Radial optic neurotomy as a treatment for anterior ischemic optic neuropathy secondary to optic disc drusen

Importance: Radial optic neurotomy (RON) was first described by Opremcak as a treatment for patients with central retinal vein occlusion (CRVO). The most common cause of visual loss in patients with optic disc drusen is nonarteritic anterior ischemic optic neuropathy (NAION). The pathogenesis of nonarteritic anterior ischemic optic neuropathy associated with optic disc drusen is assumed to be similar to the compartment-like syndrome described by Opremcak in the case of central retinal vein occlusion. Observation: An 82-year-old male with bilateral optic disc drusen presented with bilateral visual loss and severe visual field defects consistent with nonarteritic anterior ischemic optic neuropathy. A radial optic neurotomy was performed to treat the most affected eye. Postoperatively, significant and persistent improvement of visual acuity and improved automated perimetry were observed in the operated eye. Conclusion: Optic nerve head decompression by radial optic neurotomy could be a treatment option in patients with nonarteritic anterior ischemic optic neuropathy associated with optic disc drusen and severe visual field defects.