Assessment of functional and morphometric endpoints in patients with non-arteritic anterior ischemic optic neuropathy (NAION).
BACKGROUND
The primary objective of this bi-center explorative pilot study was the quantitative assessment of visual field defects and retinal nerve fiber layer thickness (RNFT) over 6 months in patients with acute non-arteritic anterior ischemic optic neuropathy (NAION), in order to elucidate the natural course of NAION and provide a reference dataset for future treatment studies.


METHODS
16 patients (age 41-80 years, nine males, seven females) suffering from acute NAION and presenting within 7 days after onset of symptoms were included in this study. The following examinations were carried out at the initial visit (month 0) and at months 2, 4 and 6: entire (90°) visual field examination with automated static white-on-white perimetry, quantified by mean defect (MD); peripapillary retinal nerve fiber layer thickness (RNFT) measurement with spectral domain optical coherence tomography (SD-OCT); assessment of distant best correct visual acuity (D-BCVA) and a quantification of the relative afferent pupillary defect (RAPD) using the swinging flashlight test with neutral density filters. Perimetric Mean Defect (MD) and RNFT values were each compared between the consecutive visits using the non-parametric Friedman test.


RESULTS
The initial MD was 6.2 dB (IQR 5.0-7.4) without significant changes further on. RNFT was 183 μm (IQR 148-252) initially, decreased significantly at month 2 (78 μm (IQR 71-93) and further at month 4 (64 μm (IQR 58-74) and 6 (61 μm (IQR 52-81), Friedman test, p < 0.001). Initially, RNFT was above normal limits (due to swelling) in 15/16 patients; at month 2 it was below normal limits in 13/16 patients, at month 4 in 12/13 patients and at month 6 in 9/10 patients. 7/16 patients exhibited segmental swelling of the optic disc, whereas the entire circumference of the optic disc showed RNFL thickening in 9/16 patients.


CONCLUSIONS
Functional deficits were present directly after onset of NAION and did not change relevantly further on. Morphological changes comprise severe swelling after onset of NAION, which rapidly turns into atrophy. Already after 2 months more than 80 % of the patients showed a RNFT below normal limits. Progressive RNFL thinning between month 2 and month 4 suggests ongoing atrophy, whereas a stable morphologic end point is reached after month 4.
Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany.
Christoph
C
Kernstock
Flemming
F
Beisse
Sarah
S
Wiethoff
Andrea
A
Mast
Elke
E
Krapp
Regine
R
Grund
Janko
J
Dietzsch
Wolf
W
Lagrèze
Dominik
D
Fischer
Ulrich
U
Schiefer
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001167:Arteritis / Q000503:physiopathology*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D018917:Optic Neuropathy, Ischemic / Q000503:physiopathology*; D010865:Pilot Projects; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*