Anterior Ischemic Optic Neuropathy (PowerPoint)

The patient is a 62-year-old female who presented in August 1996 with visual loss OD that she first noted as loss of her superior field in May 1996. She felt that it had been static since, and perhaps was even a little better in the week before she was seen. There was no pain, even with ocular rotation, no change in her perception of color or brightness, and no antecedent systemic illness. Her past medical history included several years of hypertension and arthritis of the lower back for 10 years, and she had no constitutional signs of temporal arthritis. The only other neurologic history was of mild right leg weakness noted on May 14, 1996. She also had a hiatal hernia. There was no history of diabetes. She had undergone prior evaluations before her visit. These included a negative MRI as well as a normal spinal tap. She had a known right carotid bruit that had led to carotid noninvasives that were normal. Her sedimentation rate was 54. Her initial neuro-ophthalmologic examination showed that her acuity was 20/30+ OD, 20/40 OS. American Optical color plates were 10/15 correct OU. Exophthalmometry at a base of 96 was 21.5 right eye and 20 left eye, with normal retropulsion. The pupils were 5 mm OU, sluggish OD, RRL OS, with a 1.5-1.8 log unit RAPD OD. Her motility was normal, there was no ptosis, and the cranial nerves were normal. The fields are shown in Images 97_49, 97_50, and 97_51. She also had hypoplastic optic nerve heads, OS>OD. The fluorescein angiography was performed 3 months into her course, at the time of initial neuro-ophthalmologic examination.