Elsevier

Ophthalmology

Volume 110, Issue 5, May 2003, Pages 1041-1046
Ophthalmology

Regular article
Ischemic optic neuropathy as the first manifestation of elevated cholesterol levels in young patients

Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, November 2001.
https://doi.org/10.1016/S0161-6420(03)00079-4Get rights and content

Abstract

Purpose

To investigate the relationship between idiopathic nonarteritic ischemic optic neuropathy (NAION) and serum lipid levels in patients ≤ 50 years of age.

Design

Case-control study.

Participants

Thirty-seven consecutive patients with NAION and 74 age- and gender-matched comparison patients.

Methods and main outcome measures

Serum lipid levels and the presence of several historical diseases and exposures were abstracted from the medical records in cases and controls.

Results

The mean total cholesterol level was significantly increased in patients with NAION compared with controls (235.4 vs. 204.0 mg/dl, P < 0.001). The odds ratio of having high blood cholesterol (≥ 240 mg/dl) with NAION was 3.3 (95% confidence interval, 1.4–7.8), and the likelihood increased when the comparison was restricted to nondiabetic patients. Diabetes mellitus was more common in cases than controls (P = 0.027), but systemic hypertension was not significantly different (P = 0.63). No patient (0 of 24) had a magnetic resonance imaging study consistent with optic neuritis or central nervous system demyelination. Visual improvement was uncommon.

Conclusions

This study demonstrates that hypercholesterolemia is associated with NAION in younger patients. NAION may be the first manifestation of a lipid disorder, a previously unrecognized syndrome. These patients have experienced a focal, microvascular central nervous system ischemic event at a relatively young age. Aggressive treatment of lipid abnormalities in these patients may be warranted.

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)

  • S.S. Hayreh

    Anterior ischemic optic neuropathy. VIII. Clinical features and pathogenesis of post-hemorrhagic amaurosis

    Ophthalmology

    (1987)
  • O.M. Shapira et al.

    Anterior ischemic optic neuropathy after open heart operations

    Ann Thorac Surg

    (1996)
  • M.G. Hattenhauer et al.

    Incidence of nonarteritic anterior ischemic optic neuropathy

    Am J Ophthalmol

    (1997)
  • J.E. Rossouw

    Lipid-lowering interventions in angiographic trials

    Am J Cardiol

    (1995)
  • R.W. Beck et al.

    Aspirin therapy in nonarteritic anterior ischemic optic neuropathy

    Am J Ophthalmol

    (1997)
  • D.R. Boghen et al.

    Ischaemic optic neuropathy. The clinical profile and natural history

    Brain

    (1975)
  • D.R. Guyer et al.

    The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy

    Arch Ophthalmol

    (1985)
  • G. Giuffre

    Hematological risk factors for anterior ischemic optic neuropathy

    Neuroophthalmology

    (1990)
  • S.J. Talks et al.

    Fibrinogen, cholesterol and smoking as risk factors for non-arteritic anterior ischaemic optic neuropathy

    Eye

    (1995)
  • D.M. Jacobson et al.

    Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors

    Arch Ophthalmol

    (1997)
  • S. Doro et al.

    Cup-disc ratio and ischemic optic neuropathy

    Arch Ophthalmol

    (1985)
  • I.A. Chisholm

    Optic neuropathy of recurrent blood loss

    Br J Ophthalmol

    (1969)
  • Cited by (68)

    • Diseases of the retina and the optic nerve associated with obstructive sleep apnea

      2018, Sleep Medicine Reviews
      Citation Excerpt :

      Men are slightly more affected than women (58% vs 41%) [14]. Several risk factors, in particular cardiovascular, have been described: OSA (found in 70–90%) (odds ratio [OR] = 2.82; 95% Confidence Interval [CI]: 0.62–12.94 [15]; OR = 4.9; 95% CI: 4.2–5.7 [16]), AHT [17], diabetes [18], a history of ischemic stroke, coronary ischemia [11], and dyslipidemia, notably in patients under 50 y of age [19]. Other risk factors remain controversial such as nocturnal hypoperfusion of the ONH related to a nocturnal drop in BP [20], elevation of plasma homocysteine [21], smoking [11], treatment with 5′phosphodiesterase inhibitors (sildenafil, tadalafil), notably in patients presenting AHT or myocardial infarction [22], and cataract surgery [23].

    • Visual Loss: Optic Neuropathies

      2018, Liu, Volpe, and Galetta's Neuro-Ophthalmology: Diagnosis and Management
    • Comparison of Visual Outcomes of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients with and without Diabetes Mellitus

      2017, Ophthalmology
      Citation 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

    View all citing articles on Scopus

    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.

    *

    Dr. Deramo is currently affiliated with Long Island Vitreoretinal Consultants, Great Neck, New York.

    View full text