Anterior ischemic optic neuropathy (AION) is infarction (tissue death due to low blood supply) of the optic disc (raised disc on the retina where the optic nerve connects). There are two types of optic nerve infarction:
- Nonarteritic AION: This type, accounting for 90-95 percent of AION cases, occurs more frequently in males of age 50 or older and it is frequently associated with systemic hypertension, diabetes mellitus, hyperlipidemia, sleep apnea and nocturnal hypotension.
- Arteritic AION: Caused by temporal arteritis (inflammation of blood vessels in and around the scalp), this type is less common, typically causes more severe vision loss, and usually occurs in people age 70 or older.
The vision loss associated with most cases of ischemic optic neuropathy is unilateral, meaning that you experience vision loss in only one eye. In most cases, you will notice this painless, sudden vision loss when you first wake up for the day
If due to temporal arteritis, signs and symptoms of AION may include:
- Difficultly moving your jaw
- Headache
- Muscle ache
- Neck pain
- Night sweats
- Poor appetite
- Tenderness of scalp
Uncontrolled, life-threatening hypertension (high blood pressure) can cause optic nerve swelling, which results in symptoms similar to AION. This is why it is important that you are properly diagnosed and treated by a specialist who is experienced in neuro-ophthalmology conditions.
Tests
Comprehensive Exam - Your doctor will conduct a thorough physical examination of your eyes – as well as gather a complete health history – to help determine if you have ischemic optic neuropathy.
Blood Test - If your doctor thinks you may have arteritic AION, you will need to undergo blood tests -- including sedimentation rate and c-reactive protein -- to determine the presence of inflammation.
Biopsy - If your doctor thinks you may have arteritic AION, they may order a biopsy of a small piece of artery under your skin near your temple.
Imaging - Your doctor may order magnetic resonance imaging (MRI) to make sure you don’t have compressive lesions that could be causing your vision loss.
Blood Pressure Monitoring - Your doctor may recommend careful blood pressure monitoring to make sure the blood pressure is stable.
Sleep Apnea Testing - Your doctor may recommend sleep apnea evaluation if there are sleep apnea symptoms.
Visual field - Your doctor may order a visual field test, which assesses both central and peripheral vision.
Treatments
Medication - If you have nonarteritis AION, your doctor may prescribe a corticosteroid. If you have arteritic AION, your doctor will likely order treatment of intravenous (by vein) or oral (by mouth) corticosteroid. Treatment often lasts months.
Visual Aids - There are a variety of low-vision aids available – such as magnifiers, large-print devices, and talking watches – that can help make your life easier.
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