Question 8: Is the patient’s fellow unaffected eye at risk of developing NAION? Why or why not?

Question 8: Is the patient’s fellow unaffected eye at risk of developing NAION? Why or why not?

Answer

The risk of developing NAION in the contralateral eye has been reported in 15-19% of patients within 5 years of initial eye involvement.(Miller and Arnold 2015) Occurrence in the second eye produces the clinical appearance of a ‘pseudo-Foster Kennedy syndrome,’ in which the previously affected disc is pale and the currently affected disc is swollen.

The IONDT Follow-Up Study reported that a history of diabetes and baseline visual acuity of 20/200 (6/60) or worse in the affected study eye were significantly associated with new NAION in the fellow eye; but not age, sex, aspirin use, or smoking. Furthermore, final fellow eye visual acuity was significantly worse in those patients with new fellow eye NAION whose baseline study eye visual acuity was 20/200 (6/60) or worse.

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