Validity of Administrative Coding for Nonarteritic Ischemic Optic Neuropathy.

BACKGROUND: Administrative claims have been used to study the incidence and outcomes of nonarteritic ischemic optic neuropathy (NAION), but the validity of International Classification of Diseases (ICD)-10 codes for identifying NAION has not been examined. METHODS: We identified patients at 3 academic centers who received ≥1 ICD-10 code for NAION in 2018. We abstracted the final diagnosis from clinical documentation and recorded the number of visits with an NAION diagnosis code. We calculated positive predictive value (PPV) for the overall sample and stratified by subspecialty and the number of diagnosis codes. For patients with ophthalmology or neuro-ophthalmology visit data, we recorded presenting symptoms, examination findings, and laboratory data and calculated PPV relative to case definitions of NAION that incorporated sudden onset of symptoms, optic disc edema, afferent pupillary defect, and other characteristics. RESULTS: Among 161 patients, PPV for ≥1 ICD-10 code was 74.5% (95% CI: 67.2%-80.7%). PPV was similar when restricted to patients who had visited an ophthalmologist (75.8%, 95% CI: 68.4%-82.0%) but increased to 86.8% when restricted to those who had visited neuro-ophthalmologists (95% CI: 79.2%-91.9%). Of 113 patients with >1 ICD-10 code and complete examination data, 37 (32.7%) had documented sudden onset, optic disc swelling, and an afferent pupillary defect (95% CI: 24.7%-42.0%). Of the 76 patients who did not meet these criteria, 54 (71.0%) still received a final clinical diagnosis of NAION; for most (41/54, 75.9%), this discrepancy was due to lack of documented optic disc edema. CONCLUSIONS: The validity of ICD-10 codes for NAION in administrative claims data is high, particularly when combined with provider specialty.

Reexamining the Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy: A Rochester Epidemiology Project Study.

BACKGROUND: This study aims to determine the population-based incidence and characterize the features of nonarteritic anterior ischemic optic neuropathy (NAION) using the Rochester Epidemiology Project (REP). METHODS: All patients diagnosed with an optic neuropathy from January 1, 1990, to December 31, 2016, were retrospectively reviewed to identify incident cases of NAION using the REP database, which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota residents. The overall incidence of NAION was estimated using the age-specific and sex-specific population figures for Olmsted County census data for 1990 through 2016. Visual outcomes and risk factors were evaluated. The systemic risk factors were compared with age-matched controls. RESULTS: One hundred four patients were diagnosed with NAION during the 26-year study period. The overall age and sex adjusted incidence was 3.89 per 100,000 individuals (95% confidence interval [CI]: 3.14-4.65). The incidence was 7.73 (CI: 6.24-9.22) in patients aged 40 years or older and 10.19 (CI: 8.15-12.23) in patients aged 50 years or older. Median age at diagnosis was 65 years (range, 40-90 years), and 59 (56.7%) were male. The median logMAR visual acuity at presentation was 0.35 (Snellen equivalent of 20/40) with 14 patients (13.5%) having vision of counting fingers or worse. Among the 91 patients with final visual acuity outcome data available, the median visual acuity was 0.40 (Snellen equivalent of 20/50) with 12 patients (13.2%) having vision of counting fingers or worse. Twenty-four patients (26.4%) were noted to have final acuity at least 3 Snellen lines worse than at presentation, whereas 17 patients (18.7%) were noted to improve by at least 3 lines. The median mean deviation on automated visual field testing was -10.2 dB at presentation and -11.1 dB at follow-up. Twenty-two patients (21.2%) suffered NAION in the fellow eye; the median interval between involvement of the first and second eyes was 1.39 years. Systemic diseases present in the NAION cohort included hypertension (79.8%), diabetes mellitus (39.4%), obstructive sleep apnea (23.1%), and hyperlipidemia (74.0%), which were all statistically higher than age-matched controls. CONCLUSIONS: NAION is a relatively common optic neuropathy in elderly patients with vascular risk factors. Our data indicate that the incidence of NAION has remained relatively stable in the population of Olmsted County over the past 4 decades.

Features of Peripapillary Hyperreflective Ovoid Mass-Like Structures in Nonarteritic Anterior Ischemic Optic Neuropathy Patients and Normal Controls.

Purpose: To determine the characteristics of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and in normal adults. Methods: A total of 406 included eyes were divided into four groups: acute NAION group, chronic NAION group, unaffected group, and normal eyes group. PHOMS were detected on optical coherence tomography slices from optical coherence tomography angiography scans centered on the optic nerve head (ONH). The differences in age, sex, and ONH parameters were investigated between eyes with PHOMS and eyes without PHOMS among groups. Results: The prevalence of PHOMS in acute eyes (43.48%) and fellow eyes (28.20%) was significantly higher than that in normal eyes (11.76%) (acute vs. normal, P < 0.001; fellow vs. normal, P = 0.014). In the acute group, the PHOMS score of size was negatively correlated with age in acute eyes (r = -0.486, P = 0.03). The size of PHOMS was negatively correlated with age and cup/disc ratio and positively correlated with retinal nerve fiber layer thickness in the nasal and inferior sectors in the normal groups. No differences in age, sex, ONH parameters, or visual field defects were found between eyes with PHOMS and eyes without PHOMS. Conclusions: The prevalence of PHOMS increased significantly in acute nonoptic disc drusen (NODD)-NAION eyes and fellow eyes. PHOMS could also be found among normal adults. PHOMS may be a nonspecific sign secondary to ONH edema and axoplasmic stasis. Translational Relevance: The high prevalence of PHOMS in acute NODD-NAION eyes may indicate axoplasmic stasis secondary to tissue edema.

Nonarteritic Anterior Ischemic Optic Neuropathy and the Risk of Dementia: A Nationwide Cohort Study.

BACKGROUND AND OBJECTIVES: While emerging theories suggest that vascular dysfunction may occur concurrently with the amyloid cascade in Alzheimer disease (AD) pathogenesis, the role of vascular components as primary neurodegeneration triggers remains uncertain. The aim of this retrospective, population-based cohort study conducted in Korea was to explore the link between nonarteritic anterior ischemic optic neuropathy (NAION) and dementia risk. METHODS: In this nationwide, population-based, retrospective cohort study, we identified newly diagnosed NAION from 2010 to 2017 in the Korean National Health Insurance Service database. The primary outcome was new dementia diagnoses confirmed by new ICD-10 claims coupled with antidementia medication prescriptions. We assessed dementia risk using hazard ratios (HRs) with 95% CIs over an average 2.69-year follow-up after a 1-year lag period. RESULTS: The cohort consisted of 42,943 patients with NAION and 214,715 age-matched and sex-matched controls without NAION (mean age 61.37 years ± 10.75 SD, 55.48% female). The study found a higher risk of all-cause dementia (ACD; HR 1.28, 95% CI 1.20-1.36), AD (HR 1.27, 95% CI 1.18-1.36), vascular dementia (VaD; HR 1.31, 95% CI 1.09-1.58), and other dementia (HR 1.39, 95% CI 1.11-1.73) among patients with NAION, regardless of other potential confounding factors such as age, sex, lifestyle behaviors, economic status, and preexisting health conditions. In subgroup analysis, the associations between NAION and ACD were stronger in the younger age group (HR 1.83 for those younger than 65 years vs 1.23 for those 65 years or older; p for interaction <0.001). Moreover, the association of NAION with both ACD and VaD was particularly strong among current smokers. DISCUSSION: We found a significant association between NAION and increased risk for ACD, AD, VaD, and other dementia even after adjusting for potential confounders such as lifestyle, health conditions, and demographic factors within a nationwide cohort. This study highlights the potential role of vascular pathology in dementia progression and suggests that NAION may serve as a robust predictor for dementia, highlighting the need for comprehensive neurologic assessment in patients with NAION. Further research is needed to clarify the association between NAION and dementia risk.

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide.

Importance: Anecdotal experience raised the possibility that semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) with rapidly increasing use, is associated with nonarteritic anterior ischemic optic neuropathy (NAION). Objective: To investigate whether there is an association between semaglutide and risk of NAION. Design, Setting, and Participants: In a retrospective matched cohort study using data from a centralized data registry of patients evaluated by neuro-ophthalmologists at 1 academic institution from December 1, 2017, through November 30, 2023, a search for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code H47.01 (ischemic optic neuropathy) and text search yielded 16 827 patients with no history of NAION. Propensity matching was used to assess whether prescribed semaglutide was associated with NAION in patients with type 2 diabetes (T2D) or overweight/obesity, in each case accounting for covarying factors (sex, age, systemic hypertension, T2D, obstructive sleep apnea, obesity, hyperlipidemia, and coronary artery disease) and contraindications for use of semaglutide. The cumulative incidence of NAION was determined with the Kaplan-Meier method and a Cox proportional hazards regression model adjusted for potential confounding comorbidities. Data were analyzed from December 1, 2017, through November 30, 2023. Exposures: Prescriptions for semaglutide vs non-GLP-1 RA medications to manage either T2D or weight. Main Outcomes and Measures: Cumulative incidence and hazard ratio of NAION. Results: Among 16 827 patients, 710 had T2D (194 prescribed semaglutide; 516 prescribed non-GLP-1 RA antidiabetic medications; median [IQR] age, 59 [49-68] years; 369 [52%] female) and 979 were overweight or obese (361 prescribed semaglutide; 618 prescribed non-GLP-1 RA weight-loss medications; median [IQR] age, 47 [32-59] years; 708 [72%] female). In the population with T2D, 17 NAION events occurred in patients prescribed semaglutide vs 6 in the non-GLP-1 RA antidiabetes cohort. The cumulative incidence of NAION for the semaglutide and non-GLP-1 RA cohorts over 36 months was 8.9% (95% CI, 4.5%-13.1%) and 1.8% (95% CI, 0%-3.5%), respectively. A Cox proportional hazards regression model showed higher risk of NAION for patients receiving semaglutide (hazard ratio [HR], 4.28; 95% CI, 1.62-11.29); P < .001). In the population of patients who were overweight or obese, 20 NAION events occurred in the prescribed semaglutide cohort vs 3 in the non-GLP-1 RA cohort. The cumulative incidence of NAION for the semaglutide vs non-GLP-1 RA cohorts over 36 months was 6.7% (95% CI, 3.6%-9.7%) and 0.8% (95% CI, 0%-1.8%), respectively. A Cox proportional hazards regression model showed a higher risk of NAION for patients prescribed semaglutide (HR, 7.64; 95% CI, 2.21-26.36; P < .001). Conclusions and Relevance: This study's findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality.

Nonarteritic anterior ischemic optic neuropathy and incidence of Parkinson's disease based on a nationwide population based study.

This study aimed to investigate the association between nonarteritic anterior ischemic optic neuropathy (NAION) and Parkinson's disease (PD) using a retrospective, nationwide, population-based cohort in South Korea. This study utilized data from the Korean National Health Insurance database, including 43,960 NAION patients and 219,800 age- and sex-matched controls. Cox proportional hazards regression models were used to assess the risk of developing PD in the NAION group compared to the control group after adjusting for various confounding factors. Subgroup analyses were conducted based on sex, age, and comorbidities. The incidence rate of PD was higher in the NAION group (1.326 per 1000 person-years) than in the control group (0.859 per 1000 person-years). After adjusting for confounding factors, the risk of developing PD was significantly higher in the NAION group (adjusted hazard ratio [aHR] 1.516, 95% confidence interval [CI] 1.300-1.769). Subgroup analyses did not reveal a significant difference in the risk of PD development based on sex, age, or comorbidities. This retrospective, nationwide, population-based cohort study revealed a significant association between NAION and an increased risk of developing PD in a South Korean population. The incidence rate of PD was observed to be higher in individuals diagnosed with NAION than in age- and sex-matched controls even after adjusting for potential confounding variables, with the risk being approximately 51.6% higher in the NAION group. Further research is necessary to elucidate the underlying pathophysiological mechanisms linking NAION to PD and to determine whether similar associations exist in other ethnic and geographical populations.

Are Preexisting Retinal and Central Nervous System-Related Comorbidities Risk Factors for Complications Following Robotic-Assisted Laparoscopic Prostatectomy?

ABSTRACTPurpose:To assess whether retinal and central nervous system (CNS) comorbidities are risk factors for complications following robotic assisted laparoscopic prostatectomy (RALP).Materials and Methods:A retrospective review of our RALP database identified 1868 patients who underwent RALP by a single surgeon between December 10, 2003-March 14, 2014. We hypothesized that patients with preexisting retinal or CNS comorbidities were at a greater risk of suffering retinal and CNS complications following RALP. Perioperative complications and risk of recurrence were graded using the Clavien and D'Amico systems, respectively.Results:40 (2.1%) patients had retinal or CNS-related comorbidities, of which 15 had a history of retinal surgery and 24 had a history of cerebrovascular accident, aneurysm and/or neurosurgery. One additional patient had a history of both retinal and CNS events.Patients with retinal or CNS comorbidities were significantly older, had elevated PSA levels and CCI (Charlson Comorbidity Index) scores than the control group. Blood loss, length of stay, surgical duration, BMI, diagnostic Gleason score and T-stage were not statistically different between groups.No retinal or CNS complications occurred in either group. The distribution of patients between D'Amico risk categories was not statistically different between the groups. There was also no difference in the incidence of total complications between the groups.Conclusions:RALP-associated retinal and CNS complications are rare. While our RALP database is large, the cohort of patients with retinal or CNS-related comorbidities was relatively small. Our dataset suggests retinal and CNS pathology presents no greater risk of suffering from perioperative complications following RALP.

Neuropatía óptica isquémica anterior migrañosa / Migraineous anterior optic ischemic neuropathy

Caso clínico: Se presenta el caso de un pacientevarón de 22 años de edad que acudió refiriendovisión borrosa y cefalea de cuatro días de evolución.Fue diagnosticado inicialmente de neuritis ópticadesmielinizante ante el hallazgo en la resonanciamagnética de una lesión periventricular, y tratadocon metilprednisolona intravenosa.Discusión: Ante la ausencia de mejoría de la funciónvisual tras seis meses de evolución, es probableque el diagnóstico inicial fuera erróneo y que elpaciente sufriera un cuadro de neuropatía ópticaisquémica anterior migrañosa. Se revisa la escasaliteratura publicada en relación con este tema y elpapel de la migraña como factor de riesgo cardiovascular(AU)

Case report: We report the case of a 22-year-oldman who presented with headache and blurredvision which had started four days previous. A periventricularlesion was found in the magnetic resonanceimaging. The patient was diagnosed withdemyelinating neuritis and treated with intravenousmethylprednisolone.Discusion: After six months visual function had notimproved, so the initial diagnosis was probably erroneous.It is likely that the patient suffered frommigraineous optic ischemic neuropathy. In this paperwe review the scarce literature about this topic, andthe role of migraine as a cardiovascular risk factor(AU)

Pérdida visual post cirugía cardíaca incidencia y factores de riesgo: revisión de la literatura / Visual loss after cardiac surgery: incidence and risk-factor

La pérdida de visión post cirugía cardíaca es una complicación infrecuente, pero devastadora. La incidencia reportada es variable. Realizamos una búsqueda bibliográfica de la evidencia disponible para describir su incidencia y los potenciales factores de riesgo. Se identificó una incidencia muy variable, de 0.001 por ciento a 1.3 por ciento. La causa reportada más frecuente corresponde a la neuropatía óptica isquémica. El factor de riesgo personal más significativo fue la enfermedad vascular clínica severa. Dentro de los factores de riesgo intraoperatorios, el grado de anemia, la hipotensión y la duración de la circulación extracorpórea fueron los con mayor significancia en las distintas series. Aunque la incidencia de esta complicación es baja, dada su gravedad debiera ser considerada para advertir a los pacientes con mayor riesgo preoperatorio y tratar de minimizar los factores intraoperatorios.

Lost of vision after cardiac surgery is a rare but a devastating complication. The reported incidence is variable.In order to describe it’s incidence and potential risk factors, we directed a bibliographic search of available evidence. A very variable incidence was identified, ranging from 0.001 percent to 1.3 percent. The most frecuent cause published was ischemic optic neuropathy. The most meningfull personal risk factor was clinically severe vascular disease. Among intraoperatory risk factors, the ones with the most significance in different series were anemia, hypotension and duration of extracorporeal circulation. Although the incidence of this complication is low, given it’s seriousness, it should be informed to patients with the highest preoperative risk, and intraoperatory factors should be reduced to a minimum.

Neuropatía óptica isquémica tras la embolización arterial de una fístula arteriovenosa dural. Fenómeno del robo vascular / Ischemic optic neuropathy following a dural arteriovenous fistula. Vascular steal phenomenon

Caso clínico. Paciente de 46 años, con una fístula arteriovenosa dural del seno cavernoso izquierdo, alimentada por ramificaciones durales de los dos sifones carotídeos, por ramificaciones recurrentes de la región proximal de la arteria oftálmica izquierda (AOI) y por ramificaciones de la arteria carótida externa homolateral. Después de 24 horas desde la embolización arterial con partículas de polivinil alcohol, sufrió un déficit visual del ojo izquierdo. Todos los pedículos alimentadores de la fístula se embolizaron, excepto las ramificaciones de la AOI, que se hipertrofiaron tras la embolización de las restantes. A pesar de la normalidad de la angiografía fluoresceínica retiniana, la ecografía Doppler transocular mostró un flujo turbulento, invertido y de baja resistencia en la región distal de la AOI, y un flujo anterógrado de alta resistencia en la arteria central de la retina homolateral, lo cual justifica una neuropatía óptica isquémica. Conclusiones. La neuropatía óptica isquémica se produjo como consecuencia de un fenómeno de robo vascular. La hipertrofia de las ramificaciones de la región proximal de la AOI, tras la embolización de los restantes pedículos alimentadores de la fístula, contribuyó en una comunicación de baja resistencia entre la región proximal de la arteria oftálmica y el seno cavernoso izquierdo, y causó la inversión del flujo en el tramo distal de la mencionada arteria y la consecuente disminución de la irrigación sanguínea retrobulbar (AU)

Case report. We report the case of a 46-year-old patient, with a dural arteriovenous fistula in the left cavernous sinus fed by dural branches of both carotid siphons, by recurrent branches of the left ophthalmic artery (LOA) and by dural branches of the left external carotid artery. Twenty-four hours after arterial embolization with polyvinyl alcohol particles, the patient suffered visual loss in the left eye. All feeders were embolized except the recurrent branches of the LOA, which became hypertrophied. Fluorescein angiography of the retina was normal. Transocular Doppler ultrasound showed a turbulent, inverted, low resistance flow in the LOA distal part, and a high resistance anterograde flow in the left central artery of the retina, which accounted for an ischemic optic neuropathy. Conclusions. The ischemic optic neuropathy resulted from a vascular steal phenomenon. Hypertrophy of recurrent branches of the LOA, after embolization of the remaining feeders, contributed to a low resistance shunt between the LOA proximal part and the left cavernous sinus. This shunt caused the inversion of flow in the distal part of the artery and the subsequent decrease of retrobulbar blood supply (AU)

Optic nerve and retinal contributions to visual loss in epidemic optic neuropathy

The largest neurological epidemic this century has recently occurred in Cuba where 50,000 cases of epidemic optic and peripheral neuropathy have been reported. The disorder closely resembles Strachan's syndrome described in the Caribbean in the late 19th century and a similar epidemic disorder which I have studied in Tanzania. Electrophysiological studies have indicated both optic nerve and retinal involvement in cases from Tanzania. (Plant et al..., J Neurol Sci 145 1997 127-140). Subsequently 25 Cuban patients have been studied, all in the chronic phase of the disease all with a stable residual deficit. Electroretinography revealed normal rod function but an unusual abnormality of post-receptoral core function. Specifically the response to turning the light stimulus off was abnormal showing a lower amplitude than in control subjects. These results will be discussed in the context of other toxic and nutritional disorders affecting the retina and optic nerve in the tropics and elsewhere.(AU)