I need the group's advice in case I missed anything in the workup. My current working diagnosis is NAION.
55 year old female, not a diabetic, no previous eye surgery other than lasiklast year, not on GLP-1 currently, but is overweight. Felt that vision was fuzzy after lasik in the left eye only, but still able to see well. Saw her optometrist December 5, 2025 and vision was 20/25 but she seemed to have to move her head a bit in order to see those letters. Has been getting worse since till I saw her 12 days later. Feels her depth perception is off. NO double vision. no pain with eye movement. No exposure to tick bite or cat scratches.. No systemic symptoms of GCA.
1. normal formal visual field OD
2. incomplete superior altitude OS with nasal sparing, but central vision is poor with foveal decibel at 6, where as OD was 34 decibels
3. 20/25 OD and count fingers OS
4. 3+ APD OS, couldn't see the red cap
5. IOP 14 ou
6 no cataracts,
7.c/d 0.4 od and swollen nerve os, no associated hemorrhages, not pallid edema, 360 swelling, no retinal hemorrhages or cotton wool spots
8. OCT nerve od was normal and os was thickening of all 4 quadrants, average 193. GCC difuse thinning on the left
9. OCT retina shows no macular edema
10. FA shows disc leakage os only, they will get back to me if there was any delayed choroidal filling which I under stand is typical of NAION, no mention if there was optic disc drusen
11. sleep study pending
12. MRI brain and orbits just shows faint uptake at optic nerve head, no evidence for meningioma
13. of note was she was hospitalized last june for what they called euglycemic diabetic keto acidosis from mounjaro use, with nausea, vomitng and dehydration. hasnt used it since
labs : normal cbc, 295 platelets, sed rate 22, crp <3.0(normal), normal lipid panel
normal folate, A1C was 5.5, ANA and ANCA negative, Quantiferon Negative, lysozyme normal
Aquaporin and MOG negative, rpr and FTA negative
other than sleep study pending, anything else you would recommend or is this NAION in a 55 year old, non hypertensive, non diabetic, with other eye not a disc at risk?
thank you so much for all your help
bob
Robert Bellinoff, MD
Division Head, Eye Department, Mercy Medical Group
Site Medical Director of Midtown Medical and Surgical Specialties
Mercy Medical Group
3000 Q Street
Sacramento, CA 95816
(916) 733-3311 (O)
(916) 733-3307 (F)
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