(ON) and anterior ischemic optic neuropathy (AION). We tested the hypothesis that the retrobulbar diameter of the optic nerve may be a criterion for the differential diagnosis between ON and AION. Methods: The diameter of the optic nerve was measured by B-scan ultrasonography with the eye in an abducted position. Only patients with a unilateral optic neuropathy were included, 16 ON patients (mean age 24years, 5 with and 11 without disc swelling) and 9patients with AION (mean age 72 years). As controls for the ON patients 10 young normal subjects (mean age25 years) and as controls for the AION patients 10elderly subjects with eye problems not related to the optic nerve (mean age 76 years) were examined. Results: In the ON patients with disc swelling the diameter of the optic nerve was 5.4 ± 0.5 mm in the affected and 3.0 ± 0.3 mm in the unaffected side. This difference was significant (Wilcoxon-test, p = 0.043). In the ON patients without disc swelling the diameter of the optic nerve was 4.4 ± 0.4 mm in the affected and 3.0 ± 0.3 mm in the unaffected side. This difference was significant (Wilcoxon-test, p = 0.003). In the AION patients the diameter of the optic nerve was 3.0 ± 0.3 mm on the affected and2.8 ± 0.4 mm on the unaffected side. This difference was not significant (Wilcoxon-test, p =0.093). Comparing the optic nerves with ON and AION to those of the controls, the diameter was significantly enlarged in the nerves with ON and normal in the nerves with AION (one factor repeated ANOVA). Conclusion: The diameter of the optic nerve is increased in ON without disc swelling and even more so in ON with disc swelling. The enlargement is probably due to edema of the nerve itself, not the surrounding subarachnoidal space. In AION, the diameter of the optic nerve is normal. Measuring the diameter of the optic nerve by B-scan ultrasonography is particularly useful in the differential diagnosis between ON with disc swelling and AION.

An unusual case of bilateral blindness secondary to a cavernous sinus thrombosis is reported. A woman who had undergone reconstructive surgery after tumor resection of the floor of the mouth, was readmitted 1 month later with bilateral proptosis and signs of sepsis. There were no complaints of blurred vision. A CT-scan of the orbits demonstrated a bilateral cavernous sinus thrombosis (CST) secondary to an infection at the skull base behind the myocataneous flap. A few days later she became blind, due to bilateral central retinal artery occlusion and anterior ischemic optic neuropathy. The general critical condition improved with intensive AB treatment. The patient recovered well without neurological defects apart from her permanent bilateral blindness. There were no signs of tumor recurrence. To our knowledge, this is the first documented case of bilateral blindness in a patient suffering from CST.

By estimating cup/disc ratios in fellow eyes it has been assumed that nonarteritic anterior ischemic optic neuropathy (AION) occurs more often in small optic nerve heads. Correcting the photographic magnification we used absolute size units to measure 33 affected and 25 fellow optic discs with nonarteritic AION and 7 affected and 7 fellow optic nerve heads with arteritic AION. The affected and fellow discs with nonarteritic AION (2.37 + -0.29 mm2 and 2.31 + -0.31 mm2) were significantly (p less than 0.001, Mann-Whitney-test) smaller than 457 normal optic nerve heads (2.69 + -0.70 mm2). They were significantly (p less than 0.001; Mann-Whitney-test) larger than optic nerve heads with pseudopapilledema or drusen. Affected and fellow optic nerve heads with arteritic AION were not significantly different in size from normal discs but significantly (p less than 0.005) larger than the discs affected by nonarteritic neuropathy. There were no significant form differences between the pathologic and normal discs. Optic disc morphometry can be helpful in the differentiation of nonarteritic and arteritic AION: Nonarteritic AION occurs more often in small optic discs, arteritic AION is more often in normal sized optic nerve heads.