Journal of Neuro-Ophthalmology, June 2013, Volume 33, Issue 2

Are We There Yet? Is Neuro-Ophthalmology at the Cuspof a Paradigm Shift? Lessons From Leber Hereditary Optic Neuropathy

To compare the incidence of cardiac and cerebrovascular events following non-arteritic anterior ischemic optic neuropathy (NAION) compared to published control data using the Framingham, United Kingdom Prospective Diabetes Study (UKPDS) and the National Vascular Disease Prevention Alliance (NVDPA) data. A retrospective study of all consecutive cases of NAION between 1990 and 2005. Patients were stratified into those with or without prior ischemic events and into diabetics and non-diabetics. Outcome measures included cardiovascular morbidity, cerebrovascular events and the Framingham, UKPDS and NVDPA scores for each patient. According to the NVDPA, the average absolute 5-year risk for cardiovascular disease (CVD) was 8.98, compared to 9 CVD events in our study. In the diabetic patients, 5 (17%) had a cardiac event and 2 (8%) had a cerebral vascular accident (CVA). Based on the UKPDS risk calculator, the average 10-year risk for cardiac events is 21.6%, CVA 26.8%. In the non-diabetics, there were 3 cases (7.5% ) of myocardial infarction, compared to the average 10-year Framingham risk for myocardial infarction or coronary death of 11% (8 SD). Following NAION, the incidence of cardiovascular or cerebrovascular events in patients taking aspirin is not in major excess from that expected in risk-factor agematched controls.