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The enigma of nonarteritic anterior ischemic optic neuropathy

an update for the comprehensive ophthalmologist

Gaier, Eric D.; Torun, Nurhan

Current Opinion in Ophthalmology: November 2016 - Volume 27 - Issue 6 - p 498–504
doi: 10.1097/ICU.0000000000000318
NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari

Purpose of review Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury, and frequently presents to comprehensive ophthalmologists. We review the typical and atypical clinical features and current literature on various treatment modalities for NAION.

Recent findings The epidemiology and clinical presentation of this disease can be variable, making a definitive diagnosis difficult in many cases. In addition, the differential diagnoses for this disorder, although comprising much less prevalent entities, are quite broad and can have substantial systemic implications if these alternatives go unrecognized. NAION has many systemic associations and comorbidities that deserve inquiry when the diagnosis is made. There are currently no widely accepted, evidence-based treatments for NAION. All recommendations made to patients to reduce their risk of sequential eye involvement, including avoidance of potential nocturnal hypotension, erectile dysfunction medication, and treatment of obstructive sleep apnea, have theoretical bases.

Summary NAION is a common cause of acute vision loss in adult and older patients, and thus, comprehensive ophthalmologists need to be able to diagnose and appropriately manage this disorder. We anticipate fruitful results from current and future trials aimed at neuroprotection in the affected eye and prevention of sequential eye involvement.

aDepartment of Ophthalmology, Massachusetts Eye and Ear Infirmary

bHarvard Medical School

cDivision of Ophthalmology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Correspondence to Eric D. Gaier, MD, PhD; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 0211, USA. Tel: +1 617 523 7900; e-mail:

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