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lüll The clinical spectrum of amiodarone-associated optic neuropathy Johnson LN; Krohel GB; Thomas ERJ Natl Med Assoc 2004[Nov]; 96 (11): 1477-91PURPOSE: To describe the clinical spectrum of amiodarone-associated optic neuropathy. METHODS: Observational cases series and review. RESULTS: Of 55 cases, the median interval for onset of optic neuropathy was four months after initiating amiodarone; 88% occurred within 12 months. Seven (13%) patients were asymptomatic. Twenty-two (40%) patients presented with sudden visual loss, while 26 (47%) had insidious loss of vision. Visual acuity ranged from 20/15 to light perception; 10 (18%) patients had legal blindness with visual acuity of 20/200 or worse. Visual field loss was present in 91% of cases. Color vision loss was present in eight (40%) of 20 cases. Optic disc edema was present in 85% of cases, while eight (15%) patients had retrobulbar optic neuropathy, without evidence of disc edema. Optic disc edema resolved over a median time of three months. Five patients had raised intracranial pressure on lumbar puncture. CONCLUSION: We were able to classify amiodarone-associated optic neuropathy into five clinical categories with respect to temporal characteristics and optic nerve appearance: insidious-onset (43%), acute-onset (28%), retrobulbar (13%), increased intracranial pressure (8%), and delayed-progressive onset (8%). Most cases of optic neuropathy commenced within 12 months of initiating amiodarone, with the median onset being four months. Over 10% of patients will have no visual symptoms at the onset. Ophthalmologic examinations within the first 12 months--and particularly within four months of initiating amiodarone--should improve early detection of amiodarone-associated optic neuropathy.|Aged[MESH]|Amiodarone/*adverse effects[MESH]|Anti-Arrhythmia Agents/*adverse effects[MESH]|Dose-Response Relationship, Drug[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Optic Disk/drug effects[MESH]|Optic Nerve Diseases/*chemically induced/classification/pathology[MESH]|Time Factors[MESH] |