No Association Between Non-arteritic Anterior Ischemic Optic Neuropathy and COVID-19 Vaccination
Nicholas Bellacicco1, Mustafa Jaffry1, John Benalcazar2, Kranthi Mandava1, Fahad Mostafa3, Hafiz Khan4, Nizar Souayah1
1Rutgers New Jersey Medical School, 2American University of the Caribbean, 3Texas Tech University, 4Texas Tech University Health Sciences Center
Objective:
To investigate the association between Non-arteritic anterior ischemic optic neuropathy (NAION) and COVID-19 vaccination.
Background:
NAION has been reported after COVID-19 vaccinations.
Design/Methods:
Reports filed under “optic ischaemic neuropathy” were assessed on the likelihood of being NAION or of unspecified etiology. NAION diagnosis was determined by adverse event description analysis. The reporting rate of NAION cases after COVID-19 vaccination was compared to the reporting rate of NAION after influenza vaccinations in two time periods: the COVID-19 vaccine period (December 2020-July 2021) and the pre-COVID-19 period (February 2019-September 2019). Self-controlled case series and case-centered analyses were used. Six weeks after vaccination was defined as the risk period of probable association.
Results:
43 cases with “optic ischaemic neuropathy” after COVID-19 vaccination and 0 cases after any other vaccinations were reported during COVID-19 vaccination period. 18 of these cases were likely to be NAION. 25 of these cases were assessed and the diagnostic certainty of NAION was unclear or of other etiology. 3 cases were reported in the pre-COVID-19 period after the zoster, influenza, and hepatitis A vaccines. Excluding unclear cases, the reporting rate of NAION cases after COVID-19 vaccination is not significantly different compared to after other vaccinations in comparable time periods (1.64 vs 1.57 per 10 million vaccination p= 0.942. However, this is within the incidence range reported in the general population. Using self-controlled and case centered analyses, there is a significant difference in the reporting rate of NAION after COVID-19 vaccination between the risk and control period (80% vs 6%, p< 0.0001).
Conclusions:
There is no association between NAION and COVID-19 vaccination and the reporting rate of NAION after COVID-19 vaccinations and other vaccinations is comparable. Although, NAION was reported significantly higher in the risk period compared to the control period, it is within the expected incidence range.