Letter to the Editor for ‘Neutrophil-to-Lymphocyte Ratio as a Marker in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy’

To the Editor,

We congratulate Polat et al. (1) for their study entitled ‘Neutrophil-to-Lymphocyte Ratio as a Marker in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy’. The Authors investigated neutrophil to lymphocyte ratio (NLR) in non-arteritic anterior ischemic optic neuropathy (NAION) patients and concluded that NLR may be used as a marker of NAION.

The authors subdivided NAION patients and control subjects into groups of subjects without any systemic disease and subjects with diabetes mellitus (DM) and/or hypertension (HT). They compared NLR between the patients and control subjects and found that NLR was significantly higher in subjects with NAION without any systemic disease than the control subjects without any systemic disease. HT and DM are known to be risk factors for NAION (2). It is therefore possible that NLR changes in NAION patients may also be caused by the NLR changes in DM and HT. For this reason, we kindly ask the authors to divide the control group into two groups according to the presence or absence of DM and HT. Then, the authors may compare the following three groups: NAION patients, control subjects with DM and/or HT and control subjects without DM and/or HT. We think that the result of this analysis may explore the changes of NLR in NAION patients in a better way.

Finally, the authors reported that 4 of 45 cases of NAION were bilateral. As we know, bilateral NAION is a rare entity. For this reason, we believe that some of the cases may be cas es with infectious (viral) optic neuritis. We want to ask the authors how they differentiated NAION from possible cases of infectious optic neuritis.