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Inferior altitudinal visual field loss symptoms: When Glaucomatous Damage Isn’t Glaucoma

It is important to recognize that many other conditions can cause an elevated ESR and CRP, including chronic renal failure, infection, polyarteritis nodosa, PMR, systemic lupus erythematosus, rheumatoid arthritis, rheumatic fever, ulcerative colitis, regional ileitis, cardiac disease, malignant neoplasm and proteinemias.

Matthew Cox
Tuesday, November 3, 2020
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  • The only positive finding was the confrontational test revealed a left lower homonymous quadrantanopia.

  • Contrast Sensitivity Loss. Ann Intern Med Jun; 12

  • Patients who drive whilst unaware of significant field loss may fail to judge parking, negotiate obstacles or notice other vehicles at road junctions.

  • Figure 1A.

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These individuals often present with a combination of other symptoms as well, such as new onset headache, scalp tenderness, pain at the temples symptomms occipital area of the head, jaw claudication, unintentional weight loss, fever and malaise. AAION is characterized by acute unilateral vision loss that may progress to bilateral vision loss if not diagnosed and treated with haste. In Foster-Kennedy syndrome, the vision loss is—to some degree—bilateral with asymmetry. Inclusion criteria.

She had been smoking 1 packet cigarettes a day for 2 years and other medical history was unremarkable. In the literature, the most strict diagnostic criteria for Lyme neuroborreliosis requires exposure to endemic area, negative syphilis testing, no evidence of MS, positive serum Lyme testing, positive confirmatory Western blot as well as positive CSF studies. Diagnostic dilemmas in polymyalgia rheumatica. The only positive finding was the confrontational test revealed a left lower homonymous quadrantanopia. These patients usually will not present for medical evaluation until they have lost vision in one eye, and must be evaluated for GCA before they potentially lose vision in both eyes from AAION.

Greenfield DS. Vision loss is typically permanent, infefior it is imperative that this condition is treated with corticosteroids quickly to prevent bilateral blindness. Associated Problems. Diagnostic approach in a patient presenting with polymyalgia. Overall prevalence of general visual field defects was Visual acuity may be significantly impaired. Driving with Hemianopsia.

The visual field showed a superior temporal defect on the right with diffuse loss on the left, also known as a junctional scotoma See Figure 4B. Surv Ophthalmol. Bilateral Homonymous Hemianopsia: A large lesion that effects both sides of the occipital lobe can create a bilateral homonymous hemianopsia which is a loss of both sides of the visual field in both eyes and cortical blindness. Homonymous hemianopsia, also referred to as homonymous hemianopia is the loss of half of the field of view on the same side in both eyes. Any visual field defect relating to optic nerve damage can occur.

Acknowledgements

Learn More. Extraocular muscles movement were full in all directions. Prog Retin Eye Res.

Barton, MD, and T. Two simple clinical facts can help clarify the diagnosis. Homonymous Visual Field Defects. Figure 4A.

I have having blurred vision for the last while, Altitudinl went to the optician and he said all was perfect that he would refer me to specialist. The patient usually has a relative APD, color desaturation, brightness reduction and a unilateral central visual field defect. Our planned study started inwhen automated perimetry did not exist. Receive an email when new articles are posted on. He described his headache was throbbing in nature and progressed to be persistent throughout the day.

Peripheral field loss occurs with: Glaucoma inferior altitudinal visual field loss symptoms glaucoma and open-angle glaucoma. Figure 1. In the literature, the most strict diagnostic criteria for Lyme neuroborreliosis requires exposure to endemic area, infdrior syphilis testing, no evidence of MS, positive serum Lyme testing, positive confirmatory Western blot as well as positive CSF studies. In the northeast region of the United States and northern Europe, Lyme disease is a common tick-borne infection that results from the transmission of Borrelia spp. However, the most debilitating sequelae that can occur is when the visual function is impaired.

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Look for other possibilities. Reproduction in whole or in part without permission is prohibited. Apr ;22 2

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  • In our studies, the most common location of the watershed zone is in or adjacent to the temporal part of the optic disc see figure 3A and B in the article by Hayreh

  • Please refresh your browser and try again. Aulhorn ETanzil M Comparison of visual field defects in glaucoma and in acute anterior ischemic optic neuropathy.

  • She had never seen an ophthalmologist but denied any issues with her eyes or history of ocular trauma.

  • In patients who present with the typical history of acute, painless, unilateral vision loss and who have the classic findings on examination including a hyperemic and swollen optic nerve with peripapillary splinter hemorrhages and a fellow eye with a small cup to disc ratio, no additional testing is required.

At the last follow-up, 6 months later, the patient had not experienced a new altiutdinal field loss symptoms and her neurological status was stable. The difference, again, is the optic nerve appearance, pallor out of proportion to cupping, as well as color vision loss and unilateral visual acuity loss. This Issue. The left optic nerve is tilted with a healthy rim. Figure 5A. Barton, MD, and T. Optometrists must be prepared to manage patients with acute optic neuropathies.

Issue: October 10, A detailed prevalence of various types of visual field defects is given. B: MR angiography reveals no definite abnormality. We observed a patient with a rapidly developed inferior altitudinal VFD due to a small meningioma inside the optic canal, which was almost undetectable in standard imaging studies. Branch retinal artery occlusion. Large tumors in the perisellar area, pituitary adenomas or craniopharyngiomas can produce glaucoma-like optic neuropathy.

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These tests include magnetic resonance imaging with contrast media of the vessels, duplex ultrasound and positron emission tomography scanning. Saccade Training. Ocular etiologies also would need to be ruled out including central retinal artery occlusion, central retinal vein occlusion, retinal detachment and other visible causes of potential eye disease determined by a comprehensive ye examination. There are normal nocturnal fluctuations in blood pressure and Hayreh has theorized that nocturnal systemic hypotension may contribute to NAION.

Contact US. Click Here to Manage Email Alerts. Optic nerve photographs showing abbreviated superior rims that correspond with the visual field defects Figure 1A and superior displacement of the central vessels. The effect of aspirin on the visual outcome of nonarteritic anterior ischemic optic neuropathy.

Methods The data were compiled from consecutive eyes in patients that fulfilled our inclusion and exclusion criteria. Tables 4 and 5 give details of the prevalences of various categories of visual field defects seen in this study. Kwon, MD, PhD. Epub Dec The specialist

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Thus, she was not started on antihypertensive medications and instead she began a low dose aspirin. Recent changes. Fluorescein angiography in acute nonarteritic anterior ischemic optic neuropathy. Often, the optic nerve head edema is sectoral and presents with flame hemorrhages.

Generally, the more incomplete the hemianopsias, the better the potential for rehabilitation. Some clinicians will obtain these inflammatory markers in any patient over the age of 50 years who presents with an NAION but it varies from clinician to clinician depending on their level of suspicion and clinical experience. When the watershed zone is located only in the superior temporal part of the optic nerve head see figure 16 in the article by Hayreh 21it corresponds to the frequently seen inferior nasal visual field defect in NA-AION. The IONDT was a randomized, single-masked, multicenter trial examining the safety and efficacy of optic nerve decompression surgery compared with careful observation alone in patients with NAION.

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Due to the nature of the vasculitis, one or more of the following are typically elevated: erythrocyte sedimentation rate, C-reactive protein and platelets. This patient had autosomal dominant optic atrophy. Nonarteritic anterior ischemic optic neuropathy and tobacco smoking. Second, there will be a clear separation of the visual episodes between the two eyes in ION. VanderZee practices hospital-based optometry at the same facility, where he serves as chief of optometry, and also is a fellow of the American Academy of Optometry. Experience of the Optic Nerve Treatment Trial.

Optic disk size in ischemic optic neuropathy. Eyes with unreliable visual field test results were excluded. Currently, there is one industry sponsored randomized trial using a synthetic RNA to block caspase 2, an enzyme in the apoptosis cycle. In our studies, the most common location of the watershed zone is in or adjacent to the temporal part of the optic disc see figure 3A and B in the article by Hayreh

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Such presentation occurs when there is a direct insult towards bilateral occipital lobe which lies above the calcarine fissure. Please refresh your browser and try again. Cham, Switzerland: Springer;

  • Irises were normal.

  • Leonid Skorin Jr.

  • Graefes Arch Clin Exp Ophthalmol. To obtain a valid prevalence of various types of visual field defects for each isopter, the prevalence was calculated for that isopter only among the eyes that could see that target and not for the entire eyes in the study.

  • NAION has been found to occur more commonly during the warm summer months.

  • Taken together, we think that the manifestation of superior altitudinal vision defect might be rather primarily associated with an inflammatory process. Sun U.

We did not use automated perimetry because our study started before automated perimetry was available. Only eyes whose visual field test results were judged reliable were included in the evaluation. Overall, loss of the nasal part of the visual field was the most common occurrence. Levin et al.

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It showed diffuse RNFL thinning as opposed to thinning in just the superior area. Our Literature. The British journal of ophthalmology. Microscopically, there is inflammation of the arterial wall, which is patchy or segmental. N Engl J Med. Patients with a diagnosis of glaucoma and visual field loss were excluded; however, those with elevated intraocular pressure with a documented normal field before the onset of NA-AION were included.

Get free access to newly published articles. Martin, MD, for their help with the initial compilation of the data in the data forms and to W. Thus unique visual losss lesions may occur based on which vascular supply is affected. Twitter Facebook. Homonymous Quadranopsia. For example, an absolute inferior altitudinal visual field defect Figure 1 is far more visually disabling than only a relative inferior altitudinal defect, and the latter is less disabling when it is detected with I-2e rather than I-4e Figure 2. On the other hand, mis-diagnosing an intracranial mass lesion or tumor can have grave consequences.

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On the other hand, mis-diagnosing an intracranial mass lesion or tumor can have grave loss. Massive damage to the LGB can cause an incongruent homonymous, but the unique visual field losses from the lateral geniculate body relates to the dual circulation to the region. The morphology of an infarct in nonarteritic anterior ischemic optic neuropathy.

You may find the Visual Inferuor Blurred Vision article more useful, or one of our other health articles. We observed a patient with a rapidly developed inferior altitudinal VFD due to a small meningioma inside the optic canal, which was almost undetectable in standard imaging studies. Case report and review of literature. Leber's optic atrophy. Assessing for visual field defects can be via:.

Demographic characteristics. He had no history of tobacco or alcohol use, and he ate well. Click Here to Manage Email Alerts. Patients with compressive injury may exhibit visual fields that resemble those of a glaucoma patient, with arcuate or nerve fiber bundle loss and shallow optic disc cupping.

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Nonarteritic anterior ischaemic optic neuropathy and its association with obstructive sleep apnoea: a health insurance database study. Arch Ophthalmol. Wall, MD, for their helpful suggestions and critique of the manuscript. View Metrics.

The fifth reason that the prevalence of various types of visual field defects seen in our study altitudina is the characterization of visual field defects in NA-AION. The fourth reason is the distinction between relative and absolute visual field defects. In atypical presentations, neuroimaging will be indicated. Based on this presentation and literature data, we discuss some hypotheses about pathogenesis of optic neuritis in NMO and underlying mechanisms of optic neuritis development presenting with altitudinal visual defect as well. Optic Neuritis The classic presentation of optic neuritis is a sudden, unilateral loss of vision, with the distinct symptom of pain on eye movement. Epub Dec

PION is a diagnosis by exclusion, and other causes must first be inferior altitudinal visual field loss symptoms in the differential diagnosis. Xymptoms Of the patients, Aftab et al. Other less common ocular findings in GCA include retinal artery occlusion, cilio-retinal artery occlusion and sixth nerve palsy. The fourth reason is the distinction between relative and absolute visual field defects. View Large Download. Macular splitting has more negative impact on functioning especially in reading and particularly in a right hemianopsia.

Introduction

Surv Ophthalmol. Optic disc photographs showing right nerve fiber layer swelling, arteriolar narrowing and the development of synptoms optic atrophy. Her IOPs were normal, but she displayed a relative afferent pupillary defect and decreased color vision in the affected eye. However, other disorders of the optic nerve can also produce visual field findings, nerve fiber layer loss and disc appearance that can mimic glaucoma. Central scotoma was seen in

Published foeld Apr Optic neuritis. Articles from Cureus are provided here courtesy of Cureus Inc. Toggle navigation Leadership in clinical care. Journal List J Clin Neurol v. However, the left disc also had atrophy, demonstrated by relative whitening of the rim See Figure 3A. At a follow-up visit, the patient reported that not only did all of her siblings have hypertension, but one also had a NAION, and another presumably had a central retinal artery occlusion.

Dear Editor, Altitudinal visual field defect VFDwhich involves the loss of visual sensation in the horizontal half of the visual field, is caused mainly by anterior inferior altitudinal visual field loss symptoms optic neuropathy AIONaltithdinal23 or rarely by compressive neuropathy due to a tumor or aneurysm. Some patients will have vision improvement in two weeks, with gradual vision improvement up to six months. Confirmatory Western blot testing for Lyme was positive, with two of three IgM bands positive. Among many others, differential diagnoses might include central nervous system disease from cerebral mass, cerebral vascular accident, cerebral aneurysm, subdural hemorrhage and meningitis.

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Feb ;32 1 Patients can be taught the compensatory strategy of tilting the head to move the seeing area into position. Systemic hypertension, arteriosclerosis, vasospasm or medications may reduce the autoregulatory capacity of the optic disc [46] [47]. There are several differential diagnoses to consider for an adult with unilateral optic nerve head edema with an accompanying visual field defect.

He also started to have unsteady gait, followed by blurring of vision especially at downgaze. Experience of the Optic Nerve Treatment Trial. In patients ages 50 and up, acute anterior ischemic optic neuropathy AION is the most common presentation. A comprehensive ophthalmic evaluation was performed at that time by S. See More About Ophthalmology. Pupils had been pharmacologically dilated before arrival. Footnotes Conflicts of Interest: The authors have no financial conflicts of interest.

To be included in inferior altitudinal visual field loss symptoms study, an eye was required to have a definite diagnosis of NA-AION and a satisfactory and reliable visual field test result plotted ivsual a Goldmann perimeter. The temporal artery biopsy should obtain a minimum 2cm to 2. BIAVFD is one of the presentations of occipital lobe lesion, which can be due to penetrating injury such as a bullet or as direct trauma to this area. The patient usually has associated vasculopathic risk factors, including—but not limited to—hypertension, arteriosclerotic diseases, diabetes and nocturnal hypotension.

Please provide your email address to receive an email when new articles are posted on. Prog Retin Eye Res. Articles from Cureus are provided here courtesy of Cureus Inc. Current Issue.

Alward, MD, R. However, a distinction between relative and absolute visual field defects is essential for the following reasons. Graefes Arch Clin Exp Ophthalmol.

In the first picture he demonstrates his ability to wymptoms his hand to the far side. This further revealed that the most common combination is inferior and nasal absolute visual field defect in NA-AION and much less frequently involves the superior and temporal regions. Apoptosis of retinal ganglion cells in anterior ischemic optic neuropathy. Figure 5B.

His reports were quickly criticized by neuro-scientists, but decades later he was proven correct. Jul ; 7 Hemianopsias, however, are often incomplete. We found that a combination of relative inferior altitudinal defect with absolute inferior nasal defect is usually the most common pattern in NA-AION. The EP Lens.

It is helpful to classify these syndromes by location and etiology if known since their presenting visual field loss and symptoms as well as treatment and prognosis will vary. Oct ; 10 Overall, loss of the nasal part of the visual field was the most common occurrence. However, this is usually accompanied by marked focal arterial narrowing near the disc, and the patient may give a history of acute loss of vision with headache, jaw claudication, weight loss, anorexia and fever.

The prevalence of various types of visual field defects was estimated for I-2e, I-4e, and V-4e isopters by dividing the total number of eyes with the defect by the total number of eyes that could see that symptomms target. Main page. Complete homonymous hemianopsia means the entire half of the visual field is impaired. Sex Med. In nonarteritic anterior ischemic optic neuropathy NA-AIONvisual field abnormality is an important clinical criterion for diagnosis and determination of the full extent of visual loss and disability. Overall, loss of the nasal part of the visual field was the most common occurrence. There are several locations including the temporal and parietal lobes that lead to quadranopsia but studies suggest that the majority occur in the occipital lobe.

The optic discs appeared to have abbreviated superior rims, which corresponded with the visual field defect and superior displacement vsiual the central vessels and a superior peripapillary halo See Figure 1B. Acquired loss of color vision, dyschromatopsia, is a very sensitive sign of optic nerve dysfunction. Sildenafil is an effective treatment for erectile dysfunction ED by inhibiting phophodiesterase type 5 PDE5an enzyme that regulates blood flow in the penis. ON typically presents with acute unilateral vision loss and an accompanying afferent pupillary defect. Figure 3B. Prog Retin Eye Res.

In some instances, cost-effective laboratory testing and clinical observation can be used to properly diagnose these optic nerve diseases, without the need for radiology in typical, acute presentations. Other rare causes of pseudoglaucomatous optic nerve changes include late changes after methanol-toxicity and late changes in tertiary syphilis. Arch Intern Med.

A computerized tomography CT scan of the orbit and head was ordered to rule out intracranial pathology. Intraocoluar pressures were 17 mmHg. Hayreh SS. Moreover, the field loss symptoms face of automated perimetry would make such long-term studies difficult; automated perimetry is still evolving. Visual field defects in nonarteritic anterior ischemic optic neuropathy, plotted with a Goldmann perimeter using I-2e, I-4e, and V-4e targetsshow absolute inferior altitudinal defect with I-2e, I-4e, and V-4e isopters. Unlike hemianopsias, homonymous hemianoptic scotomas blindspots are smaller areas of vision loss surrounded by and area of vision.

Report of two cases. NAION has been found to occur more commonly during the warm summer months. Splinter hemorrhages of the optic nerve are common. He was then subjected to radiotherapy treatment. Conditions that can be mistaken for glaucoma include compressive or inferior altitudinal visual field loss symptoms lesions of the optic nerve, previous ischemic optic neuropathy both arteritic and non-arteriticcongenital and hereditary optic neuropathies, post-traumatic optic neuropathy and inflammatory and demyelinating optic neuritis. Static perimetry This is the most commonly used assessment. BIAVFD is mainly associated with nonarteritic anterior ischemic optic neuropathy NAAIONretinal lesion choroiditis and coloboma or optic nerve lesion glaucoma, optic disc drusen and optic nerve hypoplasia in which all of these mainly affect structures anterior to the optic chiasm [ 45 ].

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Support Center Support Center. Prog Retin Eye Res. Find articles by Sun U. Lyme titers showed positive IgM and negative IgG.

Pain in anterior ischemic optic neuropathy. Mar ;15 visusl VanderZee practices hospital-based optometry at the same facility, where he serves as chief of optometry, and also is a fellow of the American Academy of Optometry. The left optic nerve head had superior sectoral edema, blurring the superior disc margin and obscuring the adjacent vasculature. Hemianopsias, however, are often incomplete.

Twitter Facebook. In non-arteritic ischemic optic neuropathy the contralateral disc may have a small cup; the involved eye may have altitudinal pallor without cupping, but with retinal arterial narrowing. Types of visual field defects detected. The British journal of ophthalmology. Case 4. Left Brain. Conditions that can be mistaken for glaucoma include compressive or infiltrative lesions of the optic nerve, previous ischemic optic neuropathy both arteritic and non-arteriticcongenital and hereditary optic neuropathies, post-traumatic optic neuropathy and inflammatory and demyelinating optic neuritis.

In these patients, the severity of vision loss usually peaks by adolescence and they tend to be stable for many years. The Examination of the Eye article offers further details. Create a free personal account to access your subscriptions, sign up for alerts, and more. Toggle navigation Leadership in clinical care. It is imperative that she live a healthy lifestyle and see her internist as recommended to continue to monitor for vascular changes.

NICE has issued rapid update guidelines in relation to many viisual these. As in our case, neuroborreliosis requires a day course of intravenous ceftriaxone. Meningioma of the sellar and parasellar field loss symptoms pp. NAION is more common in individuals with small, crowded optic nerve heads and minute cup-to-disc ratios, as they are more prone to ischemic episodes due to structural crowding. Furthermore, they may not have any orbital signs, and may present with a normal-appearing optic disc. Conjunctiva, sclera, corneas and anterior chambers were quiet. While optic neuropathy refers to optic nerve damage from any cause, it has many specific subtypes—and they are not all created equal.

Of note, the patient had symptoms increased her physical exercise with a new gym regimen. Over the following 2 weeks, despite increasing the altitudianl dose to 1 g three times daily, serial examinations revealed progressive disc edema bilaterally and subjective blurring of vision on the right in addition to the left. Typically, the patient with exhibit a central visual field defect alone or in conjunction with other types of visual field defects in the affected eye or eyes. Table 5 gives detailed information about the prevalence of various subcategories of visual field defects seen in NA-AION in the present study.

Receive an email when new articles are posted on. This article is for Medical Professionals. Even though this strategy was believed to improve reading speed, it has little inferior altitudinal visual field loss symptoms in patients with BIAVFD and might be dangerous especially when implementing prism [ 11 ]. Some patients will have vision improvement in two weeks, with gradual vision improvement up to six months. Via the detailed illustration of this patient and literature knowledge, we discuss the possible mechanisms behind altitudinal visual field defect in distinct etiologies other than ischemic optic neuropathy.

  • Confrontation visual fields were full in the right eye and impaired infranasally in the left eye. A tip-off that this is not the case is the apparent inferior visual field loss and the topless disc appearance.

  • Therefore, our findings are likely to be different and will, we hope, provide more reliable information on the various patterns of visual field defects seen at the initial visit in patients with NA-AION. If the first temporal artery biopsy is negative, but the index of suspicion remains high for GCA, these patients should be considered for a second temporal artery biopsy on the contralateral side.

  • Her left eye had a relative afferent pupillary defect RAPD graded with a neutral density filter at 0. Kwon a.

  • This study altitduinal of a large cohort of consecutive patients with NA-AION, investigated thoroughly in our clinic at the University of Iowa Hospitals and Clinics from towho fulfilled our inclusion and exclusion criteria. The approved optometrist then reports back to their medical officers, who make the final decision regarding whether a person is safe to drive.

  • Find articles by Jookyung Lee. Conventional MRI findings.

Efficacy of unilateral versus bilateral temporal artery biopsies for the diagnosis of giant cell arteritis. Both types of perimetry have their advantages and disadvantages, and inferior altitudinal visual field loss symptoms should be aware of those when interpreting the findings. Enroll in the Residents and Fellows contest. Indocyanine green and fluorescein angiography in nonarteritic anterior ischemic optic neuropathy. Tables 4 and 5 give details of the prevalences of various categories of visual field defects seen in this study. If this error persists, please contact ITSupport wyanokegroup.

  • Visual fields, in particular, can produce results that look like glaucoma when other pathologies are at fault. October 04,

  • Enroll in the International Ophthalmologists contest. PION also occurs in patients who have had a major hemorrhagic event from trauma or a ruptured blood vessel, producing a shock-induced neuropathy.

  • Her internist recommended she begin taking 81 mg aspirin daily and ordered an ultrasound of her carotid arteries. Others recommend the patient should have a bilateral temporal artery biopsy with 5cm sections.

  • Figure 1A. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.

Ischemic symptoms usually present as posterior ischemic optic neuropathy PION with compression of the collateral branches from the ophthalmic artery in the optic canal. If your index of suspicion is high for GCA, a temporal artery biopsy should be performed. Get free access to newly published articles Create a personal account or sign in to: Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts. Remember that the image on the retina is upside down and inverted. View Metrics.

Tables 4 and 5 also demonstrate that overall, loss of the nasal part of the visual field is the most common occurrence in NA-AION. However, other disorders of the optic nerve can also produce visual field findings, nerve fiber layer loss and disc appearance that can mimic glaucoma. Cham: Springer; Semin Ophthalmol ; Sectoral edema of the optic nerve head has resolved, and the disc margin and retinal vasculature are clearly visible. A NAION is typically characterized by acute, unilateral and painless vision loss in an individual older than 50 years. Her carotid ultrasound was positive for mild atherosclerotic plaques with no significant stenosis of either internal or common carotid arteries.

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