Fibrinogen, cholesterol and smoking as risk factors for non-arteritic anterior ischaemic optic neuropathy

Abstract

Non-arteritic anterior ischaemic optic neuropathy (AION) is thought to be due to occlusion of the posterior ciliary circulation. Raised lipid and fibrino-gen concentrations are recognised risk factors for vessel occlusion in cardiovascular disease and stroke but, although suspected as risk factors in non-arteritic AION, they have not been studied in this condition. We therefore performed a case-control study on 41 patients with non-arteritic AION, looking at these and other atherosclerotic risk factors. The odds ratio of cholesterol being >6.5 mmol/l in non-arteritic AION was 2.7 (95% confidence interval 1.09 to 6.65; p<0.05) and of fibrinogen being >3.6 g/l was 5 (2.66 to 9.39; p<0.05). Smoking was also found to be significantly associated with non-arteritic AION, the odds ratio being 16 (3.23 to 79.23; p<0.001). These were the only risk factors found to be significantly associated with non-arteritic AION. This raises the possibility that appropriate medical management of these factors could be given to prevent recurrence in the fellow eye.

References

  1. 1

    Hayreh SS . Anterior ischaemic optic neuropathy: differentiation of arteritic from non-arteritic type and its management. Eye 1990;4:25–41.

    Article  Google Scholar 

  2. 2

    Hayreh SS, Baines JAB . Occlusion of the posterior ciliary artery. III. Effects on the optic nerve head. Br J Ophthalmol 1972;56:754–64.

    CAS  Article  Google Scholar 

  3. 3

    Hayreh SS . Anterior ischaemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol 1974;58:955–63.

    CAS  Article  Google Scholar 

  4. 4

    Repka MX, Savino PJ, Schatz NJ, Sergott RC . Clinical profile and long term implications of anterior ischaemic optic neuropathy. J Ophthalmol 1983;96:478–83.

    CAS  Google Scholar 

  5. 5

    Guyer DR, Miller NR, Auer CL, Fine SL . The risk of cerebrovascular and cardiovascular disease in patients with anterior ischaemic optic neuropathy. Arch Ophthalmol 1985;103:1136–42.

    CAS  Article  Google Scholar 

  6. 6

    Beri M, Klugman MR, Kohler JA, Hayreh SS . Anterior ischaemic optic neuropathy. VII. Incidence of bilater-ality and various influencing factors. Ophthalmology 1987;94:1020–8.

    CAS  Article  Google Scholar 

  7. 7

    Foulds WS . Visual disturbance in systemic disorders, optic neuropathy and systemic disease. Trans Opthal-mol Soc UK 1969;89:125–46.

    Google Scholar 

  8. 8

    McDonald WI, Sanders MD . Migraine complicated by ischaemic papillopathy. Lancet 1971;1:521–3.

    Article  Google Scholar 

  9. 9

    Chisholm IA . Optic neuropathy of recurrent blood loss. Br J Ophthalmol 1969;53:289–95.

    CAS  Article  Google Scholar 

  10. 10

    Acheson JF, Sanders MD . Coagulation abnormalities in ischaemic optic neuropathy. Eye 1994;8:89–92.

    Article  Google Scholar 

  11. 11

    Begg IS, Drance SM, Sweeney VP . Ischaemic optic neuropathy in chronic simple glaucoma. Br J Ophthalmol 1971;55:73–90.

    CAS  Article  Google Scholar 

  12. 12

    Hayreh SS . Anterior ischaemic optic neuropathy. IV. Occurrence after cataract extraction. Arch Ophthalmol 1980;98:1410–6.

    CAS  Article  Google Scholar 

  13. 13

    Meade TW, Mellows S, Brozovic M, Miller GJ, Chakrabarti RA, North WR, et al. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park study. Lancet 1986;2:533–7.

    CAS  Article  Google Scholar 

  14. 14

    Martin MJ, Hulley SB, Browner WS, Kuller LH, Wentworth D . Serum cholesterol, blood pressure and mortality: implications from a cohort of 361 662 men. Lancet 1986;2:933–6.

    CAS  Article  Google Scholar 

  15. 15

    Harding JJ, Egerton M, van Heyningen R, Harding RS . Diabetes, glaucoma, sex and cataract: analysis of combined data from two case control studies. Br J Ophthalmol 1993;77:2–6.

    CAS  Article  Google Scholar 

  16. 16

    Qizilbash N, Jones L, Warlow C, Mann J . Fibrinogen and lipid concentrations as risk factors for transient ischaemic attacks and minor ischaemic strokes. BMJ 1991;303:605–9.

    CAS  Article  Google Scholar 

  17. 17

    Betteridge DJ, Dodson PM, Durrington PN, Hughes EA, Laker MF, Nicholls DP, et al. Management of hyperlipidaemia: guidelines of the British Hyperlipi-daemia Association. Postgrad Med J 1993;69:359–69.

    CAS  Article  Google Scholar 

  18. 18

    Miller MR, Smith JL . Ischaemic optic neuropathy. Am J Ophthalmol 1966;62:103–15.

    CAS  Article  Google Scholar 

  19. 19

    Eagling EM, Sanders MD, Miller SJH . Ischaemic papillopathy: clinical and fluorescein angiographic review of forty cases. Br J Ophthalmol 1974;58:990–1008.

    CAS  Article  Google Scholar 

  20. 20

    Hayreh SS, Zahoruk RM . Anterior ischaemic optic neuropathy. VI. In juvenile diabetes. Ophthalmologica 1981;182:13–28.

    CAS  Article  Google Scholar 

  21. 21

    Meade TW, Chakrabarti R, Haines AP, North WRS, Stirling Y . Characteristics affecting fibrinolytic activity and plasma fibrinogen concentrations. BMJ 1979;1:153–6.

    CAS  Article  Google Scholar 

  22. 22

    Ernst E . Fibrinogen: an independent risk factor for cardiovascular disease. BMJ 1991;303:596–7.

    CAS  Article  Google Scholar 

  23. 23

    Wilhelmson L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G . Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984;311:501–5.

    Article  Google Scholar 

  24. 24

    Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL . Beyond cholesterol: modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med 1989;320:915–24.

    CAS  Article  Google Scholar 

  25. 25

    Chung SM, Gay CA, McCrary JA III. Nonarteritic ischaemic optic neuropathy: the impact of tobacco use. Ophthalmology 1994;101:779–82.

    CAS  Article  Google Scholar 

  26. 26

    Royal College of Physicians of London and British Cardiac Society. Prevention of coronary heart disease: report of joint working party. J R Coll Physicians Lond 1976;10:1–63.

  27. 27

    Sawle GV, James CB, Ross Russell RW . The natural history of non-arteritic anterior ischaemic optic neuropathy. J Neurol Neurosurg Psychiatry 1990;33:830–3.

    Article  Google Scholar 

  28. 28

    Meade TW, Ruddock V, Stirling Y, Chakrabarti R, Miller GJ . Fibrinolytic activity, clotting factors, and long term incidence of ischaemic heart disease in the Northwick Park Heart Study. Lancet 1993;342:1076–9.

    CAS  Article  Google Scholar 

  29. 29

    Tyroler HA . Lowering plasma cholesterol levels decreases risks of coronary heart disease: an overview of clinical trials. In: Steinberg D, Olefsky JM, editors. Hypercholesterolemia and atherosclerosis. New York: Churchill Livingstone, 1987:99–116.

  30. 30

    Dodson PM, Kritzinger EE . Management of retinal vein occlusion. BMJ 1987;295:1434–5.

    CAS  Article  Google Scholar 

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Correspondence to S J Talks.

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Talks, S., Chong, N., Gibson, J. et al. Fibrinogen, cholesterol and smoking as risk factors for non-arteritic anterior ischaemic optic neuropathy. Eye 9, 85–88 (1995). https://doi.org/10.1038/eye.1995.13

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Keywords

  • Anterior ischaemic optic neuropathy
  • Cholesterol
  • Fibrinogen
  • Smoking

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