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Article
November 1985

The Role of Carotid Endarterectomy in Ischemic Optic Neuropathy

Author Affiliations

Nashville, Tenn

Arch Ophthalmol. 1985;103(11):1633-1634. doi:10.1001/archopht.1985.01050110027011

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Abstract

To the Editor.  —The otherwise excellent article by Guyer et al1 was flawed by the recommendation that tests for carotid artery patency be performed on patients with anterior ischemic optic neuropathy (AION). Such tests may lead to invasive procedures and expose patients to the unnecessary risks of intra-arterial cerebral angiography2 and ultimately carotid endarterectomy for asymptomatic carotid stenosis.3,4The retrolaminar portion of the optic nerve seems particularly vulnerable to ischemia from local mechanical factors5,6 and small-vessel disease.7,8 Indeed, a similarity between AION and hypertensive lipohyalinotic cerebral angiopathy, which causes lacunar strokes, not strokes resulting from extracranial carotid disease, has been suggested.8I am unaware of any evidence linking AION to extracranial carotid disease, except in the rare instance of internal carotid artery occlusion where AION is part of ischemic oculopathy, or with central retinal artery occlusion involving the optic nerve head.The case for

References
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Guyer DR, Miller NR, Aver CL, et al:  The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy . Arch Ophthalmol 1985;103:1136-1142.Article
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Hachinski V:  Comment . Arch Neurol 1985; 42:385.Article
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Chambers BR, Norris JW:  Carotid bruit controversy . Arch Neurol 1985;45:423.Article
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Beck RW, Savino PJ, Repka MX, et al:  Optic disc structure in anterior ischemic optic neuropathy . Ophthalmology 1984;91:1334-1337.Article
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Feit RH, Tomsak RL, Ellenberger C Jr:  Structural factors in the pathogenesis of ischemic optic neuropathy . Am J Ophthalmol 1984;98:105-108.Article
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Ellenberger C Jr, Netsky MG:  Infarction in the optic nerve . J Neurol Neurosurg Psychiatry 1968; 31:606-611.Article
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Ellenberger C Jr:  Ischemic optic neuropathy as a possible early complication of vascular hypertension . Am J Ophthalmol 1979;88:1045-1051.
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