New research published in Graefe's Archive for Clinical and Experimental Ophthalmology analyzed the real-world practices of neuro-ophthalmologists in the evaluation and management of typical cases of nonarteritic anterior ischemic optic neuropathy (NAION).
What is NAION?
NAION is the most prevalent acute optic neuropathy that affects middle-aged and older individuals. It occurs from a lack of sufficient blood flow to the optic nerve, which can lead to damage and vision loss.
Symptoms of NAION may include:
- Vision loss in one eye upon waking in the morning
- A dark area or shadow in the vision that affects the upper or lower half of a patient’s visual field (VF)
- Loss of contrast
- Light sensitivity
However: There is typically no warning before vision loss occurs.
Now, talk about the study.
Researchers conducted a national survey in Israel between 2019 and 2021 that involved all practicing neuro-ophthalmologists across the country (37 in total).
The survey was a structured questionnaire that assessed the neuro-ophthalmologists’ approach to risk factor evaluation and treatment of NAION. The survey included:
- 19 questions regarding risk factor
- Six questions regarding treatment and prevention of fellow-eye involvement
Findings?
Out of the 37 neuro-ophthalmologists in Israel, 36 participated in the survey.
With a considerable variation in the choice of diagnostic tests recommended, nearly 47% of the ophthalmologists recommended an embolism workup.
Most of these neuro-ophthalmologists referred patients for evaluation of the following risk factors:
- Obstructive sleep apnea (83.3%)
- Diabetes mellitus (83.3%)
- Hypertension (77.7%)
- Dyslipidemia (72.2%)
- Optic disc drusen (38.8%)
What were the findings regarding treatment?
It was found that:
- 91% did not recommend routine treatment for NAION
- However: In 16.7% of the physicians, high-dose corticosteroids were occasionally prescribed
Common recommendations included:
- Secondary prevention with aspirin (80.6%)
- Smoking cessation advice (86.1%)
- Advising against erectile dysfunction medications for men (80.6%)
Limitations?
The survey was limited to Israel, meaning the data may not have been representative of all practices.
Additionally, the survey lacked the structured iterative process necessary for achieving consensus among experts, and the closed multiple-choice question format may have limited the depth of data acquisition.
Lastly, the results could have been influenced by the participants’ experiences and beliefs—which potentially differed from evidence-based recommendations.
Expert opinion?
The investigators recommended that further research be done to establish a consensus guideline for post-NAION work-up and management recommendations.
They stated: ”Adopting a uniform approach to diagnostic testing may help reduce the risk of second-eye involvement and overall patient disability, all while maintaining cost-effectiveness.”
Take home.
These findings emphasize that there is a lack of uniformity on which tests should be ordered to evaluate risk factors associated with NAION.