Regular articleIschemic optic neuropathy as the first manifestation of elevated cholesterol levels in young patients☆
Section snippets
Nature of study
The authors performed (1) a retrospective descriptive analysis of a series of consecutive patients with NAION diagnosed at age ≤ 50 years and (2) a case-control study comparing serum lipid levels and several historical diseases and exposures in these NAION patients and in age- and gender-matched comparison patients.
NAION group
All patients with a clinical diagnosis of NAION were identified by a search of the computerized patient database of the Neuro-Ophthalmology Service of Wills Eye Hospital for the
Clinical profile
Sixty-one patients aged 50 years or younger were identified in our database. Eighteen patients had a specific cause for their optic neuropathy, and six lacked a lipid profile in the medical record. Thirty-seven satisfactory cases (51 eyes) and 74 age- and gender-matched control subjects were identified.
Reflecting the age and gender matching of cases and controls, the patients in the two groups had nearly equivalent mean ages (43.2 years in the NAION group, 43.0 years in the control group) and
Discussion
This study demonstrates statistically significant elevations of total cholesterol, LDL, and triglycerides in patients ≤ 50 years of age with NAION compared with a control population. It also corroborates earlier reports associating diabetes mellitus with NAION in these younger patients. The impact of hypercholesterolemia on coronary heart disease (CHD), the leading cause of death in the United States, is well known, and the incidence of CHD increases considerably with total cholesterol levels
References (45)
- et al.
Clinical profile and long-term implications of anterior ischemic optic neuropathy
Am J Ophthalmol
(1983) - et al.
Anterior ischemic optic neuropathy. VII. Incidence of bilaterality and various influencing factors
Ophthalmology
(1987) - et al.
Hyperopia as a risk factor for nonarteritic anterior ischemic optic neuropathy
Am J Ophthalmol
(1993) - et al.
Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy
Am J Ophthalmol
(1994) - et al.
Nonarteritic ischemic optic neuropathy. The impact of tobacco use
Ophthalmology
(1994) - et al.
Analysis of prothrombotic and vascular risk factors in patients with nonarteritic anterior ischemic optic neuropathy
Ophthalmology
(1999) Ischemic optic neuropathy as a possible early complication of vascular hypertension
Am J Ophthalmol
(1979)- et al.
Optic disc structure in anterior ischemic optic neuropathy
Ophthalmology
(1984) - et al.
Anterior ischemic optic neuropathy. IX. Cup-to-disc ratio and its role in pathogenesis
Ophthalmology
(1987) - et al.
Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders
Am J Ophthalmol
(1994)
Anterior ischemic optic neuropathy. VIII. Clinical features and pathogenesis of post-hemorrhagic amaurosis
Ophthalmology
Anterior ischemic optic neuropathy after open heart operations
Ann Thorac Surg
Incidence of nonarteritic anterior ischemic optic neuropathy
Am J Ophthalmol
Lipid-lowering interventions in angiographic trials
Am J Cardiol
Aspirin therapy in nonarteritic anterior ischemic optic neuropathy
Am J Ophthalmol
Ischaemic optic neuropathy. The clinical profile and natural history
Brain
The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy
Arch Ophthalmol
Hematological risk factors for anterior ischemic optic neuropathy
Neuroophthalmology
Fibrinogen, cholesterol and smoking as risk factors for non-arteritic anterior ischaemic optic neuropathy
Eye
Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors
Arch Ophthalmol
Cup-disc ratio and ischemic optic neuropathy
Arch Ophthalmol
Optic neuropathy of recurrent blood loss
Br J Ophthalmol
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2017, OphthalmologyCitation Excerpt :The major risk factor for NAION is thought to be the small, crowded disc at risk,4 with some data suggesting that 1 in 265 crowded discs may be affected by the disease.11 Several studies have reported an association between NAION incidence and systemic vascular disease and its risk factors, such as hypertension,12,13 hyperlipidemia,14 diabetes,3,6,9 and tobacco use.15 Although hypertension and hyperlipidemia may be significant risk factors in younger patients (aged <65 years) only,16 an increased incidence of NAION in diabetic patients aged 65 years and more also was demonstrated through analysis of a Medicare database.5
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Manuscript no. 210532.
Supported by the Heed Ophthalmic Foundation, Cleveland, Ohio (VAD, RF); the AOS-Knapp Fellowship, Cleveland, Ohio (VAD); the Ronald G. Michels Fellowship Foundation, Ridgewood, Maryland (VAD); and a grant for optic nerve research from Kenzo Isono, chairman of the Medi-Ya Corporation, Tokyo, Japan.
The authors have no proprietary interest related to this study.
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Dr. Deramo is currently affiliated with Long Island Vitreoretinal Consultants, Great Neck, New York.