Optic Disc Neovascularization as the Only Sign of Ocular Ischemic Syndrome: A Case Report

Ocular ischemic syndrome (OIS) features ocular changes occurring secondary to carotid artery occlusive disease (CAOD). We present a unique case of a 64-year-old patient who was referred to the retina clinic due to an incidental isolated finding of left optic disc neovascularization (NVD). The patient was asymptomatic with visual acuity of 6/6 unaided and with normal intraocular pressure bilaterally. Fundus fluorescein angiogram showed hyper-fluorescence on the left optic disc with no areas of capillary dropout. Carotid Doppler and CT angiogram showed significant stenosis within the left proximal internal carotid artery (ICA) and poor visualization of flow in the distal ICA. The patient was urgently referred to the vascular team, and within four months of establishing an OIS diagnosis, she had carotid endarterectomy. As a result, NVD did not show any further progression. This case highlights the importance of community retinal screening by optometrists; that OIS can be asymptomatic, the need to consider CAOD in cases of NVD; and the importance of a multidisciplinary approach.