Do occult neuroretinitis and non-arteritic anterior ischaemic optic neuropathy differ in presentation?
Reviewed by Claire Howard

This study evaluates differences between neuroretinitis and non-arteritic anterior ischaemic optic neuropathy (NAAION) in terms of patient demographics, clinical presentation, and optical coherence tomography (OCT) findings. Medical records of patients with a final diagnosis of occult neuroretinitis or NAAION were retrospectively reviewed at a single tertiary eyecare centre over a nine-year period. Notes review found 14 patients with occult neuroretinitis and 16 with a NAAION diagnosis. In terms of demographics, patients with NAAION were slightly older (median age 49, inter-quartile range [IQR]: 45–54 years, versus 41, IQR: 31–50 years) than patients with neuroretinitis. Seventy-five percent of patients with NAAION were male versus 43% with neuroretinitis (p=0.07). Systemic risk factors were present in 87.5% of patients with NAAION versus 21.4% in patients with neuroretinitis (p=0.001). Interestingly, all patients in the study presented with blurred vision, had similar visual function, and had optic disc oedema. None of the patients had evident retinitis lesions, but 10 (71%) showed evident retinitis lesion at follow-up. Neuroretinitis patients more often had vitreous cells (64% versus 6%, p=0.001), and subretinal fluid (78.6% versus 37.5%, p=0.03) than the patients with NAAION. The authors recognise that larger studies are needed and that these studies should be prospective in nature. Despite limitations, this study suggests that although neuroretinitis and NAAION may have overlapping clinical features, certain demographic and OCT features might help in distinguishing between the two conditions. Overall, NAAION patients tended to be slightly older, more frequently male, and had associated systemic diseases more often than those with neuroretinitis. Neuroretinitis patients more often had posterior vitreous cells and subretinal fluid on OCT.

Differentiating occult neuroretinitis and non-arteritic anterior ischaemic optic neuropathy: clinical and optical coherence tomography characteristics.
Ganatra S, Panchal B, Pathengay A, Sachdeva V.
NEURO-OPHTHALMOLOGY
2023;47(4):208–17.