Incipient Nonarteritic Anterior Ischemic Optic Neuropathy

Objective To describe the clinical entity of incipient nonarteritic anterior ischemic optic neuropathy (NAION). Design Cohort study. Participants Fifty-four patients (60 eyes) seen in our clinic from 1973 through 2000. Methods At their first visit to our clinic, all patients gave a detailed ophthalmic and medical history and underwent a comprehensive ophthalmic evaluation, color fundus photography, and fluorescein fundus angiography. At each follow-up visit (of 49 patients [55 eyes]), the same ophthalmic evaluation was performed, except for fluorescein fundus angiography. Main Outcome Measures Clinical features of incipient NAION. Results Mean age (± standard deviation) of the patients was 58.7±15.9 years. Median follow-up time was 6.3 years (interquartile range [IQR], 2.1–8.5). At initial visit, all had optic disc edema (ODE) without any visual loss attributable to NAION. In 55%, the fellow eye had classic NAION; in 25%, incipient progressed to classic NAION (after a median time of 5.8 weeks [IQR, 3.2–10.1]); and in 20%, classic NAION developed after resolution of the first episode of incipient NAION. Patients with incipient, compared with classic, NAION had a greater prevalence of diabetes mellitus ( P