From the Research
Bilateral anterior ischemic optic neuropathy (AION) after dialysis is primarily caused by compromised blood flow to the optic nerve, often due to hypotension or anemia, as suggested by the most recent and highest quality study 1. The condition can be classified into two types: arteritic AION (due to giant cell arteritis) and non-arteritic AION (due to other causes) 2, 3. Some key points to consider in the management of AION include:
- Blood pressure stabilization to prevent significant drops during dialysis
- Maintaining hemoglobin levels between 10-12 g/dL
- Adjusting dialysis parameters to prevent hypotension, including slower ultrafiltration rates and higher dialysate sodium concentration (140-145 mEq/L)
- Careful monitoring of fluid removal
- Prompt referral to a neuro-ophthalmologist for evaluation and management
- Consideration of corticosteroids (prednisone 60-80 mg daily for 2 weeks with gradual taper) in non-arteritic cases, although their efficacy remains controversial 1, 4. It is essential to recognize that vision loss from AION is usually permanent, making prevention through careful dialysis management crucial, especially in patients with risk factors like diabetes, hypertension, or previous vascular disease 5.