Joint position paper on anterior ischemic optic neuropathy (AION). Vascular Risk Group and Systemic Autoimmune Diseases Group (GEAS) of the Spanish Society of Internal Medicine (SEMI) together with the Spanish Retina and Vitreous Society (SERV).

Abstract

Anterior ischemic optic neuropathy (AION) is one of the leading causes of sudden, painless, monocular vision loss in individuals over 50 years of age. Two forms can be distinguished, with clearly different clinical, diagnostic, and therapeutic implications: the arteritic form, most commonly associated with giant cell arteritis (GCA), which constitutes a medical and ophthalmological emergency; and the non-arteritic form, which is far more frequent and for which no specific effective treatment is currently available. Despite its clinical relevance and the frequent coexistence of vascular risk factors, the management of AION remains heterogeneous, with considerable variability in care pathways, etiological assessment, and follow-up and secondary prevention strategies. This situation highlights the need for a comprehensive and coordinated approach, in which close collaboration between Ophthalmology and Internal Medicine is essential. This position statement is part of a series of joint working groups documents promoted by the Vascular Risk Group of the Spanish Society of Internal Medicine (SEMI) and the Spanish Retina and Vitreous Society (SERV), which began with the consensuses on retinal arterial and venous occlusion. Internists with extensive experience in vasculitis and systemic diseases, who are members of the Systemic Autoimmune Diseases Group (GEAS), have participated in the preparation of this text. The aim is to establish a consensus-based proposal for the clinical management of AION. The epidemiological, pathophysiological, diagnostic and therapeutic aspects of the disease are critically reviewed, and practical recommendations are provided to improve early detection, etiological management and the prevention of visual and systemic complications, with particular emphasis on the role of the internist in the care of these patients. The recommendations included in this document should be interpreted as expert consensus-based recommendations, particularly in those sections where high‑quality evidence is lacking.