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Ischemic optic neuropathy may be early sign of high cholesterol

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PHILADELPHIA — Elevated cholesterol levels are a risk factor for idiopathic nonarteritic ischemic optic neuropathy in patients under age 50, a study here found. The eye condition may be the first manifestation of elevated serum levels in relatively young patients, according to Vincent Deramo, MD, and colleagues.

Cholesterol-associated ischemic optic neuropathy is otherwise indistinguishable from idiopathic nonarteritic ischemic optic neuropathy (NAION), the researchers report in the May issue of Ophthalmology.

Idiopathic NAION typically occurs in people between the ages of 55 and 70, with most cases manifesting between the ages of 60 and 68. Cholesterol-associated ischemic optic neuropathy should be suspected in relatively young patients with optic disc edema or optic nerve pallor, the authors said.

Between May 1995 and October 1998, Dr. Deramo and colleagues identified 577 patients at Wills Eye Hospital with a clinical diagnosis of NAION. Of those, 37 patients (51 eyes) under 50 years old were included in the study. They were compared with 74 age- and gender-matched controls. The mean follow-up period was 36 weeks.

Patients in the NAION group had statistically significant differences in their mean serum levels of total cholesterol, low-density lipoproteins and triglycerides.

In this study, patients were unaware of lipid abnormalities until their visual problems developed, according to the researchers. Ischemic vascular disease may be more prevalent in this age group of patients than previously thought, the authors said. They also theorized that damage to the short posterior ciliary arteries of the orbit and the prelaminar capillary branches of the central retinal artery occur at a younger age than previously thought.