NON-ARTERITIC AION IN DIABETICS

This calls for special mention, because it is the source of tremendous confusion. Our study⁴⁴ and others have shown that the prevalence of diabetes in non-arteritic AION patients is significantly higher than in the general population. So diabetics are more likely to develop non-arteritic AION than non-diabetics. Non-arteritic AION in diabetics, particularly young diabetics, often shows some characteristic features.^30,36,39,54 These include the following:

1. In diabetics, during the initial stages, the optic disc edema is usually associated with prominent, dilated and frequently telangiectatic vessels over the disc, and there are many more peripapillary retinal hemorrhages than in non-diabetics (Figs. 7-A, 8-A) - these findings may easily be mistaken for proliferative diabetic retinopathy associated with optic disc neovascularization and wrongly treated with panretinal photocoagulation.⁵⁴ When the optic disc edema resolves, these prominent telangiectatic disc vessels and retinal hemorrhages resolve spontaneously (Figs. 7-B, 8-B); if the eye happens to be treated with panretinal photocoagulation because it is thought to have diabetic optic disc neovascularization, spontaneous resolution may incorrectly be attributed to the unnecessary treatment!
2. My studies showed that diabetics seem to have a higher prevalence of incipient NAION¹⁷ (see above) than non-diabetics. This is because diabetics have frequent ophthalmic evaluations, particularly when they have diabetic retinopathy, and the condition is discovered more often. Non-diabetics, by contrast, seek treatment only when they develop visual loss, so the incipient NAION phase is missed, except in a rare eye seen by chance during a routine eye examination. When non-arteritic AION in diabetics is detected during its incipient phase, it does not fit the expected pattern; the patient has no visual loss at that stage, and the disc edema is associated with the above vascular changes and seems to last much longer than in the usual non-arteritic AION, in whom the incipient AION phase is completely missed.
3. My studies have shown that the incidence of second eye involvement in diabetics is higher than in non-diabetics.⁴ They may even occasionally present with bilateral non-arteritic AION, which can further confuse the picture.

These features of non-arteritic AION in diabetics have resulted in an erroneous impression about the disease and have caused unnecessary confusion and controversy. It has been mistakenly called a distinct clinical entity, "diabetic papillopathy". I have discussed this controversy in detail elsewhere.^39,54 There is also a mistaken impression that "diabetic papillopathy" tends to run a benign course. This is not true of most of these patients whom I have studied. The course of their disease is similar to that of other non-arteritic AION patients.

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