PROGNOSIS OF ARTERITIC AND NON-ARTERITIC AION

ARTERITIC AION:

I have found that patients, ophthalmologists and physicians all want to know whether there is any possibility that high-dose steroid therapy will reverse the visual loss due to arteritic AION, and also whether there is any chance of further visual loss while on corticosteroid therapy. I investigated both these issues and have discussed those elsewhere in detail.^56,57

1. Visual Improvement with high dose steroid therapy in giant cell arteritis: My study⁵⁷ showed that only 4% of eyes with visual loss due to arteritic AION improved, as judged by improvement in both visual acuity and central visual field. The data also suggested that there is a better chance of visual improvement with early diagnosis and immediate start of steroid therapy. There was no evidence that intravenous megadose steroid therapy was more effective than oral therapy in visual improvement.
2. Visual deterioration in giant cell arteritis patients while on high doses of steroid therapy: My study⁵⁶ showed that although 4% of the eyes did experience further visual deterioration within 5 days after the start of the high-dose steroid therapy, no deterioration happened after that time. It is clear from reports in the literature, as well as my experience, that if a patient is given inadequate steroid therapy or the therapy is tapered off prematurely, visual deterioration can develop anytime. This shows that early, adequate steroid therapy is effective in preventing further visual loss in 96% of the giant cell arteritis patients. There was no evidence that intravenous megadose steroid therapy was more effective than oral therapy in preventing visual deterioration.
   

NON-ARTERITIC AION:

In this type of AION, once the optic disc edema has resolved, which usually takes 2-3 months, the vision usually remains stable in that eye. My study⁵² showed that recurrence of non-arteritic AION in the same eye is uncommon (only 6%). This study indicated that nocturnal arterial hypotension may be a risk factor; however, since non-arteritic AION is a multifactorial disease, other so far unknown risk factors may also play a role.

In contrast to that, my studies⁴ showed that the risk of second eye involvement by non-arteritic AION is about 25% on a follow-up of about 3 years. In non-arteritic AION, the risk of developing AION in the second eye faster is significantly greater in (i) young (<45 years old) diabetics than older diabetics or persons with other systemic diseases, (ii) in men than in women, and (iii) in younger than older persons.

Since AION is a stroke of the optic nerve, many patients worry that they will also experience a stroke in the brain. Our experience has shown that the risk of a stroke in the brain does not seem to be any higher in non-arteritic AION patients than in other people unless they happened to have both arterial hypertension and diabetes mellitus.⁴⁴

I hope that this brief description of AION has provided a working knowledge of the condition, and its management. If patients with AION need further professional information, they should be urged to talk to their ophthalmologist, who is familiar with them and their condition.

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