Hemodialysis-Related Vision Loss from Anterior Ischemic Optic Neuropathy

Abstract

Vision loss from nonarteritic anterior ischemic optic neuropathy (NAION) is a rare complication of hemodialysis. Here, we present a case in a young woman and discuss the pathophysiology and implications for the nephrologist. A 24-year-old woman with end-stage renal disease developed unilateral, painless vision loss following treatment with hemodialysis. Fundoscopy revealed severe left inferior chalky-white opticdisc edema, a presentation consistent with NAION. Her intradialytic blood pressure was reviewed and found to be significantly lower than her baseline, and a multidisciplinary meeting took place between her ophthalmologist and nephrologist to modify her dialysis sessions to minimize the chance of progression or involvement of her fellow eye. At the 2-month follow-up, the opticdisc edema resolved, and her visual function remained stable. Overall, NAION is a rare complication of hemodialysis and may be a result of intradialytic hypotension, platelet and endothelial dysfunction, anemia, and accumulations of toxins such as urea. As there are no established treatments for NAION, management should focus on optimizing modifiable risk factors to prevent further vision loss in the other eye. These factors include increasing the number of dialysis sessions and duration of sessions, reducing the temperature of the dialysate, discouraging eating, and increasing the dialysate’s calcium concentration. Prompt recognition of NAION and multidisciplinary teamwork can minimize the risk of NAION progression and involvement of the contralateral eye.

Keywords

• nonarteritic ischemic optic neuropathy
• congenital nephrotic syndrome
• hemodialysis
• hypotension