NANOSNET

What is the longest period of time someone has seen for persistent disc edema after the acute visual loss in a patient without disc drusen who remained on their GLP-1 meds?

Yesterday, I saw for the first visit, a woman without much in the way of vascular risk factors aside from non-diabetic metabolic syndrome, who was seen by an ophthalmologist when she had left sided visual loss with disc edema 14 months ago.  She had been on wegovyfor about 18 months when she had the left sided visual change.  She remained on the medicine (I do not  think the association with GLP-1 was considered) and then lost vision in the other eye a month ago.  But the initial eye still has disc edema 14 months in, although she only stopped the GLP-1 a few weeks ago.   She had a reasonable workup initially, I will get an LP after a repeat MRI, but am I wrong in thinking that remaining on the GLP-1 long after disc involvement should not lead to persistent disc edema for this long, or has someone seen this behave more like amiodarone withquite  persistent disc edema?

What a strange scenario. Was a fluorescein angiogram done to distinguish true disc edema from a post-edema gliosis akin to what we see in post-papilledema? 

Infiltrative is precisely what I am thinking.

Did not do a FA.   She has neither PHOMS , nor vit-pap traction.

And she has no symptoms of elevated ICP

Larry, 

I'd like to see a picture of the disc because if it is focal temporal swelling and elevation of the nerve w overlying epipapillary telangiectatic vessels you can always have what Lawton used to refer to as pseudohamangioma of the optic nerve following an AION with other people referring to the entity as luxury perfusion of the disk, and these patients in my experience often maintain excellent central acuity in spite of the arcuate defects from

their AION. This swelling can persist for prolonged periods 

Matt

I

If they are not accurate, an AION seems unlikely. 

Well, they were neither accurate nor arcuate, meaning that she was not great in terms of reliability.  But also, her color vision loss is out of proportion to her acuity drop.  I have already told the patient and referring docs that I do not believe this was NAION, I am just looking for group experience regarding if whether in cases where we do think it is GLP-1, how long does disc edema persist.

I've had a couple of unusual cases where they were actually swelling in the second eye at presentation, or shortly thereafter but was asymptomatic without associated field loss, and then  months later on the order of perhaps 4 months, the second eye deteriorated becoming symptomatic. My presumed GLP1 cases, once symptomatic, act in similar fashion to an otherwise typical AION with the edema resolving over a couple of months or perhaps a little longer.

I forgot to add in that the cases of prolonged swelling prior to visual loss in these unusual cases of bilateral involvement at presentation are similar to what we always described  as pre-ischemic papillopathy or incipient AION which certainly can persist for months prior to visual loss or spontaneously resolve without visual loss.