Incipient Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

A 61-year old white man with hypertension, diabetes, and dyslipidema was seen in neuro-ophthalmology consultation for asymptomatic right optic disc edema. He had a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). He had normal visual function including normal 24-2 SITA-Fast Humphrey visual fields in both eyes (Figure 2). MRI of the brain and orbits was normal without any signs of an optic nerve sheath meningioma or chronically raised intracranial pressure (Figure 3). Optical coherence tomography of the optic nerve did not show any evidence of vitreopapillary traction (Figure 4). The patient was followed and he continued to maintain excellent visual function and his right optic disc edema resolved 4 months after his initial visit (Figure 5). [[Figure 1. Optic disc photos of both eyes demonstrating right optic disc edema and a left small, crowded optic nerve ("disc-at-risk"). Figure 2. Normal 24-2 SITA-Fast Humphrey visual field in the right eye. There is one dot (depression centrally) in the left eye, which may be an artifact. Figure 3. Normal MRI of the orbits with contrast. There were no sign of optic nerve sheath meningioma. The brain MRI did not show any sign of intracranial hypertension. Figure 4. Normal Spectralis optical coherence tomography of the optic nerve. Figure 5. Optic disc photos and pattern deviation from the 24-2 SITA-Fast Humphrey visual field. He maintained excellent visual function and his optic disc photos resolved 4 months after his initial visit.]]