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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 Ischemia212 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 Ischemia153 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 Ischemia127 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 Ischemia136 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 Ischemia122 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 Ischemia154 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 Ischemia198 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 Ischemia117 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 Ischemia191 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 Ischemia103 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 Ischemia147 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 Ischemia69 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 Ischemia114 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 Ischemia70 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 Ischemia83 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 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_mani17.jpg
Non-Arteritic Anterior Ischemic Optic Neuropathy - Peripapillary Choroidal Ischemia99 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 Ischemia188 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.