OCT 04, 2013
By Michael Vaphiades, DO
Neuro-Ophthalmology/Orbit
This review discusses the three major misconceptions about nonarteritic anterior ischemic optic neuropathy (NA-AION): (1) that its pathogenesis is not known, (2) that it its nature, pathogenesis and management are similar to those of ischemic cerebral stroke, and (3) that there is no treatment for it.
The review’s author, Sohan Singh Hayreh, MD, PhD, writes that the pathogenesis of NA-AION is in fact known but is highly complex, that high-dose corticosteroid therapy during the initial stages has rationale and can be beneficial, that aspirin has no beneficial effect, and that risk factors must be eliminated to reduce the risk of further visual loss.
He also discusses the management of other types of ischemic optic neuropathy. Arteritic AION is due to giant cell arteritis (GCA) and is an ocular emergency. It requires early diagnosis and management to prevent visual loss. He notes that it is well-established that high-dose systemic corticosteroid therapy is the treatment of choice.
He also reviews types of posterior ischemic optic neuropathy (PION): arteritic PION, nonarteritic PION and surgical PION. Management of arteritic PION, since it is due to GCA, involves high-dose systemic corticosteroid therapy to prevent any further visual loss. Nonarteritic PION requires the same steroid therapy regimen as used for NA-AION. For surgical PION, he says that no treatment has been found to be effective to recover or improve the lost vision.