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• W2609360366 abstract "I read with interest the Hoyt Lecture by Arnold (1) dealing with nonarteritic anterior ischemic optic neuropathy (NAION). The observation of a small cup-to-disc ratio in these patients was made by William F. Hoyt, but Arnold erroneously attributed this to Sohan Singh Hayreh from an article discussing the development of disc cupping after an attack of arteritic AION instead (reference 17 in Arnold's article). Yet, Bill Hoyt was the first to recognize this disc morphology in patients with NAION—what was subsequently aptly termed “the disc-at-risk” by Ron Burde (reference 18 of Arnold's article). Hoyt's seminal observations and statements were made public in February 1982 at the Rocky Mountain Neuro-Ophthalmologic Society Meeting, spurring others in attendance to obtain additional supportive evidence. He also later advised a young Roy Beck to make use of the extensive database at the University of Iowa to obtain confirmatory results, Hayreh's initial skepticism notwithstanding. Despite not having requested authorship on any of the ensuing manuscripts, recognition and attribution of credit was nonetheless made to Hoyt by both Beck and Hayreh within the text of several publications (citations no. 19 and 24 cited by Arnold) and by other colleagues in various corroborating investigations (2,3). Three decades later, it appears that some publications (1,3) which confuse the discovery of the optic disc risk factors reflect only a perusal of manuscript titles and author listings, without attention to the manuscript text. Arnold further indicates that such relatively cupless discs may lead to a compartment syndrome in the pathogenesis of NAION (1,3,4). However, no supportive data, whether through MRI or other means, has emerged to support such a mechanism. Indeed, this neuropathy may occasionally occur in discs with large cup-to-disc ratios as Hoyt and colleagues published in this journal 19 years ago (5). A more crucial oversight, however, has been to neglect any discussion of the potential effects of abrupt vitreous separation from or about the optic nerve head. It is precisely around such at-risk discs where vitreous is most strongly adherent to axons devoid of a protective internal limiting membrane and where vitreous attachments to the central disc vessels are located (6–8) in apposition to neural tissue. The possibility of vitreous separation inducing an optic neuropathy was first considered and publicly voiced by Hoyt in 1978 at the sixth Annual Aspen Retinal Detachment Society Meeting, Snowmass, Aspen, Colorado. However, this observation has been entirely elided from Arnold's latest publications dealing with NAION (1,9), despite an editorial in Ophthalmology by Hoyt and myself detailing a likely dynamic pathophysiologic mechanism (8). This evolution and refinement of the original 1978 proposal has engendered considerable debate in the neuro-ophthalmic community, including in public forums between Dr. Arnold and the author (12th European Neuro-Ophthalmology Society Meeting, Optic neuropathies I, June 22, 2015, Ljubljana, Slovenia), as well as numerous letters to the editor. The proposed mechanism is supported by data accumulated in the literature, pointing out that despite its common designation, ischemia that has been assumed is not actually evident in so-called NAION (8). Findings instead point to a papillary vitreous detachment neuropathy, or PVD-N, produced when elevated vitreous shear stress forces develop at the optic nerve head during abrupt vitreous separation. Such rapid stretch of viscoelastic axons (which become less elastic with age) causes cytoskeletal microtubular damage much like concussive brain damage that results from sudden blows to the cranium. Surface capillary tearing with hemorrhage also may occur, which does not correlate with loss of visual acuity (10), unlike the corresponding and distinctive disc pallor noted with arteritic ischemic optic neuropathy. Open-mindedness, skepticism of established dogma, scholarly inclusiveness, and rigorous use and citation of the literature have been the hallmarks of Hoyt's scientific teaching and career. The above comments should be included to accurately represent the evolving profile of NAION in the 14th annual Hoyt lecture." @default.
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• W2609360366 date "2017-06-01" @default.
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• W2609360366 title "The 14th Hoyt Lecture Ischemic Optic Neuropathy: The Evolving Profile, 1966–2015: Comment" @default.
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• W2609360366 doi "https://doi.org/10.1097/wno.0000000000000525" @default.
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