Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis
- Madhura Tamhankar, MD
Madhura Tamhankar, MD
- Assistant Professor of Ophthalmology
- University of Pennsylvania
- Nicholas J Volpe, MD
Nicholas J Volpe, MD
- Tarry Professor and Chairman
- Department of Ophthalmology
- Northwestern Feinberg School of Medicine
Ischemic optic neuropathy is the most common optic nerve disorder in patients over age 50 years . Ischemic optic neuropathy is generally categorized as anterior (affecting the optic disc) versus posterior (retrobulbar) and as arteritic versus nonarteritic. Anterior involvement is common with both arteritic and nonarteritic ischemic optic neuropathy.
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy. It is an idiopathic, ischemic insult of the optic nerve head characterized by acute, monocular, painless visual loss with optic disc swelling.
This topic will discuss the clinical features, and diagnosis of NAION. The epidemiology, pathogenesis, etiologies, prognosis, and treatment of NAION are discussed separately. Other forms of ischemic optic neuropathy and other optic neuropathies are discussed separately. (See "Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies" and "Nonarteritic ischemic optic neuropathy: Prognosis and treatment" and "Clinical manifestations of giant cell (temporal) arteritis" and "Optic neuropathies".)
Presenting symptoms — Patients describe monocular loss of vision occurring over hours to days. Symptoms were present upon awakening in as many as 73 percent of patients according to some reports; however, in the Ischemic Optic Neuropathy Decompression Trial (IONDT) symptoms first present on awakening were reported in just 42 percent [2,3]. Some patients report altitudinal (often inferior) vision loss or a scotoma. It is common for visual loss to progress over the first few days; in one study the average time to peak vision loss was about five days . Most patients stabilize in one to two weeks [2,5].
It is rare for the symptoms to occur in both eyes at the same time. In one series, 11 percent had a bilateral presentation, but most of these cases occurred in the setting of severe blood pressure fluctuations (eg, surgery, dialysis) . (See "Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies", section on 'Etiology and risk factors'.)
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