Consultant Endocrinologist, Department of Diabetes & Endocrinology, G. D. Hospital & Diabetes Institute, Kolkata, West Bengal, India, Corresponding Author.
Consultant Physician and Diabetes Specialist, Department of Diabetes & Endocrinology, Jothydev's Diabetes and Research Centre, Trivandrum, Kerala, India.
J Assoc Physicians India. 2024 Aug;72(8):11-12. doi: 10.59556/japi.72.0621.
Nonarteritic anterior ischemic optic neuropathy (NAION) was first documented by a French physician Jean-Pierre Saint-Yves in 1817 (19th century). The clinical description of NAION was not known until 1935 when C. Miller Fischer thoroughly described it. Briefly, NAION is a rare (2.5-11.8 per 1,00,000 cases in men above 50 years) but serious condition that causes sudden painless loss of vision due to ischemia of the optic nerve. It is more common in Caucasians compared with Asians and is associated with various risk factors such as hypertension, type 2 diabetes (T2D), smoking, hyperlipidemia, obesity, obstructive sleep apnea, small optic nerve cup ("disk at risk"), optic nerve drusen, and certain drugs, especially phosphodiesterase type 5 inhibitors (PDE-5I), amiodarone, and cabergoline. Although the clinical development programs and real-world studies of semaglutide [a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved for the treatment of T2D and obesity] did not report any significant increase in the risk of NAION, a recent retrospective cohort study suggested a possible link between NAION and semaglutide. This editorial briefly summarizes the current knowledge about NAION and its relation to metabolic disorders, cardiovascular, and antidiabetes drugs and puts a perspective concerning semaglutide.
非动脉炎性前部缺血性视神经病变（NAION）于 1817 年（19 世纪）由法国医生让-皮埃尔·圣伊夫首次记录。直到 1935 年，C·米勒·费舍尔（C. Miller Fischer）对其进行了彻底描述，NAION 的临床描述才为人所知。简而言之，NAION 是一种罕见的疾病（50 岁以上男性每 10 万人中有 2.5-11.8 例），但很严重，会导致视神经缺血引起的突发性无痛视力丧失。与亚洲人相比，它在白种人中更为常见，与各种危险因素有关，如高血压、2 型糖尿病（T2D）、吸烟、高血脂、肥胖、阻塞性睡眠呼吸暂停、小视神经杯（“风险盘”）、视神经结节和某些药物，特别是磷酸二酯酶 5 抑制剂（PDE-5I）、胺碘酮和卡麦角林。尽管司美格鲁肽（一种用于治疗 T2D 和肥胖的胰高血糖素样肽-1 受体激动剂（GLP-1RA））的临床开发计划和真实世界研究并未报告 NAION 风险显著增加，但最近的一项回顾性队列研究表明，NAION 与司美格鲁肽之间可能存在关联。这篇社论简要总结了目前关于 NAION 及其与代谢紊乱、心血管和抗糖尿病药物的关系的知识，并就司美格鲁肽提出了一些看法。
