Journal article
Progression of Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) Occurs Early and is Unassociated with Modifiable Risk Factors
American journal of ophthalmology, Vol.284, pp.181-195
04/2026
DOI: 10.1016/j.ajo.2026.01.012
PMID: 41544737
Abstract
To report the true frequency and risk factors for acute NAION progression and identify modifiable features to reduce vision worsening.
Secondary case-control analysis of the QRK207 multicenter, double-masked, sham-controlled, randomized clinical trial.
We analyzed 599 study eyes with acute NAION (of 729 individuals prospectively enrolled in the QRK207 trial) with separate screening and Day 1 (mean 2.5-day interval) evaluations for progression. No participants included in this analysis received treatment. The Month 2 analysis included only the 167 sham-injected study eyes.
Visual outcomes were assessed using best-corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and standardized automated perimetry.
We defined progression as ≥10 ETDRS letter loss (also analyzed ≥15 ETDRS letter loss) or worsening of censored corrected average total deviation (avgTD) using quantile regression to define progression and recovery thresholds. We evaluated systemic and ophthalmic features associated with progression.
From screening to Day 1, 7.3% (43/583) eyes had ≥10 ETDRS letter loss and 4.1% eyes had ≥15 ETDRS letter loss. Diabetes mellitus, hypertension, hyperlipidemia (HLD), and cardiovascular risk factors did not increase risk of progression. Previous fellow-eye (FE) NAION and obstructive sleep apnea (OSA) were significantly associated with ≥10 ETDRS letter loss. Only FE NAION remained a risk factor ≥ 15 ETDRS letter loss.
Of the 167 sham-injected eyes with screening to Month 2 evaluation, 21.6% (36/167) had ≥10 ETDRS letter loss and 14.4% (24/167) had ≥15 ETDRS letter loss. 91.6% of eyes (33/36) progressed within 22 days of symptom onset (by Day 8). Of the 139 sham-injected eyes with Day 1 to Month 2 evaluation, 18.7% had ≥10 ETDRS letter loss and 13.7% had ≥15 ETDRS letter loss.
TD progression from screening to Day 1 occurred in 32.1% (192/599) eyes, 66.1% remained stable, and 1.8% improved. FE NAION and HLD were associated with TD progression.
Worsening of vision in NAION occurs acutely. The results do not support cardiovascular risk factors as important hazard features for NAION progression. The only consistent factor associated with progression for both BCVA and VF loss was previous FE NAION.
Details
- Title: Subtitle
- Progression of Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) Occurs Early and is Unassociated with Modifiable Risk Factors
- Creators
- Zoë R. Williams - University of Rochester Medical CenterRachelle Morgenstern - Icahn School of Medicine at Mount SinaiAsala N. Erekat - Icahn School of Medicine at Mount SinaiDavid Szanto - Icahn School of Medicine at Mount SinaiMichael Wall - University of IowaNeil R. Miller - Johns Hopkins UniversityLeonard A. Levin - McGill UniversityBrian Woods - University Hospital GalwayMark J. Kupersmith - New York Eye and Ear InfirmaryQuark NAION Study Group
- Resource Type
- Journal article
- Publication Details
- American journal of ophthalmology, Vol.284, pp.181-195
- DOI
- 10.1016/j.ajo.2026.01.012
- PMID
- 41544737
- NLM abbreviation
- Am J Ophthalmol
- ISSN
- 0002-9394
- eISSN
- 1879-1891
- Publisher
- Elsevier Inc
- Grant note
- New York Eye and Ear Infirmary Foundation, New York, N.Y.Research to Prevent Blindness, Inc., New York, NYShulman Family NAION Fund at Icahn School of Medicine at Mount SinaiResearch to Prevent BlindnessHealth Research Board: ICAT-2022-001 ICAT Programme - Health Service ExecutiveNational Doctors Training and PlanningHealth and Social Care, Research and Development DivisionNorthern Ireland Medical and Dental Training AgencyDepartment of Agriculture, Food and the MarineCollege of Anaesthesiologists of Ireland
The New York Eye and Ear Infirmary Foundation, New York, N.Y.; Research to Prevent Blindness, Inc., New York, NY unrestricted grant to the Department of Ophthalmology; Shulman Family NAION Fund at Icahn School of Medicine at Mount Sinai; unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology, University of Rochester School of Medicine; The Health Research Board (ICAT-2022-001) and the ICAT Programme, which is supported by the Health Service Executive, National Doctors Training and Planning, the Health and Social Care, Research and Development Division, the Northern Ireland Medical and Dental Training Agency, the Department of Agriculture, Food and the Marine and the College of Anaesthesiologists of Ireland.
- Language
- English
- Electronic publication date
- 01/14/2026
- Date published
- 04/2026
- Academic Unit
- Neurology; Ophthalmology and Visual Sciences
- Record Identifier
- 9985121499302771
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