Andrew G. Lee, MD, and Drew Carey, MD, discuss findings from a retrospective study examining ischemic stroke risk in patients with non-arteritic anterior ischemic optic neuropathy and the implications for vascular risk factor management.
In this episode of
Lee is the chair of the Blanton Eye Institute at Houston Methodist Hospital and a professor of ophthalmology, neurology, and neurosurgery at the Weill Cornell Medical College. Carey is the Neil R. Miller Rising Professor of Ophthalmology in the division of neuro-ophthalmology with the
Drawing on data from an HMO database of 800,000 patients, the study identified 605 patients with NAION—reflecting the condition’s relative rarity at approximately 1 in 12,000—and found an increased risk of both large vessel and small vessel strokes in the NAION group compared with controls. No increased risk of cardioembolic stroke was observed, consistent with NAION’s characterization as a hypoperfusion rather than embolic event.
The takeaway: Although patients with NAION do not require acute stroke evaluation, ensuring their vascular risk factors are identified and optimized is an important component of their long-term care.
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Carey noted that the absolute risk increase was approximately 4% for large vessel strokes and 1.5% for small vessel strokes, and discussed how these findings have prompted him to reconsider whether carotid evaluations may be appropriate for NAION patients given the observed association with large vessel disease. He cautioned, however, that a finding of carotid stenosis in this context would not necessarily warrant surgical intervention, as NAION is not a carotid embolic event in the same way a central retinal artery occlusion is.
The discussion also addressed the role of aspirin, with Carey noting that blanket aspirin recommendations are not supported and that a holistic approach using tools such as the 10-year ASCVD calculator is more appropriate for guiding antiplatelet decisions in this population.
