Abstract：
OBJECTIVE: The evaluation and management of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) lacks standardized guidelines. This study aimed to investigate the real-world practices of neuro-ophthalmologists in the evaluation and management of typical NAION cases.
METHODS: A national survey, conducted between 2019 and 2021, involved all practicing neuro-ophthalmologists. A structured questionnaire assessed their approach to risk factor evaluation and treatment of NAION, with 19 questions about risk factors and six questions concerning treatment and prevention of fellow-eye involvement.
RESULTS: Thirty-six out of 37 neuro-ophthalmologists participated. Most physicians referred patients for evaluation of the following risk factors: obstructive sleep apnea (83.3%), diabetes mellitus (83.3%), hypertension (77.7%), dyslipidemia (72.2%), and optic disc drusen (38.8%). However, there was considerable variation in the choice of diagnostic tests recommended. Furthermore, nearly 47% recommended an embolism workup. Regarding treatment, the majority (91%) did not recommend routine treatment for NAION, although in 16.7%, high-dose corticosteroids were occasionally prescribed. Secondary prevention with aspirin (80.6%), smoking cessation advice (86.1%), and advising against erectile dysfunction medications for men (80.6%) were common recommendations.
CONCLUSIONS: While the risk factors associated with NAION are well-reported, there is a lack of uniformity on which tests should be ordered to evaluate these risk factors. Most neuro-ophthalmologists concur that routine treatment for NAION is not warranted, but not unanimously. Future studies to develop a consensus guideline for post-NAION work-up and management recommendations may assist in the detection and management of preventable risk factors.
METHODS: A national survey, conducted between 2019 and 2021, involved all practicing neuro-ophthalmologists. A structured questionnaire assessed their approach to risk factor evaluation and treatment of NAION, with 19 questions about risk factors and six questions concerning treatment and prevention of fellow-eye involvement.
RESULTS: Thirty-six out of 37 neuro-ophthalmologists participated. Most physicians referred patients for evaluation of the following risk factors: obstructive sleep apnea (83.3%), diabetes mellitus (83.3%), hypertension (77.7%), dyslipidemia (72.2%), and optic disc drusen (38.8%). However, there was considerable variation in the choice of diagnostic tests recommended. Furthermore, nearly 47% recommended an embolism workup. Regarding treatment, the majority (91%) did not recommend routine treatment for NAION, although in 16.7%, high-dose corticosteroids were occasionally prescribed. Secondary prevention with aspirin (80.6%), smoking cessation advice (86.1%), and advising against erectile dysfunction medications for men (80.6%) were common recommendations.
CONCLUSIONS: While the risk factors associated with NAION are well-reported, there is a lack of uniformity on which tests should be ordered to evaluate these risk factors. Most neuro-ophthalmologists concur that routine treatment for NAION is not warranted, but not unanimously. Future studies to develop a consensus guideline for post-NAION work-up and management recommendations may assist in the detection and management of preventable risk factors.
摘要：
目的：非动脉炎性前部缺血性视神经病变（NAION）的评估和治疗缺乏标准化指南。本研究旨在调查神经眼科医生在典型NAION病例的评估和管理中的现实实践。
方法：全国调查，在2019年至2021年之间进行，涉及所有执业神经眼科医生。一份结构化问卷评估了他们对NAION风险因素评估和治疗的方法，有19个关于危险因素的问题和6个关于治疗和预防同眼受累的问题。
结果：37名神经眼科医生中有36名参加。大多数医生推荐患者评估以下危险因素：阻塞性睡眠呼吸暂停（83.3％），糖尿病（83.3%），高血压（77.7%），血脂异常（72.2%），和视盘玻璃疣(38.8%)。然而,所推荐的诊断性检查的选择存在相当大的差异.此外，近47%的人建议进行栓塞检查.关于治疗,大多数(91%)不推荐NAION的常规治疗，尽管在16.7%中，偶尔使用大剂量皮质类固醇.阿司匹林二级预防（80.6%），戒烟建议(86.1%),和建议男性使用勃起功能障碍药物(80.6%)是常见的建议。
结论：虽然与NAION相关的危险因素报告良好，评估这些危险因素的测试缺乏统一性。大多数神经眼科医生都认为，没有必要对NAION进行常规治疗，但不是一致的。未来为NAION后的工作和管理建议制定共识指南的研究可能有助于发现和管理可预防的风险因素。
方法：全国调查，在2019年至2021年之间进行，涉及所有执业神经眼科医生。一份结构化问卷评估了他们对NAION风险因素评估和治疗的方法，有19个关于危险因素的问题和6个关于治疗和预防同眼受累的问题。
结果：37名神经眼科医生中有36名参加。大多数医生推荐患者评估以下危险因素：阻塞性睡眠呼吸暂停（83.3％），糖尿病（83.3%），高血压（77.7%），血脂异常（72.2%），和视盘玻璃疣(38.8%)。然而,所推荐的诊断性检查的选择存在相当大的差异.此外，近47%的人建议进行栓塞检查.关于治疗,大多数(91%)不推荐NAION的常规治疗，尽管在16.7%中，偶尔使用大剂量皮质类固醇.阿司匹林二级预防（80.6%），戒烟建议(86.1%),和建议男性使用勃起功能障碍药物(80.6%)是常见的建议。
结论：虽然与NAION相关的危险因素报告良好，评估这些危险因素的测试缺乏统一性。大多数神经眼科医生都认为，没有必要对NAION进行常规治疗，但不是一致的。未来为NAION后的工作和管理建议制定共识指南的研究可能有助于发现和管理可预防的风险因素。
