65歲劉先生一早起床，發現左眼變得模糊，但因眼睛不腫不痛不癢，未能及時就診，拖了5天才尋求門診就醫，經過眼底檢查顯示，劉先生左眼視神經盤腫脹合併出血，經診斷為「非動脈性前部缺血性視神經病變」(NAION)，俗稱「視神經中風」。
什麼是視神經中風？亞東醫院眼科部眼神經科主任黃子倫表示，「視神經」就像是一條連結眼睛和大腦的電纜線，負責把視網膜上感光細胞收集到的訊息傳遞至大腦，形成影像。眼球本體的角膜、視網膜疾病種類雖多，幾乎都已有醫療方法，唯獨視神經一旦中風，眼與腦之間的連結中斷，眼睛就看不見了。
視神經中風是50歲以上中老年人最常見的急性視神經病變，但年輕族群也有患病風險，尤其以糖尿病控制不良族群為主。視神經中風主要症狀是單眼無痛急性視力模糊，好像一層紗擋住視線，或是上、下半部視野缺損。
黃子倫指出，視神經中風症狀有時會與視網膜中風混淆，甚至有人將視線模糊誤認為老花眼，置之不理，以致延誤就醫。視神經中風急性發作後，如果沒有接受治療，四到六周後視神經盤就萎縮，視力將永遠無法恢復。
視神經中風(缺血性視神經病變)的發病率，在台灣為10萬人中有3.72人罹患，每年新增病例約900名。根據研究，視神經中風患者，產生缺血性腦中風的風險比一般人高 2.03倍；有睡眠呼吸中止症的病人，罹患視神經中風的機率比一般人多1.95倍，因此防止上述疾病的交叉出現，具有相當重要的意義。
黃子倫指出，視神經一旦中風，眼睛的對比敏感度跟視野會大受影響，嚴重時視力模糊、視野缺陷，看出去的影像殘缺模糊，甚至到達視力低於0.1的法定失明定義。由於到目前為止，還沒有出現視神經中風的有效療法，唯有在病發短短的兩周黃金治療期內緊急處理，有機會挽回一些視力。
視神經中風的危險因子？通常因夜間低血壓(臥睡血液灌流不足)、睡眠呼吸中止症(腦部以上血管缺氧)增加病變風險，及服用特定藥物下發生(如壯陽藥，導致血管急速擴張)，病人往往一早醒來，突然發現一隻眼睛不明原因看不見了。
視神經中風的確診，可藉由「免散瞳彩色眼底攝影機」，透過眼底檢查可發現病人視神經有明顯水腫，不需花費太久時間即可確診。黃子倫說明，發作的二周黃金治療期內，通常以施打類固醇做為急性治療。一旦錯過黃金治療期，就無有效治療方法，且另一眼日後也有可能同樣發生視神經中風，最終導致雙眼視力永久受損。
黃子倫呼籲，若發現急性視力模糊的症狀，切勿輕忽，一定要把握關鍵的兩周黃金治療期盡快就醫，消除視神經水腫，保護還沒受傷害的神經纖維，以及找出危險因子，以降低另一眼視神經缺血病變機率。
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Mr. Liu, who was 65 years old, got up in the morning and found that his left eye became blurred. However, his eyes were not swollen and painless. He could not go to the doctor in time. After 5 days, he sought medical treatment. After fundus examination, Mr. Liu’s left eye optic disc was swollen and merged. Hemorrhage, diagnosed as "non-arterial anterior ischemic optic neuropathy" (NAION), commonly known as "optical nerve stroke."
What is an optic nerve stroke? Huang Zilun, director of the Department of Ophthalmology, Department of Ophthalmology, Yadong Hospital, said that the "optical nerve" is like a cable connecting the eyes and the brain. It is responsible for transmitting the information collected by the photoreceptor cells on the retina to the brain to form an image. Although there are many types of cornea and retinal diseases in the eyeball body, almost all of them have medical methods. Only when the optic nerve has a stroke, the connection between the eye and the brain is interrupted, and the eyes are invisible.
Optic nerve stroke is the most common acute optic neuropathy in middle-aged and elderly people over 50 years old, but young people also have the risk of disease, especially the poor control of diabetes. The main symptom of optic nerve stroke is monocular painless acute vision blur, as if a layer of yarn blocks the line of sight, or the upper and lower half of the visual field defect.
Huang Zilun pointed out that the symptoms of optic nerve stroke are sometimes confused with retinal stroke, and some people even mistake the line of sight for presbyopia, and ignore it, so that they delay medical treatment. After an acute episode of optic nerve stroke, if there is no treatment, the optic disc will shrink after four to six weeks, and vision will never recover.
The incidence of optic nerve stroke (ischemic optic neuropathy) is 3.72 in 100,000 people in Taiwan, and about 900 new cases each year. According to the study, the risk of ischemic stroke is 2.03 times higher than that of the average person in patients with optic nerve stroke. Patients with sleep apnea are 1.95 times more likely to have an optic nerve stroke than the average person, thus preventing the crossover of the above diseases. Significance.
Huang Zilun pointed out that once the optic nerve has a stroke, the contrast sensitivity and visual field of the eye will be greatly affected. In severe cases, the vision is blurred and the visual field is defective. It is seen that the image is incompletely blurred, and even reaches the definition of legal blindness with visual acuity below 0.1. Since there has been no effective treatment for optic nerve stroke so far, it is only possible to recover some vision during the short two-week gold treatment period.
What are the risk factors for optic nerve stroke? Usually due to low blood pressure at night (insufficient blood perfusion), sleep apnea (hypoxia in the upper cerebral ventricle) increases the risk of disease, and taking certain drugs (such as aphrodisiac, leading to rapid expansion of blood vessels), patients often wake up early Come, suddenly found that one eye is unknown for unknown reasons.
The diagnosis of optic nerve stroke can be confirmed by the fundus examination through the fundus examination. It can be found that the patient's optic nerve has obvious edema and it takes no time to confirm the diagnosis. Huang Zilun explained that during the two-week gold treatment period, steroids are usually used as acute treatment. Once the gold treatment period is missed, there is no effective treatment, and the other eye may also have an optic nerve stroke in the future, which will eventually lead to permanent damage to both eyes.
Huang Zilun urged that if you find symptoms of acute blurred vision, don't neglect it. Be sure to grasp the key two-week gold treatment period as soon as possible, eliminate optic nerve edema, protect nerve fibers that have not been damaged, and identify risk factors to reduce the other. One eye optic nerve ischemic lesion probability.
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