Analysis of gender-related differences in clinical characteristics of patients with non arteritic anterior ischemic optic neuropathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Yue ,  Wang Ying , Jiao Wenxin , Lin Jilu , Wang Jianing

Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China;

Corresponding author：

Wang Ying, Email: wangyingtcm@163.com

Keywords：

Non-arteritic anterior ischemic optic neuropathy; Gender; Risk factors; Visual function; Visual field

DOI：

10.3760/cma.j.cn511434-20250303-00082

Video：

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Objective To observe the clinical characteristics of non arteritic anterior ischemic optic neuropathy (NAION) in patients of different genders. Methods A retrospective clinical analysis. A total of 183 cases (246 eyes) of NAION with complete diagnosis and treatment confirmed by Departments of Neuro-ophthalmology/Acupuncture and Moxibustion of Eye Hospital, China Academy of Chinese Medical Sciences from June 2018 to December 2023 were included. Among them, 101 cases (138 eyes) were male and 82 cases (108 eyes) were female. Their age was (59.2±9.8) years. The number of right and left eyes were 120 and 126, respectively. The patient's gender, age, disease course, history of hypertension, history of diabetes, history of hyperlipidemia, history of smoking and drinking, best corrected visual acuity (BCVA), intraocular pressure, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness were recorded in detail. Visual field defects were classified into diffuse defects, ring scotoma, fan-shaped or wedge-shaped defects, upper and lower half defects, arcuate scotoma, and quadrantanopia. Logistic regression analysis was utilized to determine whether gender was an independent factor affecting the degree of visual field impairment in NAION. Results Compared with female patients, male patients showed earlier onset age, a shorter interval between binocular onsets, a higher morbidity rate of hyperlipidemia, and a higher proportion with history of smoking and drinking, with statistically significant differences (P＜0.05). There was no statistically significant difference in disease duration, intraocular pressure, pRNFL thickness, and intraocular perfusion pressure between patients of different genders (P＞0.05). Female patients exhibited better BCVA than male patients, but the difference was not statistically significant (P＞0.05). The degree of visual field impairment in female patients was significantly better than that in males. Males’ visual field defects were mostly in the lower half, while females’ defects were mostly of arcuate scotoma, with statistically significant differences (P＜0.05). The results of multiple logistic regression analysis showed that the gender of male was an independent risk factor for severe visual field impairment in NAION patients (odds ratio=2.936, 95% confidence interval 1.275-6.763, P=0.011). Conclusions Male NAION patients have an earlier onset age and a shorter interval between the initial and contralateral eye onset. Male patients exhibit a more severe degree of visual field impairment, which is mostly manifested as lower half visual field defect. While female patients tend to develop arcuate scotoma. After adjusting for other influencing factors, the gender of male remains an independent risk factor for severe visual impairment in NAION patients.

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2.	Hayreh SS. Ischemic optic neuropathy[J]. Prog Retin Eye Res, 2009, 28(1): 34-62. DOI: 10.1016/j.preteyeres.2008.11.002.
3.	Dotan G, Korczyn AD. Nonarteritic ischemic optic neuropathy and other vascular diseases[J]. Neuroepidemiology, 2013, 40(3): 225-226. DOI: 10.1159/000343960.
4.	Johnson LN, Arnold AC. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy. Population-based study in the state of Missouri and Los Angeles County, California[J]. J Neuroophthalmol, 1994, 14(1): 38-44.
5.	Lee MS, Grossman D, Arnold AC, et al. Incidence of nonarteritic anterior ischemic optic neuropathy: increased risk among diabetic patients[J]. Ophthalmology, 2011, 118(5): 959-963. DOI: 10.1016/j.ophtha.2011.01.054.
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7.	中华医学会眼科学分会神经眼科学组. 我国非动脉炎性前部缺血性视神经病变诊断和治疗专家共识(2015年)[J]. 中华眼科杂志, 2015, 51(5): 323-326. DOI: 10.3760/cma.j.issn.0412-4081.2015.05.002.Neuro-ophthalmology Group, Ophthalmology Branch of Chinese Medical Association. Expert consensus on diagnosis and treatment of non-arteritic anterior ischemic optic neuropathy in China (2015)[J]. Chin J Ophthalmol, 2015, 51(5): 323-326. DOI: 10.3760/cma.j.issn.0412-4081.2015.05.002.
8.	邱思羽, 孔祥梅, 房召彬, 等. 24 h眼灌注压与原发性开角型青光眼和正常眼压性青光眼的相关性研究[J]. 中国眼耳鼻喉科杂志, 2021, 21(5): 335-340. DOI: 10.14166/j.issn.1671-2420.2021.05.005.Qiu SY, Kong XM, Fang ZB, et al. Correlation research about 24-hour intraocular perfusion pressure with primary open-angle glaucoma and normal tension glaucoma[J]. Chin J Ophthalmol and Otorhinolaryngol, 2021, 21(5): 335-340. DOI: 10.14166/j.issn.1671-2420.2021.05.005.
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14.	肖庆, 白海霞, 胡江华, 等. 不同病程非动脉炎性前部缺血性视神经病变患眼视盘血流密度观察[J]. 中华眼底病杂志, 2021, 37(10): 763-768. DOI: 10.3760/cma.j.cn511434-20210806-00424.Xiao Q, Bai HX, Hu JH, et al. Observation of the optic disc vessel density in the affected eye with non-arteritic anterior ischemic optic neuropathy of different stages[J]. Chin J Ocul Fundus Dis, 2021, 37(10): 763-768. DOI: 10.3760/cma.j.cn511434-20210806-00424.
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17.	Hayreh SS, Jonas JB, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy and tobacco smoking[J]. Ophthalmology, 2007, 114(4): 804-809. DOI: 10.1016/j.ophtha.2006.07.062.
18.	赵小玉, 李志清, 魏瑞华, 等. 急性乙醇中毒性视神经病变1例[J]. 中华眼视光学与视觉科学杂志, 2023, 25(2): 152-154. DOI: 10.3760/cma.j.cn115909-20211120-00454.Zhao XY, Li ZQ, Wei RH, et al. A case of acute alcohol toxic optic neuropathy[J]. Chin J Ophthalmol Vis Sci, 2023, 25(2): 152-154. DOI: 10.3760/cma.j.cn115909-20211120-00454.
19.	Hayreh SS. Ischemic optic neuropathies-where are we now?[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(8): 1873-1884. DOI: 10.1007/s00417-013-2399-z.
20.	Quaranta L, Katsanos A, Russo A, et al. 24-hour intraocular pressure and ocular perfusion pressure in glaucoma[J]. Surv Ophthalmol, 2013, 58(1): 26-41. DOI: 10.1016/j.survophthal.2012.05.003.
21.	王晶莹, 王影, 赵子德, 等. 缺血性视神经病变相关分子的病理机制[J]. 国际眼科杂志, 2021, 21(7): 1187-1190. DOI: 10.3980/j.issn.1672-5123.2021.7.11.Wang JY, Wang Y, Zhao ZD, et al. Molecular pathologic mechanism associated with ischemic optic neuropathy[J]. Int Eye Sci, 2021, 21(7): 1187-1190. DOI: 10.3980/j.issn.1672-5123.2021.7.11.
22.	Kryczka KE, Kruk M, Piotrowski W, et al. Menopause improves the predictive value of common cardiovascular risk scores in women with premature coronary artery disease[J]. Menopause, 2018, 25(4): 408-414. DOI: 10.1097/GME.0000000000001029.
23.	徐利, 刘俊田. 雌激素在心脑血管疾病中的抗炎作用及机制[J]. 生理科学进展, 2008, 39(2): 155-158.Xu L, Liu JT. The anti-inflammatory effect and mechanisms of estrogen in cardiocerebrovascular diseases[J]. Progress in Physiological Sciences, 2008, 39(2): 155-158.
24.	Hata M, Oishi A, Muraoka Y, et al. Structural and functional analyses in nonarteritic anterior ischemic optic neuropathy: optical coherence tomography angiography study[J]. J Neuroophthalmol, 2017, 37(2): 140-148. DOI: 10.1097/WNO.0000000000000470.
25.	杨晖, 张秀兰, 于强, 等. 非动脉炎性前部缺血性视神经病变视野表现分析[J]. 中华眼底病杂志, 2011, 27(2): 149-152. DOI: 10.3760/cma.j.issn.1005-1015.2011.02.010.

1. Miller NR, Arnold AC. Current concepts in the diagnosis, pathogenesis and management of nonarteritic anterior ischaemic optic neuropathy[J]. Eye (Lond), 2015, 29(1): 65-79. DOI: 10.1038/eye.2014.144.
2. Hayreh SS. Ischemic optic neuropathy[J]. Prog Retin Eye Res, 2009, 28(1): 34-62. DOI: 10.1016/j.preteyeres.2008.11.002.
3. Dotan G, Korczyn AD. Nonarteritic ischemic optic neuropathy and other vascular diseases[J]. Neuroepidemiology, 2013, 40(3): 225-226. DOI: 10.1159/000343960.
4. Johnson LN, Arnold AC. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy. Population-based study in the state of Missouri and Los Angeles County, California[J]. J Neuroophthalmol, 1994, 14(1): 38-44.
5. Lee MS, Grossman D, Arnold AC, et al. Incidence of nonarteritic anterior ischemic optic neuropathy: increased risk among diabetic patients[J]. Ophthalmology, 2011, 118(5): 959-963. DOI: 10.1016/j.ophtha.2011.01.054.
6. Cestari DM, Gaier ED, Bouzika P, et al. Demographic, systemic, and ocular factors associated with nonarteritic anterior ischemic optic neuropathy[J]. Ophthalmology, 2016, 123(12): 2446-2455. DOI: 10.1016/j.ophtha.2016.08.017.
7. 中华医学会眼科学分会神经眼科学组. 我国非动脉炎性前部缺血性视神经病变诊断和治疗专家共识(2015年)[J]. 中华眼科杂志, 2015, 51(5): 323-326. DOI: 10.3760/cma.j.issn.0412-4081.2015.05.002.Neuro-ophthalmology Group, Ophthalmology Branch of Chinese Medical Association. Expert consensus on diagnosis and treatment of non-arteritic anterior ischemic optic neuropathy in China (2015)[J]. Chin J Ophthalmol, 2015, 51(5): 323-326. DOI: 10.3760/cma.j.issn.0412-4081.2015.05.002.
8. 邱思羽, 孔祥梅, 房召彬, 等. 24 h眼灌注压与原发性开角型青光眼和正常眼压性青光眼的相关性研究[J]. 中国眼耳鼻喉科杂志, 2021, 21(5): 335-340. DOI: 10.14166/j.issn.1671-2420.2021.05.005.Qiu SY, Kong XM, Fang ZB, et al. Correlation research about 24-hour intraocular perfusion pressure with primary open-angle glaucoma and normal tension glaucoma[J]. Chin J Ophthalmol and Otorhinolaryngol, 2021, 21(5): 335-340. DOI: 10.14166/j.issn.1671-2420.2021.05.005.
9. ……[M]//钟一声, 叶纹. 现代临床视野检查与解释. 北京: 人民军医出版社, 2004: 15-17.M]//Zhong YS, Ye W. Modern clinical perspective examination and interpretation. Beijing: People's Military Medical Press, 2004: 15-17.
10. ……[M]//袁钟生, 钟华. 现代临床视野检测. 北京: 人民军医出版社, 2015: 15-17(页码和上一条一模一样, 请确认核实).M]//Yuan ZS, Zhong H. Modern clinical vision detection. Beijing: People's Military Medical Press, 2015: 15-17.
11. De Moraes CG, Sun A, Jarukasetphon R, et al. Association of macular visual field measurements with glaucoma staging systems[J]. JAMA Ophthalmol, 2019, 137(2): 139-145. DOI: 10.1001/jamaophthalmol.2018.5398.
12. The IONDT Research Group. The ischemic optic neuropathy decompression trial (IONDT)[J]. Control Clin Trials, 1998, 19(3): 276-296. DOI: 10.1016/s0197-2456(98)00003-8.
13. Kupersmith MJ, Anderson S, Durbin M, et al. Scanning laser polarimetry, but not optical coherence tomography predicts permanent visual field loss in acute nonarteritic anterior ischemic optic neuropathy[J]. Invest Ophthalmol Vis Sci, 2013, 54(8): 5514-5519. DOI: 10.1167/iovs.13-12253.
14. 肖庆, 白海霞, 胡江华, 等. 不同病程非动脉炎性前部缺血性视神经病变患眼视盘血流密度观察[J]. 中华眼底病杂志, 2021, 37(10): 763-768. DOI: 10.3760/cma.j.cn511434-20210806-00424.Xiao Q, Bai HX, Hu JH, et al. Observation of the optic disc vessel density in the affected eye with non-arteritic anterior ischemic optic neuropathy of different stages[J]. Chin J Ocul Fundus Dis, 2021, 37(10): 763-768. DOI: 10.3760/cma.j.cn511434-20210806-00424.
15. 所引章节作者. 所引章节文题[M]//周翔天. 低视力学. 北京: 人民卫生出版社, 2017: 1-2.M]//Zhou XT. Low vision science. Beijing: People's Medical Publishing House, 2017: 1-2.
16. 林冀鲁, 王影, 焦文鑫, 等. 近20年中国缺血性视神经病变研究现状的可视化分析[J]. 中华眼底病杂志, 2023, 39(11): 918-927. DOI: 10.3760/cma.j.cn511434-20230420-00175.Lin JL, Wang Y, Jiao WX, et al. Visual analysis of the research status of ischemic optic neuropathy in China in the past 20 years[J]. Chin J Ocul Fundus Dis, 2023, 39(11): 918-927. DOI: 10.3760/cma.j.cn511434-20230420-00175.
17. Hayreh SS, Jonas JB, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy and tobacco smoking[J]. Ophthalmology, 2007, 114(4): 804-809. DOI: 10.1016/j.ophtha.2006.07.062.
18. 赵小玉, 李志清, 魏瑞华, 等. 急性乙醇中毒性视神经病变1例[J]. 中华眼视光学与视觉科学杂志, 2023, 25(2): 152-154. DOI: 10.3760/cma.j.cn115909-20211120-00454.Zhao XY, Li ZQ, Wei RH, et al. A case of acute alcohol toxic optic neuropathy[J]. Chin J Ophthalmol Vis Sci, 2023, 25(2): 152-154. DOI: 10.3760/cma.j.cn115909-20211120-00454.
19. Hayreh SS. Ischemic optic neuropathies-where are we now?[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(8): 1873-1884. DOI: 10.1007/s00417-013-2399-z.
20. Quaranta L, Katsanos A, Russo A, et al. 24-hour intraocular pressure and ocular perfusion pressure in glaucoma[J]. Surv Ophthalmol, 2013, 58(1): 26-41. DOI: 10.1016/j.survophthal.2012.05.003.
21. 王晶莹, 王影, 赵子德, 等. 缺血性视神经病变相关分子的病理机制[J]. 国际眼科杂志, 2021, 21(7): 1187-1190. DOI: 10.3980/j.issn.1672-5123.2021.7.11.Wang JY, Wang Y, Zhao ZD, et al. Molecular pathologic mechanism associated with ischemic optic neuropathy[J]. Int Eye Sci, 2021, 21(7): 1187-1190. DOI: 10.3980/j.issn.1672-5123.2021.7.11.
22. Kryczka KE, Kruk M, Piotrowski W, et al. Menopause improves the predictive value of common cardiovascular risk scores in women with premature coronary artery disease[J]. Menopause, 2018, 25(4): 408-414. DOI: 10.1097/GME.0000000000001029.
23. 徐利, 刘俊田. 雌激素在心脑血管疾病中的抗炎作用及机制[J]. 生理科学进展, 2008, 39(2): 155-158.Xu L, Liu JT. The anti-inflammatory effect and mechanisms of estrogen in cardiocerebrovascular diseases[J]. Progress in Physiological Sciences, 2008, 39(2): 155-158.
24. Hata M, Oishi A, Muraoka Y, et al. Structural and functional analyses in nonarteritic anterior ischemic optic neuropathy: optical coherence tomography angiography study[J]. J Neuroophthalmol, 2017, 37(2): 140-148. DOI: 10.1097/WNO.0000000000000470.
25. 杨晖, 张秀兰, 于强, 等. 非动脉炎性前部缺血性视神经病变视野表现分析[J]. 中华眼底病杂志, 2011, 27(2): 149-152. DOI: 10.3760/cma.j.issn.1005-1015.2011.02.010.

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Latest ArticlesAnalysis of gender-related differences in clinical characteristics of patients with non arteritic anterior ischemic optic neuropathy

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