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81-year-old woman has had injections in both eyes for wet age-related macular degeneration in the right eye, most recently treated April 21st of 2009 and the left eye was treated February 23rd of 2010. (2 weeks ago) Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. VISUAL ACUITY: Vision OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ afferent pupillary defect. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula is dry with patchy drusen. OS: Vertical C/D ratio is 0.2. There is a whitening of the superior and inferior pole of the optic nerve and there is patchy pigment epithelial thickening centrally. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows slightly delayed choroidal and retinal filling in the left eye. The macula stains but does not leak. The right eye has a few staining drusen. IMPRESSION: 1. ISCHEMIC OPTIC NEUROPATHY – LEFT EYE 2. ELEVATED INTRAOCULAR PRESSURE – LEFT EYE 3. WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE 4. DRY AGE-RELATED MACULAR DEGENERATION – RIGHT EYE DISCUSSION: I explained to the patient that unfortunately she has ischemic optic neuropathy. With her headaches and whitening of the nerve, there is a small possibility this could represent arteritic ischemic optic neuropathy. I am going to obtain a sedimentation rate and C-reactive protein on her within the next day or two. If those are high, she will need to be started on steroids and have a temporal artery biopsy. (these were negative) In the meantime, I asked her to take Xalatan drops in the left eye once a day to normalize the intraocular pressure. I asked her to return here in one week for an intraocular pressure check. I would appreciate it if you could obtain a visual field test on her in the near future.

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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 157 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection - Fellow eye - Reticular Pseudodrusen - Reticular Macular Disease225 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 114 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 225 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 127 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 101 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 102 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 118 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 70 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 80 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 67 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 75 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 100 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 90 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 132 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 122 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 151 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD00000
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81-year-old woman has had injections in both eyes for wet age-related macular degeneration in the right eye, most recently treated April 21st of 2009 and the left eye was treated February 23rd of 2010. (2 weeks ago) Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. VISUAL ACUITY: Vision OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ afferent pupillary defect. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula is dry with patchy drusen. OS: Vertical C/D ratio is 0.2. There is a whitening of the superior and inferior pole of the optic nerve and there is patchy pigment epithelial thickening centrally. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows slightly delayed choroidal and retinal filling in the left eye. The macula stains but does not leak. The right eye has a few staining drusen. IMPRESSION: 1. ISCHEMIC OPTIC NEUROPATHY – LEFT EYE 2. ELEVATED INTRAOCULAR PRESSURE – LEFT EYE 3. WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE 4. DRY AGE-RELATED MACULAR DEGENERATION – RIGHT EYE DISCUSSION: I explained to the patient that unfortunately she has ischemic optic neuropathy. With her headaches and whitening of the nerve, there is a small possibility this could represent arteritic ischemic optic neuropathy. I am going to obtain a sedimentation rate and C-reactive protein on her within the next day or two. If those are high, she will need to be started on steroids and have a temporal artery biopsy. (these were negative) In the meantime, I asked her to take Xalatan drops in the left eye once a day to normalize the intraocular pressure. I asked her to return here in one week for an intraocular pressure check. I would appreciate it if you could obtain a visual field test on her in the near future.