Woman presents with transient visual obscurations

A 32-year-old woman with a medical history of hypertension and obesity and an ocular history of myopia presented to the comprehensive ophthalmology clinic for recurrent, transient bilateral vision loss over a 4-month period. The vision loss was occurring four to five times per day and lasting 2 to 3 minutes with complete spontaneous resolution. The visual symptoms were associated with postural changes and headaches.On initial examination, best corrected visual acuity was 20/25- in the right eye and 20/20 in the left eye. Color vision was intact bilaterally. Confrontational visual fields were full in the right eye with an inferotemporal deficit in the left eye. Both pupils were equal in size and reactive to light without afferent pupillary defect. Extraocular movements were full bilaterally. IOPs were normal. Slit lamp examination was unremarkable. Dilated funduscopic examination showed Frisen grade 3 to 4 optic nerve edema bilaterally (Figure 1).