Etiology of optic atrophy: a prospective observational study from Saudi Arabia

Abstract

BACKGROUNDOptic atrophy (OA) represents permanent retinal ganglion cell loss warranting study to establish etiology.OBJECTIVESTo describe neurogenic causes of OA.DESIGNProspective, observational.SETTINGTertiary care center, Riyadh, Saudi Arabia.PATIENTS AND METHODSWe included consecutive patients of all ages with OA caused by lesions affecting the visual pathways who were referred over a 9-month period (November 2013 to July 2014). Diagnosis was based on visual acuity, ophthalmoscopic features and ancillary tests. Patient demographics, results of a clinical examination, test data and etiology were recorded. For each cause of OA, both gender and age group were analyzed as potential risk factors using simple univariate logistic regression. OA associated with glaucoma and retinal diseases was excluded.MAIN OUTCOME MEASUREDescription of causes of OA.RESULTSTwo hundred and four patients and 353 eyes met inclusion criteria. The median age was 27 years (range 3 months-77 years; interquartile range, 27 years) among 111(54.4%) females and 93(45.6%) males, with no statistically significant difference in age of presentation between the genders. The majority of lesions were bilateral (n=151, 74%). Tumors were the most common cause, accounting for 127 (62.2%) cases. These occurred mostly in adults (72.4%) compared to the pediatric group (OR=3.3, 95% CI: 1.79–6.03; P<.001). Hereditary neoplasia (OR=5.55; 95% CI: 1.67–18.42; P=.005) and metabolic diseases (OR=17.57; 95% CI: 2.15–143.62; P=.007) were more common causes in the pediatric group. There were no significant associations between gender or visual acuity and etiology of OA. In developed nations, OA is frequently the result of ischemia and neuritis. We found many other causes, especially orbital and intracranial tumors.CONCLUSIONSThe frequency of tumors as the cause of OA may represent a higher incidence of aggressive tumors coupled with poor recognition/acknowledgement of symptoms and limited access, resulting in late presentations.LIMITATIONSThese findings may reflect bias from selective referrals to a tertiary center and may not represent all of Saudi Arabia.

Posterior segment eye diseases: prevalence, pattern, and attribution to visual impairment among adult saudi population

“…Most cases were found as a complication of the proliferative diabetic DR and wet forms of ARMD. In the current study, the commonest cause of OA was glaucoma which is different from Mbekeanis et al (2017) [21], who stated that tumors are the commonest causes of OA in 62.2% of their studied cases, while in the present study, history of tumors was found only in 16% of cases. The general prevalence of vitreous hemorrhage, OA and RD were not reported in the previous literature.…”

Posterior segment eye diseases: Prevalence, pattern, and attribution to visual impairment among adult Saudi population

“…However, we would like to correct a statement that was made in error. In their discussion, Elmorsy and Rehman stated that they found that glaucoma was the most common cause of optic atrophy and that this was contrary to our publication in Annals of Saudi Medicine (2017) [2], which found that optic neuropathy was most frequently secondary to tumors. As authors of the latter paper, we would like to state in the strongest of terms that these two studies were different in purpose, design, patient populations and locations studied and thus are not directly comparable.…”

“…Lastly, our study was conducted in a specialist referral center in Riyadh whilst the other study was of a free eye camp in the northeastern town of Arar. We concluded that the high frequency of tumors as the cause of optic atrophy likely represented a higher incidence of aggressive tumors coupled with poor recognition/acknowledgement of symptoms and limited access to appropriate centers, resulting in late presentations [2]. We noted that this was different from western populations, where ischemic and neuritis cases predominate as neurogenic causes of optic neuropathy.…”

“…We suggested that a wider-ranging, prospective study that included other regions and hospital center types might yield more representative information about all causes of optic atrophy and other causes of visual incapacity in the Saudi population. Additionally, intercurrent medical history, drug intake, social (ethnicity, socio-economy, smoking, life-style, diet) and province of habitation (different geographic and environmental exposures), regional traditions/cultural mores and history of consanguinity should be included [2]. Such a study might help produce a foundation for the development of public health measures to prevent unnecessary visual impairment and blindness in this population.…”

Study of etiologic factors for optic atrophy

“…Ascending OA develops in acute and chronic vascular impairments, optic nerve inflammation, and central and peripheral retinal degeneration. Identification of the etiology of OA is important in the clinical practice to select the pathogenetic treatment, since management strategy for patients with OA varies depending on the presence of brain neoplasms, demyelination process, intoxication or vascular ocular disorders [4][5][6][7][8].…”