Risk Factors for Non-arteritic Anterior Ischemic Optic Neuropathy: A Large Scale Meta-Analysis

Abstract

Objective: We conducted a meta-analysis to explore all the potential risk factors for non-arteritic anterior ischemic optic neuropathy (NAION) based on the published literature.Methods: A comprehensive literature search through the online databases was performed to obtain studies concerning the risk factors of NAION up to June 2020. Pooled unadjusted odds ratios (ORs) or rate ratios (RRs) were calculated to evaluate the weight of risk factors. This study was registered in PROSPERO under the number CRD42018084960.Results: Our meta-analysis included 49 original studies comprising of more than 10 million patients. The following risk factors were proved to be significantly associated with NAION: male gender (OR = 1.67, 95% CI: 1.50–1.85, P < 0.00001), hypertension (RR = 1.28, 95% CI: 1.20–1.37, P < 0.00001), hyperlipidemia (RR = 1.43, 95% CI: 1.26–1.62, P < 0.00001), diabetes mellitus (DM) (RR = 1.53, 95% CI: 1.36–1.73, P < 0.00001), coronary heart disease (CHD) (RR = 1.68, 95% CI: 1.24–2.27, P = 0.0008), sleep apnea (RR = 3.28, 95% CI: 2.08–5.17, P < 0.00001), factor V Leiden heterozygous (RR = 2.21, 95% CI: 1.19–4.09, P = 0.01), and medication history of cardiovascular drugs.Conclusion: We concluded that the above risk factors were significantly related to NAION. Better understanding of these risk factors in NAION can help the direct therapeutic approaches.

Non-Arteritic Anterior Ischemic Optic Neuropathy Associated With the Use of Phosphodiesterase Type 5 Inhibitors: A Literature Review

“…In African Americans, it is less prevalent and is most common in Caucasians probably since African Americans are more likely to have a large physiologic cup and less likely to have a crowded disc, which is the leading predisposing factor for creating NAION [ 25 ]. NAION is a progressive disease in nature, and the rate of contralateral eye involvement is 15-20% in the following five years [ 26 , 27 ].…”

“…Hypertension, DM, hyperlipidemia, stroke, and prothrombotic disorders were all reported as NAION-related cardiac and cerebrovascular diseases. Hyperhomocysteinemia, nocturnal hypotension, and other conditions [ 24 , 26 ]. Several other systemic and ocular factors have also been studied in previously published articles, including smoking, obstructive sleep apnea, PDE5 inhibitors, depression, anemia, chronic obstructive pulmonary disease, hypothyroidism, small optic disc, age-related macular degeneration, and glaucoma [ 26 ].…”

Diabetes Mellitus Associated Progressive Neurovascular Retinal Injury: Recommendations for Imaging and Functional Testing and Potential Role for Early Intervention with Modern Retinal Laser Therapy

“…NO is the primary vasodilator that provides for the normal small arteriolar autoregulatory capabilities discussed above. Furthermore, capillary hypertension, caused by the elevated flow levels in the remaining patent vessels, is recognized to stimulate the endothelial cell production of intercellular adhesion molecules (ICAMS) that slow and obstruct the normal passage of WBC's through those capillaries [57] with subsequent breakdown and endothelial injury [58,59]. Studies of retinal vessel oxygen saturations indicate a reduction in oxygen delivery, confirming such focal occlusions with increased flows that occur within the surrounding microvasculature units early within diabetics [60].…”

“…This will then empower initiation of treatments before the death and severe, diffuse atrophy that is the current threshold. Improvements in the OCTangio device scanning times have improved the evaluation of flow characteristics, and with improved sectoral microvascular lumen reconstruction will enable identification of the early focal abnormalities (perhaps along with analysis of retinal capillary white blood cell flow densities utilizing the non-invasive blue field, entoptic phenomenon [57,125]). Whether these preclude or are associated with the focal neuronal apoptosis is for evaluation in the future as new methods now allow the functional testing to be overlaid onto the neuronal and microvascular occlusion lesion imaging.…”

Vision-Related Quality of Life and Association Between Retinal Parameters in Patients with Non-Arteritic Anterior Ischemic Optic Neuropathy

“…1 , 2 The insufficient blood supply to the optic nerve head leads to acute edema, ischemia and other pathophysiology of the optic nerve head. 3 Clinically, in the acute phase, it is mostly manifested as painless loss of vision occurring over hours to days or optic disc edema, and visual field defects, which have a serious impact on the life and work of the patient. 4 …”