Professor Anthony C Arnold
This presentation summarizes a study designed to identify the spectrum of clinical and fluorescein angiographic features of optic disc ischaemia in patients younger than 50 years. The retrospective case series consisted of two phases. The first compared 108 cases of nonarteritic anterior ischaemic optic neuropathy in patients younger than 50 years (NAIONy) to a cohort of 108 cases in patients older than 50 years (NAIONo). Predisposing risk factors, fluorescein angiographic features, and clini-cal course were compared. In the second phase, 12 cases of diabetic papillopathy under age 50 were assessed by fluorescein angiographic criteria for evidence of optic disc ischaemia and compared to patients with NAIONy.
NAIONy comprised 108 (12.7%) of 848 NAION cases reviewed. Fellow eye involvement rate was significantly higher for NAIONy (42.6%) patients, than for NAIONo (29.6%). Fluorescein angio-graphic features of ischaemia were documented in 81.5% of eyes studied. In one case, these features were documented for optic disc oedema prior to visual loss. Diabetic papillopathy demonstrated similarly delayed filling consistent with ischaemia, even without significant visual field loss. We conclude that ischaemic optic neuropathy in patients younger than 50 years is not rare. A spec-trum of optic disc ischaemia ranging from perfusion delay without visual loss to severely impaired perfusion and visual loss includes optic neuropathies previously considered nonischaemic.