Anterior Ischemic Optic Neuropathy in End Stage Renal Disease

Ischemic optic neuropathy was described in patients with end stage renal disease (ESRD). They usually suffer from chronic anemia and fluctuating blood pressure. These patients are vulnerable to ischemic complications including ischemic optic neuropathy. The pathophysiology arises from interruption of the posterior ciliary artery blood supply to the prelaminar optic nerve due to atherosclerosis, and is exacerbated by episodic hypotension and severe anemia. Although this is a form of non-arteritic ischemic optic neuropathy (NAION), they lack the general features including the disc at risk appearance. They are often misdiagnosed as giant cell arteritis (GCA), or idiopathic intracranial hypertension (IIH). Ischemic optic neuropathy in ESRD is an important entity to recognize as it influences the management of these medically fragile patients.