This document discusses a new classification system for vascular optic neuropathies. It proposes several stages: prodromal, incipient, subacute, chronic (slowly progressive), acute, and post ischemic. For each stage it provides details on characteristics such as optic disc appearance and visual symptoms. It also notes that diabetes can cause several presentations of vascular optic nerve disease including acute, papillopathy, and chronic stages with or without neovascularization. The classification aims to improve early detection and management of vascular optic neuropathies.
INTRODUCTION
Optic nerve ischemia most frequently occurs at the optic nerve head, where structural crowding of nerve fibers and reduction of the vascular supply may combine to impair perfusion to a critical degree and produce optic disc edema. The most common such syndrome is termed anterior ischemic optic neuropathy(AION).
Generally, AION is categorized as either arteritic (associated with temporal arteritis) or nonarteritic .
1.BRIEF ANATOMY OF EYE
2.OPTIC NEUROPATHY
3. SIGNS OF OPTIC NEUROPATHY
4. CLASSIFICATION OF OPTIC NEUROPATHY
5. IN DETAIL ABOUT DIFFERENT OPTIC NEUROPATHY
6. MANAGEMENT OF OPTIC NEUROPATHY
INTRODUCTION
Optic nerve ischemia most frequently occurs at the optic nerve head, where structural crowding of nerve fibers and reduction of the vascular supply may combine to impair perfusion to a critical degree and produce optic disc edema. The most common such syndrome is termed anterior ischemic optic neuropathy(AION).
Generally, AION is categorized as either arteritic (associated with temporal arteritis) or nonarteritic .
1.BRIEF ANATOMY OF EYE
2.OPTIC NEUROPATHY
3. SIGNS OF OPTIC NEUROPATHY
4. CLASSIFICATION OF OPTIC NEUROPATHY
5. IN DETAIL ABOUT DIFFERENT OPTIC NEUROPATHY
6. MANAGEMENT OF OPTIC NEUROPATHY
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
Metabolic optic neuropathies
The three subcategories of metabolic optic neuropathies are
•Heredodegenerative (such as leber's hereditary optic neuropathy).
•Nutritional deficiencies (such as vitamins B12 or folic acid).
•Toxicities (such as ethambutol or cyanide).
The presentation was made under the wise guidance of my professor DR.(prof) P. Rawat (MGMMC & M.Y. HOSPITAL, INDORE).It covers the essential aspects of optic neuritis & optic atrophy.
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
Metabolic optic neuropathies
The three subcategories of metabolic optic neuropathies are
•Heredodegenerative (such as leber's hereditary optic neuropathy).
•Nutritional deficiencies (such as vitamins B12 or folic acid).
•Toxicities (such as ethambutol or cyanide).
The presentation was made under the wise guidance of my professor DR.(prof) P. Rawat (MGMMC & M.Y. HOSPITAL, INDORE).It covers the essential aspects of optic neuritis & optic atrophy.
This ppt describe about the incidence, diagnosis and management of maculopathy in caaes of pathological myopia.
Data collected and created by Vivek Chaudhary
For queries : vivek977optom@gmail.com
Altitudinal Visual Field Defect case study.
Altitudinal visual field defect (VFD), which involves the loss of visual sensation in the horizontal half of the visual field, is caused mainly by anterior ischemic optic neuropath
Glaucoma is always a chronic, long term disease.
Glaucoma is always associated with some damage to the optic nerve and often a related change in the visual field.
glaucoma and cataract.pdf, After the class the students will be able :
Explain the structures and function of eye.
Explain the age affect on vision.
Describe the definition , etiology, risk factors, pathophysiology, medical management, surgical management and Nursing management of Glaucoma.
Describe the definition , etiology, risk factors, pathophysiology, medical management, surgical management and Nursing management of cataract.
List down the health education for Glaucoma and cataract.
1. A New Look
Prof Dr Sherif Ahmed Kamel Amer
MD ophthalmology, Cairo University, ICO.Ophth.
Professor & Head of The Ophthalmology Department,
Faculty of Medicine, Beni Suef University.
Supervisor of The Neuro-Ophthalmology
Clinic, National Eye Center (Rod El Farag).
Consultant Neuro_Ophthalmologist, Magrabi Eye
Hospitals, Egypt
2. The classic syndrome consists of an acute
vascular insult to the optic nerve leading to
infarction of the optic nerve head.
The disease presents with a sudden and
painless deterioration of vision, usually
discovered on waking in the morning, and
involving mostly the lower part of the visual
field in one eye
3. 1.Anterior ischemic optic neuropathy (AION):
Affects anterior part of the optic nerve.
2.Posterior ischemic optic neuropathy
(commonly abbreviated to PION): This is a rare
type due to acute ischemia of posterior part of
the optic nerve.
4. Arteritic AION (A-AION): This is the most
serious type and is dueto giant cell arteritis
(GCA).
Non-arteritic AION (NA-AION): This is the
usual and the most common one, and consists
of all cases other than GCA
5. Predisposing Factors: systemic or local (in the
eye and/or optic nerve head).
Precipitating Factors: These act as the final
insult, resulting in ischemia of the ONH and
AION. A fall of BP during sleep (nocturnal
arterial hypotension) is an important factor in
this category
6. The disk at risk
(subclinical
ischemia) shows the
following signs:
Small scleral canal
Crowding of nerve
fibers (Obliterated
Cup).
Disc hyperemia
25%-40% of fellow eyes are
expected to develop NA-AION
7. Optic disc swelling without any visual loss;
this indicates an early sign of non-arteritic
AION.
Optic disc edema usually lasts for several
months unlike those seen initially with
visual loss.
8. It is an infrequent but important subtype of
NA-AION.
Further loss of vision may be experienced
days or weeks after the initial decrease in
vision.
In some, a new ischemic episode may be the
cause of the further visual loss.
Rarely, especially if the loss is intermittent
and gradual, a reversible loss may be seen
that can improve spontaneously.
9.
10.
11.
12. The number of cases with bilateral simultaneous
presentation with 20 cases having bilateral
simultaneous acute vascular optic neuropathy.
2
8
2
20
0 5 10 15 20 25
Diabetic
papillopathy
Chronic
Subacute
Acute
The Mode Of Presentation of Eyes With Bilateral Simultaneous
Vascular Optic Neuropathies
25. Vascular optic nerve diseases are a group of
diseases caused by deficient vascular supply of
the optic nerve on acute or chronic basis and
take different presentations and courses.
The term ischemic optic neuropathy with it
subdivision anterior or posterior or arteritic
and non-arteritic is very far beyond explaining
the correct classification of these group of
diseases.
26. Diabetic patients showed four types of
presentations:
(a) the typical acute presentation with pale swelling
and altitudinal field defects
(b) diabetic papillopathy with marked disc swelling
without pallor
(c) disc swelling with disc pallor without history of
the acute stage, and
(d) disc swelling with disc pallor without history of
the acute stage, and with neovascularization of the
disc (NVDs). Presentations other than the acute stage
were always bilateral while the acute presentation
was unilateral and bilateral.
27. Diabetic eyes show the following stages of
vascular optic nerve disease disease: (a) disc at
risk (b) incipient stage (c) diabetic papillopathy
(d) Acute vascular optic neuropathy (e) chronic
disease with or without NVDs (f) post ischemic
neuropathy.
Another special point for eyes associated with
diabetes is the higher incidence of bilateral
simultaneous ischemic acute optic neuropathy.
The severity of involvement of both eyes was
always variable.
28. A new look to the clinical classification is
mandatory in order to make an early
detection of subclinical cases for possible
prophylaxis of susceptible cases.
The current classification of vascular optic
neuropathies is seriously deficient and does
not describe different stages of the disease..
29. Prodromal Vscular Neuropathy :
Disc at risk
Fellow discs
Discs in patients with longstanding,
uncontrolled risk factor, or more
than one risk factor.
Incipient Vascular Neuropathy: Nerve
head with swelling without visual loss.
30. Subacute Vascular Neuropathy:
Optic disc swelling without pallor associated
with nerve fiber layer hemorrhages and
transient attacks of blurring of vision or
transient field defects.
31. Chronic (Slowly Progressive) Vascular
Neuropathy:
Dry chronic vascular optic neuropathy: slowly
progressive disc ischemia without disc edema not
passing through the acute stage.
Vascular neuropathy due to anemia
Wet chronic vascular optic neuropathy: slowly
progressive disc ischemia with disc edema with or
without pallor not passing through the acute stage
Diabetic vascular neuropathy; Papillopathy
32. Acute Vascular Neuropathy:
–Mild with BCVA of 66-612
–Moderated with BCVA of 618-636
–Acute profound with BCVA of 660 or less
–Acute recurrent.
33. Post Ischemic Optic Neuropathy
– On top of acute.
– On top chronic.