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The following is a summary of “Non-arteritic anterior ischemic optic neuropathy in black patients,” published in the October 2024 issue of Ophthalmology by Banc et al.
Researchers conducted a retrospective study to compare the systemic and ocular characteristics of Black and White patients with non-arteritic anterior ischemic optic neuropathy (NAION).
They collected self-reported race data from all patients with NAION between 2014 and 2022 at a single US neuro-ophthalmology service. All Black and white patients with NAION were randomly chosen and included. Information was gathered on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. Color fundus photographs and optic nerve OCT images were reviewed to assess the cup-to-disc ratio and document optic disc drusen. A counterfactual random forest was used to estimate race-based associations for each characteristic, adjusting for other factors.
The results showed 32 Black patients with NAION (mean age 57 ± 11 years, 38% male) and 69 of 432 White patients (mean age 57 ± 15 years, 59% male) were included. Black patients had significantly longer delays between NAION onset and neuro-ophthalmic exam (1.5 to <3 months: odds ratio [OR] 4.07 P = 0.03; 6 to <12 months: OR 6.05, P = 0.007). Black patients were more significant in chronic kidney disease (OR 7.53, P = 0.003) and hemodialysis (OR 13.69, P = 0.02). No significant differences were found in the cup-to-disc ratio (0.15 to <0.25: OR 2.83, P = 0.09; 0.25 to <0.35: OR 0.56, P = 0.46; ≥0.35: OR 0.66, P = 0.44).
They concluded that referral delay occurs in Black patients with NAION due to its relative rarity and concern for alternate diagnoses. Black patients with NAION were more likely to have chronic kidney disease with dialysis than White patients. Although racial differences in the cup-to-disc ratio exist, the underlying compartment mechanism is likely the same between races.