NAION

                                                               (Non-Arteritic Anterior Ischemic Optic Neuropathy)

• Older age (>50-60)

• Painless vision loss

• Normal visual acuity sometimes

• Normal MRI orbits if done (often not needed)

• Optic nerve swelling (lasts 6 weeks after symptom onset)

• Small optic nerve cup size (from birth) causes narrowing of blood vessels to the optic disc

• Often inferior (lower) visual field loss

• Obstructive sleep apnea (snoring with choaking while sleeping) is a risk factor

• Avoid erectile dysfunction medication: Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) to reduce risk to the unaffected eye later on

• 81-325 mg aspirin daily lowers the risk to the other eye

• Tight control of blood pressure (not too high, not too low), avoiding severe anemia, keeping cholesterol down, keeping weight down, no smoking, no cocaine, all lower the risk to the other eye

• Taking blood pressure medication in the morning rather than bedtime reduces the risk of nocturnal hypotension, a theoretical risk factor for NAION

• Avoid altitudes >6,000 feet (ex. airplanes) and scuba diving until the optic nerve swelling has resolved (>6 weeks after onset)

• Several case reports indicate perhaps a slight increased risk of NAION due to GLP-1 stimulators (Ozempic, Wegovy, Mounjaro, Zepbound, Trulicity, Victoza, etc.)

• Unfortunately two clinical trials I enrolled patients in failed to show benefit but research is ongoing and hopefully new treatments will become available soon

 

 

10/08/24