complete VISION IMPAIRMENT. There are two forms:
arteritic, associated with giant-cell arteritis (an
inflammatory disorder of the arteries that typically
affects the temporal arteries) and nonarteritic,
which correlates with CARDIOVASCULAR DISEASE(CVD)
such as HYPERTENSION(high BLOOD PRESSURE) and
ATHEROSCLEROSIS. Other conditions associated with
the nonarteritic form include DIABETES, HYPOTENSION
(low blood pressure), and RHEUMATOID ARTHRITIS.
Vision impairment due to ischemic optic neu-
ropathy comes on suddenly. In a characteristic pat-
tern, a person wakes up in the morning with
noticeable loss of VISUAL ACUITYand VISUAL FIELD.
This may continue for several days, improving as
the day goes on, though in short order becomes
permanent. The diagnostic path begins with OPH-
THALMOSCOPYand SLIT LAMP EXAMINATIONto visualize
the optic disk (portion of the optic nerve that
attaches to the RETINA), which appears pale and
swollen. Diagnosis of giant cell arteritis by temporal
ARTERYbiopsy confirms the diagnosis of the arteritic
form of ischemic optic neuropathy. Doctors arrive
at the diagnosis of the nonarteritic form on the
basis of symptoms and ruling out other causes.
Treatment for arteritic ischemic optic neuropa-
thy is CORTICOSTEROID MEDICATIONSto reduce the
INFLAMMATION. Vision loss, however, is irreversible.
There are no effective treatments for the nonar-
teritic form, which does not appear to improve
with corticosteroids. Lifestyle modifications such
as SMOKING CESSATIONimprove circulation in gen-
eral with the presumption that such improvement
also affects optic structures. ASPIRIN THERAPY, such
as prescribed as a prophylactic measure for HEART
ATTACKand stroke, may have a preventive effect
with the arteritic form. It is especially important to
manage underlying health conditions that affect
circulation, such as hypertension and diabetes.
When the ischemic optic neuropathy affects
only one EYE, the person can make adaptations
and adjustments to accommodate the vision
impairment that do not necessarily require sub-
stantial changes in lifestyle. Most people can still
read, work, and perform other functions of daily
living with visual acuity in only one eye. Ischemic
optic neuropathy that involves both eyes can sig-
nificantly affect lifestyle.
See alsoTOXIC OPTIC NEUROPATHY; VASCULITIS.98 The Eyes