Immunoprofiling of Nonarteritic Anterior Ischemic Optic Neuropathy

Mesentier-Louro, Louise A.; Stell, Laurel; Yan, Yan; Montague, Artis A.; Perez, Vinicio de Jesus; Liao, Yaping Joyce

doi:10.1167/tvst.10.8.17

Cited by 6 publications

(1 citation statement)

References 38 publications

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“…In preclinical studies, exposure to systemic hypoxia leads to endoplasmic reticulum stress, glial cell reactivity and loss, retinal thickness changes, and upregulation of inflammatory pathways (14,15). This is consistent with increased inflammatory biomarkers in the blood of patients with NAION (16). Because hypoxia worsens with increased altitude, arterial oxygen saturation and ocular perfusion pressure decrease, retinal venous pressure increases, and intraocular pressure remains stable (17).…”

Section: Discussionsupporting

confidence: 80%

High Altitude as a Risk Factor for the Development of Nonarteritic Anterior Ischemic Optic Neuropathy

Liu¹,

Mesentier-Louro²,

Shariati³

et al. 2022

Journal of Neuro-Ophthalmology

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Background:Episodic high-altitude exposure leads to optic disc edema and retinopathy. It is uncertain whether high-altitude exposure is a risk factor for nonarteritic anterior ischemic optic neuropathy (NAION).Methods:We performed a single-center, retrospective, cross-sectional case study of 5 patients with high-altitude–associated NAION (HA-NAION) from April 2014 to April 2019. Main study parameters included known vascular risk factors for NAION, evolution of visual acuity, visual field, optic disc, and macula measurements.Results:We studied 5 eyes of 5 patients with HA-NAION that occurred at 7,000–9,000 ft above sea level, 28 patients with classic NAION that developed at sea level (normal altitude NAION or NA-NAION), and 40 controls. All 5 patients with HA-NAION had clinically confirmed NAION by a neuro-ophthalmologist within 3–21 days of onset and comprehensive follow-up evaluations (average follow-up of 23 months). Other than high-altitude exposure, 4 of 5 patients had undiagnosed obstructive sleep apnea (OSA, apnea–hypopnea index 5.4–22.2) and 1 had systemic vascular risk factors. All patients had disc-at-risk in the contralateral eye. The best-corrected distance visual acuity was 20/20 to 20/70 (median logMAR 0) at presentation and 20/70 to counting finger (median logMAR 0) at ≥6 months. Automated static perimetry revealed average mean deviation of −18.6 dB at presentation and −22.1 dB at ≥6 months. The average retinal nerve fiber layer was 244 µm (80–348 µm) at onset and 59 µm (55–80 µm) at ≥6 months. The average ganglion cell complex thickness was 50 µm (43–54 µm) at onset and 52 µm (50–55 µm) at ≥6 months. The patients with OSA were started on home continuous positive airway pressure treatment. Visual outcomes were similar in patients with HA-NAION and NA-NAION. - After addressing all NAION risk factors, no new events occurred in the HA-NAION group within 2-8 years with or without repeat high-altitude exposure.Conclusions:NAION can occur under high-altitude conditions. HA-NAION is associated with relatively younger age at onset, disc-at-risk, and OSA. These patients exhibit a relatively progressive course of vision loss after initial onset and severe thinning of optic nerves on optical coherence tomography. Treatment for OSA is recommended, especially with repeated high-altitude exposure.

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Section: Discussionsupporting

confidence: 80%

High Altitude as a Risk Factor for the Development of Nonarteritic Anterior Ischemic Optic Neuropathy

Liu¹,

Mesentier-Louro²,

Shariati³

et al. 2022

Journal of Neuro-Ophthalmology

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Upregulation of retinal VEGF and connexin 43 in murine nonarteritic anterior ischemic optic neuropathy induced with 577 nm laser

Rangel

Mesentier-Louro

Lowe

et al. 2022

Experimental Eye Research

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Diagnostic significance of neutrophil-to-lymphocyte ratio in non-arteritic anterior ischemic optic neuropathy: a meta-analysis

Kashani,

Nourigheimasi,

Valisno

et al. 2024

Eur J Med Res

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Background We aimed to determine the association of neutrophil-to-lymphocyte ratio (NLR) with non-arteritic anterior ischemic optic neuropathy (NAION). Methods We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus and Web of Science were searched from the establishment of the database to May 5, 2022 to find the relevant studies. The quality of the included literature was evaluated with the Newcastle–Ottawa scale (NOS). The results are reflected in the form of standard mean difference (SMD) and 95% confidence interval (CI). Results Finally, six articles were included in our study. Compared with healthy controls, patients’ NLR levels were significantly higher (SMD = 0.47; CI 95% = 0.30–0.65, p<0.001). The included studies were not statistically heterogeneous (I 2 = 0.0%, p = 0.60); thus, the analysis used the fixed-effect model. The pooled sensitivity of NLR was 0.69 (95% CI 0.60–0.67), and the pooled specificity was 0.59 (95% CI 0.50–0.67). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NLR were 1.71(95%CI 1.48–1.98), 0.50 (95%CI 0.41–0.62), and 3.38 (95%CI 2.57–4.44), respectively. Conclusions Our findings suggest NLR to be a potential marker of NAION, while also implicating a role for inflammation in underlying pathophysiology.

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Immunoprofiling of Nonarteritic Anterior Ischemic Optic Neuropathy

Cited by 6 publications

References 38 publications

High Altitude as a Risk Factor for the Development of Nonarteritic Anterior Ischemic Optic Neuropathy

High Altitude as a Risk Factor for the Development of Nonarteritic Anterior Ischemic Optic Neuropathy

Upregulation of retinal VEGF and connexin 43 in murine nonarteritic anterior ischemic optic neuropathy induced with 577 nm laser

Diagnostic significance of neutrophil-to-lymphocyte ratio in non-arteritic anterior ischemic optic neuropathy: a meta-analysis

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