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Abstract #10089 Published in IGR 6-1
Anterior ischemic optic neuropathy in eyes with optic disc drusen
Purvin V; King R; Kawasaki A; Yee RArchives of Ophthalmology 2004; 122: 48-53
BACKGROUND: There have been anecdotal reports of anterior ischemic optic neuropathy (AION) occurring in eyes with optic disc drusen (ODD), but the clinical features of this condition have not been well characterized. OBJECTIVES: To better describe the clinical features of AION associated with ODD and to compare the clinical features of this condition with those of 'garden variety' nonarteritic AION. METHODS: The authors reviewed the medical records of 20 patients who experienced an episode of AION in an eye with ODD. In four patients, both eyes were affected; thus, 24 eyes were studied. The diagnosis of ODD was made by ophthalmoscopic identification, orbital ultrasonography, or computed tomographic scanning. They recorded age, sex, vascular risk factors, symptoms, visual acuity, visual fields, and results of the follow-up examination in all patients. These findings were compared to data from previously reported series of patients with nonarteritic AION. RESULTS: The 20 patients included 14 males and six females (age range, 18-69 years; mean, 49.4 years). Vascular risk factors were identified in ten patients (50%). Three patients reported episodes of transient visual loss before their fixed deficit. The visual acuity at the initial examination was 20/60 or better in 15 (62%) of the 24 eyes; eight had a visual acuity of 20/20. The predominant pattern of visual field loss was an altitudinal or arcuate defect in 19 (79%) and a centrocecal scotoma in five (21%) of the 24 eyes. There was subjective worsening of vision before the initial neuro-ophthalmic examination in 11 eyes (46%) and objective documentation of progression in seven eyes (29%). The final visual acuity was 20/40 or better in 13 (62%) of 21 eyes and 20/200 or worse in three (14%) of 21 eyes. CONCLUSIONS: These patients were strikingly similar to those with nonarteritic AION unassociated with drusen in regard to prevalence of vascular risk factors, pattern of visual field loss, and occurrence of a subsequent similar event in the fellow eye. However, in contrast, patients with ODD-AION were younger than those with nonarteritic AION, were more likely to report preceding episodes of transient visual obscuration, and enjoyed a more favorable visual outcome.
Dr. V. Purvin, Midwest Eye Institute, Indianapolis, IN 46280, USA. vpurvin@iupui.edu
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
