The Characteristics and Visual Outcomes of Dialysis-Associated Non-Arteritic Ischemic Optic Neuropathy: A Comprehensive Systematic Review.

Abstract

Non-arteritic ischemic optic neuropathy (NAION) is a common cause of sudden, painless vision loss, often triggered by inadequate blood supply. Dialysis, essential for end-stage renal disease (ESRD), can precipitate intradialytic hypotension, potentially leading to dialysis-associated NAION (DA-NAION). Our protocol was prospectively registered on PROSPERO (CRD42023464202). On 12 December 2023, five databases were searched: PubMed, Scopus, Web of Science, Google Scholar, and Cochrane. We have included all primary studies reporting NAION post-dialysis. Data about baseline characteristics, dialysis types, and NAION were extracted. From 250 identified papers, 24 studies involving 36 patients were included. Patients with DA-NAION presented at a younger age compared to non-dialysis NAION cases. Patients on continuous peritoneal dialysis (CPD) were significantly younger by about 17 years compared to those on hemodialysis. Visual outcomes were generally poor, with an average best corrected visual acuity (BCVA) of 1.33 logMAR (20/428 Snellen). Bilateral involvement was more common in CPD patients (100%) compared to hemodialysis patients (37.5%) (p = .002). Progressive NAION was observed in 33.3% of cases, and 16.7% experienced recurrent episodes. Systemic comorbidities were common, with 47.2% of patients having systemic diseases and 55.6% suffering from cardiovascular diseases (CVD). This systematic review highlights that dialysis, particularly CPD, is associated with the development of NAION. Younger age and systemic comorbidities may be notable risk factors. Bilateral involvement and poor visual outcomes are more common in DA-NAION compared to non-dialysis NAION.