Individual Prognosis and Clinical Course of Nonarteritic Anterior Ischemic Optic Neuropathy

To investigate the clinical course of nonarteritic anterior ischemic optic neuropathy (NAION), in particular the presence of individual prognostic markers and the occurrence of a 2-stage progression of the disease.

In this retrospective study, 116 eyes of 100 patients with NAION were included. The selection was made in reverse consecutive order, starting with patients who presented to the University Eye Clinic, Tuebingen, Germany in December 2022.

Sixty-three percent of the patients were men, median age was 61.5 years. Of all patients, obstructive sleep apnea was found in 73.5%, arterial hypertension (aHT) in 69.9%. Second eye involvement was observed in 15% of the patients. The median follow-up was 56 days. Median visual acuity (VA, decimal) of all eyes examined was 0.63 in the first test and 0.5 in the final test, a clinically relevant VA decrease of at least 2 lines occurred in 27.5%. A worsening of visual field (VF) defects happened in 42.5%. Worst VA and VF prognosis were in relation to an initial circular swelling of the optic disc. Best final VA occurred with initial superior swelling, best final VF findings with initial inferior swelling. Considerable increase in optic disc swelling during the observation period occurred in 16.4% of the eyes (n = 19) at a median of 24 days after initial presentation.

The configuration of the initial optic disc swelling is a prognostic marker, with circular swelling having the worst prognosis for VA and VF. In total, 16.4% of the affected eyes, particularly in men with initially good visual acuity, showed a 2-stage progression of optic disc swelling with poor visual prognosis. Second eye involvement occurred in 15% of our cohort.