Had a 25yo male presented for routine eye exam, no complaints. BVA 20/20 OD,OS,OU. No APD, no visual field defect, normal color vision, no decrease in acuity, IOP normal. Both optic nerve heads were hyperemic. My question is what is a possible differential for a pt such a this with no symptoms, that is this young and has hyperemic nerves. Only significant health history is occassional tobacco use.