Systemic Disease Management May Limit Bilateral and Sequential NAION Risk

Managing systemic diseases is crucial to avoid bilateral or sequential recurrences of nonarteritic anterior ischemic optic neuropathy (NAION), according to a poster presented at the 2023 Southeastern Educational Congress of Optometry (SECO) meeting in Atlanta from March 1 to 5.

Nicolette Ruta, OD, and JulieAnne M. Roper, OD, from the WJB Dorn Veterans Affairs Medical Center in Columbia, South Carolina presented a case series of bilateral and sequential NAIONs and detailed strategies for limiting known risk factors.

NAION risk factors are similar to those for stroke, and NAION shares signs with optic neuritis and arteritic anterior ischemic optic neuropathy (AAION). Visual acuity loss tends to be less severe in NAION compared with AAION, and pain rarely occurs with NAION, unlike in optic neuritis. The amount of color vision loss tends to correspond with the amount of vision loss in NAION. 

Although uncommon, the poster presenters stress that patients with NAION do have an additional risk for recurrence within the same eye (3-5%) or occurrence in the contralateral eye (15%) within 5 years. Risk factors for bilateral NAION, which most often occurs within the first 2 years, include bilateral optic disc drusen and age younger than 50 years at onset. In patients older than 50 years, bilateral NAION is associated with severe blood pressure fluctuations, diabetes mellitus, and poor visual acuity in the initially affected eye.

Sequential NAION, which is rare, tends to occur in patients aged 45 to 64 years. Nocturnal diastolic arterial hypotension is associated with ipsilateral sequential NAION.

Treatment for NAION entails controlling risk factors, avoiding hypertensive medications at bedtime to limit blood pressure decreases, and smoking cessation. Clinicians may consider single vision lenses with improved illumination to improve the common symptom of decreased brightness. Multidisciplinary care, thorough medication review, prompt treatment, and systemic disease management are crucial, the poster presenters stress.