BRAO - old - sectoral optic atrophy
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74-year-old woman was seen in the office on 7/13/2010. She had cataract surgery in April in both eyes. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. Also, she notices a superotemporal shadow in that eye. The area superior to the very central vision nasally seems okay to her. The left eye is fine. She is on Omnipred and Xibrom. She does not take baby aspirin and she has not, to her knowledge, had any problem with stroke. She does have high blood pressure and high cholesterol.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/50. IOP: 15 in both eyes.
SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. The right eye has an open capsule.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. There is sectoral pallor of the superotemporal quadrant of the optic nerve. The retinal vessels all look to be intact.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. The optic nerve looks nice and pink.
OCT SCAN: The macular scan shows loss of the nerve fiber layer superior to the macula. The other retinal layers look to be largely intact in the right eye only. The left eye has a normal macular scan. The nerve fiber layer scans do show nerve fiber layer atrophy of the superior pole of the optic nerve in the right eye only.
PHOTOGRAPHS: Photos confirm clinical findings.
IMPRESSION:
1. SECTORAL OPTIC ATROPHY – RIGHT EYE
2. PROBABLE BRANCH RETINAL ARTERY OCCLUSION – RIGHT EYE
DISCUSSION: I explained to the patient there is optic atrophy in the right eye and she apparently has loss of nerve fiber layer in the distribution where her visual field loss is. This looks to probably have been from a previous branch retinal arterial occlusion, although I cannot completely rule out the possibility that it might have been from a bout of ischemic optic neuropathy. Unfortunately, at this point there is nothing to do to or for her eye. I suggested she have a visual field test done by you.
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 707 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 767 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 791 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 851 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 606 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 628 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 662 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 526 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 500 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 565 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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Sectoral Optic Atrophy from an old Branch Retinal Artery Occlusion 567 views74-year-old woman had cataract surgery 3 months ago. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. OD is 20/60, OS is 20/50
(0 votes)
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74-year-old woman was seen in the office on 7/13/2010. She had cataract surgery in April in both eyes. Her vision in the right eye has been abnormal since. She notices a shadow in the inferior vision in the right eye. Also, she notices a superotemporal shadow in that eye. The area superior to the very central vision nasally seems okay to her. The left eye is fine. She is on Omnipred and Xibrom. She does not take baby aspirin and she has not, to her knowledge, had any problem with stroke. She does have high blood pressure and high cholesterol.
VISUAL ACUITY: Vision OD is 20/60, OS is 20/50. IOP: 15 in both eyes.
SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. The right eye has an open capsule.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. There is sectoral pallor of the superotemporal quadrant of the optic nerve. The retinal vessels all look to be intact.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. The optic nerve looks nice and pink.
OCT SCAN: The macular scan shows loss of the nerve fiber layer superior to the macula. The other retinal layers look to be largely intact in the right eye only. The left eye has a normal macular scan. The nerve fiber layer scans do show nerve fiber layer atrophy of the superior pole of the optic nerve in the right eye only.
PHOTOGRAPHS: Photos confirm clinical findings.
IMPRESSION:
1. SECTORAL OPTIC ATROPHY – RIGHT EYE
2. PROBABLE BRANCH RETINAL ARTERY OCCLUSION – RIGHT EYE
DISCUSSION: I explained to the patient there is optic atrophy in the right eye and she apparently has loss of nerve fiber layer in the distribution where her visual field loss is. This looks to probably have been from a previous branch retinal arterial occlusion, although I cannot completely rule out the possibility that it might have been from a bout of ischemic optic neuropathy. Unfortunately, at this point there is nothing to do to or for her eye. I suggested she have a visual field test done by you.
