There have been anecdotal reports of anterior ischemic optic neuropathy(AION) occurring in eyes with optic disc drusen (ODD), but the clinical featuresof this condition have not been well characterized.
To better describe the clinical features of AION associated with ODDand to compare the clinical features of this condition with those of "gardenvariety" nonarteritic AION.
We reviewed the medical records of 20 patients who experienced an episodeof AION in an eye with ODD. In 4 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. We recorded age,sex, vascular risk factors, symptoms, visual acuity, visual fields, and resultsof the follow-up examination in all patients. These findings were comparedwith data from previously reported series of patients with nonarteritic AION.
Our 20 patients included 14 men and 6 women (age range, 18-69 years;mean, 49.4 years). Vascular risk factors were identified in 10 patients (50%).Three patients reported episodes of transient visual loss before their fixeddeficit. The visual acuity at the initial examination was 20/60 or betterin 15 (62%) of the 24 eyes; 8 had a visual acuity of 20/20. The predominantpattern of visual field loss was an altitudinal or arcuate defect in 19 (79%)and a centrocecal scotoma in 5 (21%) of the 24 eyes. There was subjectiveworsening of vision before the initial neuro-ophthalmic examination in 11eyes (46%) and objective documentation of progression in 7 eyes (29%). Thefinal visual acuity was 20/40 or better in 13 (62%) of 21 eyes and 20/200or worse in 3 (14%) of 21 eyes.
Our patients were strikingly similar to those with nonarteritic AIONunassociated with drusen in regard to prevalence of vascular risk factors,pattern of visual field loss, and occurrence of a subsequent similar eventin the fellow eye. In contrast, however, patients with ODD-AION were youngerthan those with nonarteritic AION, were more likely to report preceding episodesof transient visual obscuration, and enjoyed a more favorable visual outcome.