Etiologies of Optic Disc Edema in Patients with Significant Visual Compromise

Theme: Neuro-ophthalmology
What: Neuro-ophthalmology
Part of: Neuro-ophthalmology I / Neuro-ophtalmolgie I
When: 6/1/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 714 B

Abstract

Background: To evaluate the most common conditions causing optic disc edema (ODE) in patients with significant visual compromise (i.e., best-corrected visual acuity (BCVA) ≤ 20/400).

Methods: This was a retrospective review of consecutive patients presenting to tertiary neuro-ophthalmology clinics at the University of Toronto over a 5-year period. Inclusion criteria were (1) presence of ODE, (2) documented fundus imaging, and (3) BCVA of 20/400 or worse.

Results: In total, 656 patients with ODE were included in this study. 49 patients (7.5%) had an initial BCVA of ≤ 20/400. There were 54 eyes at baseline and 49 eyes at final follow-up. A total of 20 male and 29 female patients were included. The mean patient age was 55.9 years. Female patients were significantly older than male patients (p < 0.05). The two most common causes of ODE were non-arteritic anterior ischemic optic neuropathy (NAION) (n = 22; 40.7%) and optic neuritis (ON) (n = 22; 40.7%). Additional causes included arteritic anterior ischemic optic neuropathy (AAION) (n = 5; 9.26%), uveitis-related (n = 3; 5.56%), papilledema from idiopathic intracranial hypertension (IIH) (n = 1; 1.85%), and Vogt–Koyanagi–Harada disease (n = 1; 1.85%). No significant difference was observed in initial BCVA between ON and NAION groups (p = 0.52). Final BCVA was significantly better in the ON group (p < 0.0001). Initial BCVA was worst in the AAION group (2.62 ± 0.54 logMAR). When stratified by age, the most common cause of ODE in patients <40 was ON (83%). In patients >80, NAION (60%) and AAION (40%) were the most common etiologies. Moreover, between 60-80, NAION was the sole cause (100%).

Conclusions: Only a small proportion of patients with ODE and significant visual compromise are seen in neuro-ophthalmology (10%). The two most common causes were ON and NAION. Although a smaller proportion of patients were diagnosed with AAION, VKH, uveitis, and IIH, it is crucial to recognize these diagnoses as prompt treatment can preserve vision and be lifesaving.

 

Presenter(s)

Presenting Author: Bhadra Pandya

Additional Author(s):

Aaditeya Jhaveri, Temerty Faculty of Medicine, University of Toronto

Farooq Shamshad, University of Alberta Faculty of Medicine

Edward Margolin, Department of Ophthalmology and Vision Sciences, University of Toronto

Jonathan Micieli, Department of Ophthalmology and Vision Sciences, University of Toronto

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