alexa Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment | Abstract
ISSN: 2155-9570

Journal of Clinical & Experimental Ophthalmology
Open Access

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Review Article

Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment

Rudrani Banik*
The New York Eye & Ear Infirmary, NY, USA
Corresponding Author : Rudrani Banik, M.D
Associate Adjunct Surgeon
The New York Eye & Ear Infirmary, 310 East 14th Street
Suite 319 South, New York 10003, USA
Tel: +1-212-979-4500
Fax: +1-212-979-4512
E-mail: [email protected]
Received March 01, 2013; Accepted March 21, 2013; Published March 28, 2013
Citation: Banik R (2013) Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment. J Clin Exp Ophthalmol S3:004. doi:10.4172/2155-9570.S3-004
Copyright: © 2013 Banik R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute ischemic optic neuropathy. The condition typically affects middle-aged and elderly individuals, though it may occur in younger age groups. Recent evidence suggests that its prevalence is higher than previously estimated. The clinical presentation of NAION is very classic and includes acute loss of visual afferent function (acuity, field and/or color) with the funduscopic appearance of an edematous optic nerve. The unaffected fellow eye usually has a small, crowded appearance described as a ‘disc at risk’. The pathophysiology of NAION is believed to be multi-factorial with the common pathway being circulatory insufficiency of the small caliber vessels supplying the optic nerve head. However, the exact location and mechanism of ischemia are still under debate. Prognosis of NAION is guarded; up to 50% of patients may have acuity of 20/200 or less with significant visual field loss, though approximately 40% will have improvement in their acuity. There are currently two animal models employed in investigating the histopathologic, molecular, and electrophysiologic changes seen in NAION. Treatment of the condition is quite controversial. Numerous medical and surgical interventions have been tried without clear evidence of benefit. The Ischemic Optic Neuropathy Decompression Trial demonstrated no benefit of optic nerve sheath fenestration in acute NAION. The role of oral corticosteroids is unclear, as is the use of aspirin in the prevention of the condition in the fellow eye. Several other promising agents are currently under investigation for the treatment of acute NAION.

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