Ischemic optic neuropathy as the first manifestation of elevated cholesterol levels in young patients.
OBJECTIVE
To investigate the relationship between idiopathic nonarteritic ischemic optic neuropathy (NAION) and serum lipid levels in patients </= 50 years of age.


METHODS
Case-control study.


METHODS
Thirty-seven consecutive patients with NAION and 74 age- and gender-matched comparison patients.


METHODS
Serum lipid levels and the presence of several historical diseases and exposures were abstracted from the medical records in cases and controls.


RESULTS
The mean total cholesterol level was significantly increased in patients with NAION compared with controls (235.4 vs. 204.0 mg/dl, P < 0.001). The odds ratio of having high blood cholesterol (>/= 240 mg/dl) with NAION was 3.3 (95% confidence interval, 1.4-7.8), and the likelihood increased when the comparison was restricted to nondiabetic patients. Diabetes mellitus was more common in cases than controls (P = 0.027), but systemic hypertension was not significantly different (P = 0.63). No patient (0 of 24) had a magnetic resonance imaging study consistent with optic neuritis or central nervous system demyelination. Visual improvement was uncommon.


CONCLUSIONS
This study demonstrates that hypercholesterolemia is associated with NAION in younger patients. NAION may be the first manifestation of a lipid disorder, a previously unrecognized syndrome. These patients have experienced a focal, microvascular central nervous system ischemic event at a relatively young age. Aggressive treatment of lipid abnormalities in these patients may be warranted.
Neuro-Ophthalmology Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Vincent A
VA
Deramo
Robert C
RC
Sergott
James J
JJ
Augsburger
Rod
R
Foroozan
Peter J
PJ
Savino
Anthony
A
Leone
D000328:Adult; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000175:diagnosis*; D008297:Male; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies
D002784:Cholesterol