title: Progression of asymptomatic optic disc swelling to non-arteritic anterior ischaemic optic neuropathy.
abstract: BACKGROUND
  The time of onset of optic disc swelling in non-arteritic anterior ischaemic optic neuropathy (NAION) is not known, and it is commonly assumed to arise simultaneously with vision loss. Our goal is to report the presence and persistence of optic disc swelling without initial vision loss and its subsequent evolution to typical, symptomatic NAION.
  
  
  METHODS
  Clinical case series of patients with optic disc swelling and normal visual acuity and visual fields at initial presentation who progressed to have vision loss typical of NAION. All subjects underwent automated perimetry, disc photography and optic coherence tomography and/or fluorescein angiography to evaluate optic nerve function and perfusion.
  
  
  RESULTS
  Four patients were found to have sectoral or diffuse optic disc swelling without visual acuity or visual field loss; the fellow eye of all four had either current or prior NAION or a 'disc at risk' configuration. Over several weeks of clinical surveillance, each patient experienced sudden onset of visual field and/or visual acuity loss typical for NAION.
  
  
  CONCLUSIONS
  Current treatment options for NAION once vision loss occurs are limited and may not alter the natural history of the disorder. Subjects with NAION may have disc swelling for 2-10 weeks prior to the occurrence of visual loss, and with the development of new therapeutic agents, treatment at the time of observed disc swelling could prevent vision loss from NAION.
authors: Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors: Prem S
authors: http://orcid.org/0000-0001-5824-8322
authors: PS
authors: Subramanian
authors: Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA.
authors: Lynn K
authors: LK
authors: Gordon
authors: Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA.
authors: Laura
authors: L
authors: Bonelli
authors: Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA.
authors: Anthony C
authors: AC
authors: Arnold
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000473:pathology* / Q000503:physiopathology; D010211:Papilledema / Q000473:pathology* / Q000503:physiopathology; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
keywords: Field of vision; Optic Nerve