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68-year-old woman was seen in the office on 5/27/2011. She had a Bell’s palsy in the right eye in 2000. The right eye has always had some trouble because of that but then she noticed central vision loss in the right eye about a week ago. It is getting a little bit better. The left eye sees fine. She had an ear infection also at the same time. She has no headaches, no fevers, no jaw claudication, and no weakness or recent constitutional symptoms or weight change suggestive of a giant cell arteritis. VISUAL ACUITY: OD 20/160, OS 20/25. IOP: 15 OU. The Amsler grid is normal in both eyes. SLIT LAMP EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is posterior vitreous separation. There is a swelling in the inferior pole of the optic nerve. The nerve is reasonably pink though. OS: Vertical C/D ratio is 0.1. There is posterior vitreous separation. The macula and periphery look healthy. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: Does show some choroidal hyper perfusion around the optic nerve in the very early frames and then everything fills normally. In the late frames, there is leakage around the optic nerve typical for ischemic optic neuropathy. IMPRESSION: 1. NON ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY – RIGHT EYE 2. CATARACTS – BOTH EYES DISCUSSION: I explained to the patient she does have ischemic optic neuropathy in the right eye. She is leaving for Maryland Monday. Today is Friday. I gave her the name of a neuroophthalmologist to see near her home in the meantime. I told her I would be happy to see her back when she is back in town. There is a possibility this may get better. She has some difficulty tolerating aspirin. I asked her to try taking an enteric-coated baby aspirin every other day just for now to protect her other eye.

daionodchoroidalischemia_mani01.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia215 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani02.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia159 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani03.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia130 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani04.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia139 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani05.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia125 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani06.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia159 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani07.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia202 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani08.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia134 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani09.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia195 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani10.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia107 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani11.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia163 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani12.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia72 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani13.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia116 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani14.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia72 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani15.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia85 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani16.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia131 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani17.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia101 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.00000
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daionodchoroidalischemia_mani18.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia192 views68-year-old woman noticed central vision loss in the right eye about a week ago. It is getting a little bit better. OD 20/160, OS 20/25.55555
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68-year-old woman was seen in the office on 5/27/2011. She had a Bell’s palsy in the right eye in 2000. The right eye has always had some trouble because of that but then she noticed central vision loss in the right eye about a week ago. It is getting a little bit better. The left eye sees fine. She had an ear infection also at the same time. She has no headaches, no fevers, no jaw claudication, and no weakness or recent constitutional symptoms or weight change suggestive of a giant cell arteritis. VISUAL ACUITY: OD 20/160, OS 20/25. IOP: 15 OU. The Amsler grid is normal in both eyes. SLIT LAMP EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is posterior vitreous separation. There is a swelling in the inferior pole of the optic nerve. The nerve is reasonably pink though. OS: Vertical C/D ratio is 0.1. There is posterior vitreous separation. The macula and periphery look healthy. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: Does show some choroidal hyper perfusion around the optic nerve in the very early frames and then everything fills normally. In the late frames, there is leakage around the optic nerve typical for ischemic optic neuropathy. IMPRESSION: 1. NON ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY – RIGHT EYE 2. CATARACTS – BOTH EYES DISCUSSION: I explained to the patient she does have ischemic optic neuropathy in the right eye. She is leaving for Maryland Monday. Today is Friday. I gave her the name of a neuroophthalmologist to see near her home in the meantime. I told her I would be happy to see her back when she is back in town. There is a possibility this may get better. She has some difficulty tolerating aspirin. I asked her to try taking an enteric-coated baby aspirin every other day just for now to protect her other eye.