What's next for nonarteritic anterior ischemic optic neuropathy?

Portland, OR-No definitive medical or surgical treatments for nonarteritic anterior ischemic optic neuropathy (NAION) have emerged following years of research. Although research continues on multiple fronts, such as mechanisms of neurodegeneration and the potential for neuroprotection strategies, clinicians may instead want to focus on risk factors, said Julie Falardeau, MD.

Researchers continue their studies on the best approach to treating NAION. Recently, the use of vascular endothelial growth factor inhibitors was the subject of several studies, and is likely to remain a key target in future ones.

Systemic corticosteroid therapy, however, remains a controversial topic in the neuro-ophthalmology community despite positive findings in a recent large, prospective study, said Dr. Falardeau, assistant professor, neuro-ophthalmology, Casey Eye Institute, Oregon Health & Science University and Devers Eye Institute, Portland, OR.

CPAP use in NAION patients

Obstructive sleep apnea is a significant risk factor for NAION, and because it has many associated comorbidities, should be discussed with patients who have NAION, Dr. Falardeau said.

The Sleep Apnea Scale of the Sleep Disorders Questionnaire is an effective screening tool, and a referral for a sleep study is recommended when apnea is suspected. Individuals who test positive generally benefit from treatment with a continuous positive airway pressure (CPAP) device.

"Keep in mind that there [are] no strong data supporting the hypothesis that treatment with CPAP might be protective against developing NAION in the other eye," Dr. Falardeau said. "We need larger studies to evaluate the benefit of CPAP in preventing NAION in patients with sleep apnea. However, untreated sleep apnea can cause hypertension, cardiovascular disease, chronic headaches, and memory issues, so it's not a benign condition, and patients truly benefit from treatment."