Treatment strategy for non-arteritic anterior ischemic optic neuropathy

Tzu-Lun Huang^{a, b}, Kung-Hung Lin^c, Rong-Kung Tsai^{a, b}

^a Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
^c Department of Neurology, Taiwan Adventist Hospital, Taipei, Taiwan

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Abstract
Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of sudden optic nerve (ON)-related visual loss in persons over the age of 55. The pathogenesis is still unclear and no effective treatment has been established. The possible pathway is a vicious cycle of ischemia causing consequential compartment syndrome at the optic nerve head, resulting in further ischemia and optic nerve fiber infarction. Many medical and surgical interventions aim to shorten the duration of disk edema. The Ischemic Optic Neuropathy Decompression Trial (INODT) was the only level I evidence of treatment trial but it ended in failure. The use of steroids for acute NAION is still controversial. Several clinical case-serial reports showed some benefits. A recently developed animal model of anterior ischemic optic neuropathy may provide valuable preclinical data for both drug testing and treatment strategies.

Keywords
Anti-vascular endothelial growth factor; Corticosteroid; Neuroprotection; Non-arteritic anterior ischemic optic neuropathy