黑人非动脉炎性前部缺血性视神经病变。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-10-15 DOI:10.1016/j.ajo.2024.09.036

Ana Banc , George Muntean , Valérie Biousse , Mark J. Kupersmith , Nancy J. Newman , Beau B. Bruce

{"title":"黑人非动脉炎性前部缺血性视神经病变。","authors":"Ana Banc , George Muntean , Valérie Biousse , Mark J. Kupersmith , Nancy J. Newman , Beau B. Bruce","doi":"10.1016/j.ajo.2024.09.036","DOIUrl":null,"url":null,"abstract":"<div><h3>PURPOSE</h3><div>Prior studies have shown that nonarteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared with those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black patients with NAION compared with White patients.</div></div><div><h3>DESIGN</h3><div>Retrospective, cross-sectional study.</div></div><div><h3>METHODS</h3><div>Self-reported race was collected from all patients with NAION seen between 2014 and 2022 from a single US neuro-ophthalmology service. All Black patients with NAION and a randomly selected sample of White patients with NAION were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures.</div></div><div><h3>RESULTS</h3><div>We included 32 Black patients with NAION (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: odds ratio [OR], 4.07, <em>P</em> = .03; 6 to <12 months: OR, 6.05, <em>P</em> = .007). Chronic kidney disease (OR, 7.53, <em>P</em> = .003) and hemodialysis (OR, 13.69, <em>P</em> = .02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR, 2.83, <em>P</em> = .09; 0.25 to <0.35: OR, 0.56, <em>P</em> = .46; ≥0.35: OR, 0.66, <em>P</em> = .44).</div></div><div><h3>CONCLUSIONS</h3><div>Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black patients with NAION were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White patients with NAION, suggesting that the underlying proposed compartment mechanism is the same between races.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"270 ","pages":"Pages 192-202"},"PeriodicalIF":4.1000,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nonarteritic Anterior Ischemic Optic Neuropathy in Black Patients\",\"authors\":\"Ana Banc , George Muntean , Valérie Biousse , Mark J. Kupersmith , Nancy J. Newman , Beau B. Bruce\",\"doi\":\"10.1016/j.ajo.2024.09.036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>PURPOSE</h3><div>Prior studies have shown that nonarteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared with those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black patients with NAION compared with White patients.</div></div><div><h3>DESIGN</h3><div>Retrospective, cross-sectional study.</div></div><div><h3>METHODS</h3><div>Self-reported race was collected from all patients with NAION seen between 2014 and 2022 from a single US neuro-ophthalmology service. All Black patients with NAION and a randomly selected sample of White patients with NAION were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures.</div></div><div><h3>RESULTS</h3><div>We included 32 Black patients with NAION (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: odds ratio [OR], 4.07, <em>P</em> = .03; 6 to <12 months: OR, 6.05, <em>P</em> = .007). Chronic kidney disease (OR, 7.53, <em>P</em> = .003) and hemodialysis (OR, 13.69, <em>P</em> = .02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR, 2.83, <em>P</em> = .09; 0.25 to <0.35: OR, 0.56, <em>P</em> = .46; ≥0.35: OR, 0.66, <em>P</em> = .44).</div></div><div><h3>CONCLUSIONS</h3><div>Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black patients with NAION were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White patients with NAION, suggesting that the underlying proposed compartment mechanism is the same between races.</div></div>\",\"PeriodicalId\":7568,\"journal\":{\"name\":\"American Journal of Ophthalmology\",\"volume\":\"270 \",\"pages\":\"Pages 192-202\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2024-10-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0002939424004689\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002939424004689","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

目的：先前的研究表明，与白人相比，黑人非动脉炎性前部缺血性视神经病变（NAION）并不常见，但这种差异背后的原因尚不清楚。我们的目标是分析黑人 NAION 患者的全身和眼部特征，并与白人患者进行比较。设计回顾性横断面研究方法：对 2014-2022 年间在美国一家神经眼科医院就诊的所有 NAION 患者的自我报告种族进行收集。其中包括所有黑人 NAION 患者和随机抽取的白人 NAION 患者样本。我们收集了有关高血压、高脂血症、糖尿病、甲状腺功能减退、肥胖、缺血性心脏病、心房颤动、心脏起搏器植入、慢性肾病、透析、贫血、阻塞性睡眠呼吸暂停、深静脉血栓、中风、磷酸二酯酶抑制剂的使用和吸烟状况的信息。我们查看了彩色眼底照片和视神经 OCT 图像，以评估杯盘比并记录是否存在视盘色素沉着。结果我们纳入了 32 名黑人 NAION 患者（平均年龄为 57 ± 11 岁，38% 为男性）和 432 名白人患者中的 69 名（平均年龄为 57 ± 15 岁，59% 为男性）。黑人患者从 NAION 发病到接受神经眼科检查的时间明显较长（1.5 到 <3 个月：OR 4.07，P = 0.03；6 到 <12 个月：OR 6.05，P = 0.007）。黑人患者患慢性肾病（OR 7.53，P = 0.003）和血液透析（OR 13.69，P = 0.02）的频率明显更高。杯盘比无明显差异（0.15 至 <0.25：OR 2.83，P = 0.09；0.25 至 <0.35：OR 0.56，P = 0.46；≥0.35：OR 0.66，P = 0.44）。与白人患者相比，黑人 NAION 患者更有可能患有慢性肾脏疾病并正在接受透析治疗。尽管杯盘比存在已知的种族差异，但我们发现黑人和白人 NAION 患者之间没有差异，这表明不同种族之间的隔间机制是相同的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Nonarteritic Anterior Ischemic Optic Neuropathy in Black Patients

PURPOSE

Prior studies have shown that nonarteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared with those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black patients with NAION compared with White patients.

DESIGN

Retrospective, cross-sectional study.

METHODS

Self-reported race was collected from all patients with NAION seen between 2014 and 2022 from a single US neuro-ophthalmology service. All Black patients with NAION and a randomly selected sample of White patients with NAION were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures.

RESULTS

We included 32 Black patients with NAION (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: odds ratio [OR], 4.07, P = .03; 6 to <12 months: OR, 6.05, P = .007). Chronic kidney disease (OR, 7.53, P = .003) and hemodialysis (OR, 13.69, P = .02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR, 2.83, P = .09; 0.25 to <0.35: OR, 0.56, P = .46; ≥0.35: OR, 0.66, P = .44).

CONCLUSIONS

Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black patients with NAION were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White patients with NAION, suggesting that the underlying proposed compartment mechanism is the same between races.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.