Non-Arteritic Ischemic Optic Neuropathy Following COVID-19 Vaccination in Korea: A Case Series

Abstract

Background: To report the clinical manifestations of non-arteritic anterior ischemic optic neuropathy (NAION) cases after coronavirus disease 2019 (COVID-19) vaccination in Korea.

Methods: This multicenter retrospective study included patients diagnosed with NAION within 42 days of COVID-19 vaccination. We collected data on vaccinations, demographic features, presence of vascular risk factors, ocular findings, and visual outcomes of patients with NAION.

Results: The study included 16 eyes of 14 patients (6 men, 8 women) with a mean age of 63.5 ± 9.1 (range, 43-77) years. The most common underlying disease was hypertension, accounting for 28.6% of patients with NAION. Seven patients (50.0%) had no vascular risk factors for NAION. The mean time from vaccination to onset was 13.8 ± 14.2 (range, 1-41) days. All 16 eyes had disc swelling at initial presentation, and 3 of them (18.8%) had peripapillary intraretinal and/or subretinal fluid with severe disc swelling. Peripapillary hemorrhage was found in 50% of the patients, and one (6.3%) patient had peripapillary cotton-wool spots. In eight fellow eyes for which we were able to review the fundus photographs, the horizontal cup/disc ratio was less than 0.25 in four eyes (50.0%). The mean visual acuity was logMAR 0.6 ± 0.7 at the initial presentation and logMAR 0.7 ± 0.8 at the final visit.

Conclusion: Only 64% of patients with NAION after COVID-19 vaccination have known vascular and ocular risk factors relevant to ischemic optic neuropathy. This suggests that COVID-19 vaccination may increase the risk of NAION. However, overall clinical features and visual outcomes of the NAION patients after COVID-19 vaccination were similar to those of typical NAION.

Keywords: Coronavirus Disease 2019 (COVID-19); Non-Arteritic Anterior Ischemic Optic Neuropathy; Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2); Vaccination.

Fig. 1. Images of the fundus and visual field maps. (A) Fundus photograph and corresponding horizontal cross-sectional optical coherence tomography scan in a patient with non-arteritic anterior ischemic optic neuropathy following coronavirus disease 2019 vaccination. Severe optic disc edema and peripapillary sub-retinal fluid (white arrow) are seen. (B) Visual field test results (grayscale map, total deviation probability map, and pattern deviation probability map) of the patients show the inferior altitudinal defect.

Fig. 2. Line chart showing the changes of visual acuity.

NLP = no light perception, LP = light perception, HM = hand motion, CF = count finger. ^aTwo eyes showed the same changes.