Evaluation for NAION

Treatment of NAION is not proven so far, thus, I recommend further evaluation for risk factors of NAION.

In Asia, especially Korea, anterior ischemic optic neuropathy is rarely associated with Giant cell arteritis. So I just ask some valuable information such as jaw claudication, headache and tenderness around temporal lobe to patients.

In NAION, I prefer to check blood tests including CBC, lipid profile, ESR and CRP.

Some reports have suggested that hyperlipidemia is a risk factor of NAION, although there is debate. 

ESR and CRP are a hallmark of arteritic anterior ischemic optic neurpathy and we should consider a possibility of arteritic ischemic optic neuropathy despite low prevalence of arteritic form in Asia.

Under 50 years old, I recommend orbit MRI not brain MRI!! or thrombophilic factors including Factor V Laiden, protein C and S. Actually, I have rarely seen the thrombophilic factor positive patients. So, I wonder the cost-effectiveness of blood test to detect thrombophilic factors.

Some compressive optic neuropathy patients have complained of acute visual loss, thus, we should consider imaging study when the optic disc swelling is not resolved within 2 months.