Original article
Anterior Ischemic Optic Neuropathy in Patients Younger than 50 Years

https://doi.org/10.1016/j.ajo.2007.07.031Get rights and content

Purpose

To characterize anterior ischemic optic neuropathy (AION) in patients younger than 50 years.

Design

Retrospective study.

Methods

Records of all AION patients seen between 1989 and 2006 were reviewed. Patients younger than 50 years when initial visual loss occurred were included.

Results

Of 727 consecutive patients with AION, 169 (23%) were younger than 50 years (median, 43 years; range, 13 to 49 years; 58% men; 93% White). Involvement was unilateral in 59% of patients and bilateral in 41%. At least one cardiovascular risk factor was found in 74% of patients. Hypercoagulable states and vasculitis were found in 8%. An underlying small or anomalous optic disk was found in 92% of eyes (210/230). Isolated disk anomalies (without systemic risk factors) were present in 26% of eyes. Final visual acuities were 20/40 or better in 64% of eyes and 20/200 or worse in 22%. Among patients with bilateral involvement, final visual acuity was similar in the two eyes in 70% of patients. Anemia and type I diabetes were associated significantly with fellow eye involvement. Recurrent AION in the same eye occurred in 6% of patients.

Conclusions

AION in younger patients is not uncommon and represents 23% of AION patients in a tertiary neuro-ophthalmic service. Except for giant cell arteritis, ocular and systemic risk factors and associated disorders are similar to those described in older AION patients. Younger AION patients have better visual acuity outcomes but a higher risk of fellow eye involvement than older AION patients.

Section snippets

Methods

Medical records of all patients with AION seen in the Neuro-Ophthalmology Unit at Emory University between 1989 and 2006 were reviewed. Diagnosis of AION was made by two experienced neuro-ophthalmologists (N.J.N. and V.B.) according to the following criteria: 1) a history of sudden or rapidly progressive visual loss secondary to an optic neuropathy; 2) documentation of optic disk edema at the time of visual loss; 3) no evidence of another neurologic or ocular disorder that may be responsible

Demographics

Among the 727 consecutive patients with AION seen in our unit between 1989 and 2006, 169 patients (23%) were younger than 50 years and were included in our study (Table 1). Ninety-nine patients (59%) had unilateral involvement and 70 patients (41%) had bilateral involvement; therefore, analyses were conducted on 239 eyes. There were 98 men (58%) and 71 women (42%), aged 13 to 49 years (median, 43 years; Figure 1). Women had their first onset of AION at a significantly younger age than men

Discussion

AION is the most frequent acute optic neuropathy in patients older than 50 years. Although AION is less common in younger patients, it is by no means rare. Several large series have reported that 10.5% to 12.5% of AION patients are younger than 45 years (Table 1).11, 17, 18, 20 Our study confirmed that AION in the young is not uncommon and represents 23% of AION patients younger than 50 years and 15% of AION patients younger than 45 years in a tertiary neuro-ophthalmic service. Ninety-three

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