Are Erectile Dysfunction Medications Causally Related to Nonarteritic Anterior Ischemic Optic Neuropathy?

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Title Are Erectile Dysfunction Medications Causally Related to Nonarteritic Anterior Ischemic Optic Neuropathy?
Creator Michael S. Lee, MD; Michael Vaphiades, DO
Affiliation Departments of Ophthalmology and Visual Neurosciences, Neurology, and Neurosurgery (MSL), University of Minnesota, Minneapolis, Minnesota; and Department of Ophthalmology (MV), University of Alabama at Birmingham, Birmingham, Alabama
Abstract To delineate the factors contributing to overdiagnosis of idiopathic intracranial hypertension (IIH) among patients seen in a neuro-ophthalmology service at a tertiary center.; ; We retrospectively reviewed new patients referred with a working diagnosis of IIH over 8 months. The Diagnosis Error Evaluation and Research taxonomy tool was applied to cases referred with a diagnosis of IIH and a discrepant final diagnosis.; ; Of 1,249 patients, 165 (13.2%) were referred either with a preexisting diagnosis of IIH or to rule out IIH. Of the 86 out of 165 patients (52.1%) with a preexisting diagnosis of IIH, 34 (39.5%) did not have IIH. The most common diagnostic error was inaccurate ophthalmoscopic examination in headache patients. Of 34 patients misdiagnosed as having IIH, 27 (27/34 [79.4%]; 27/86 [31.4%]) had at least 1 lumbar puncture, 29 (29/34 [85.3%]; 29/86 [33.7%]) had a brain magnetic resonance imaging, and 8 (8/34 [23.5%]; 8/86 [9.3%]) had a magnetic resonance/computed tomography venogram. Twenty-six had received medical treatment, 1 had lumbar drain, and 4 were referred for surgery. In 8 patients (8/34 [23.5%]; 8/86 [9.3%]), an alternative diagnosis requiring further evaluation was identified.; ; Diagnostic errors resulted in overdiagnosis of IIH in 39.5% of patients referred for presumed IIH, and prompted unnecessary tests, invasive procedures, and missed diagnoses. The most common errors were inaccurate ophthalmoscopic examination in headache patients and thinking biases, reinforcing the need for rapid access to specialists with experience in diagnosing optic nerve disorders. Indeed, the high prevalence of primary benign headaches and obesity in young women often leads to costly and invasive evaluations for presumed IIH.
Subject Erectile Dysfunction / drug therapy; Humans; Male; Optic Neuropathy, Ischemic / chemically induced; Phosphodiesterase 5 Inhibitors / adverse effects; Phosphodiesterase 5 Inhibitors / therapeutic use; Risk Factors
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Date 2016-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2016, Volume 36, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6mp8xqm
Setname ehsl_novel_jno
ID 1276502
Reference URL https://collections.lib.utah.edu/ark:/87278/s6mp8xqm
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