Ophthalmologist James Cameron, MD answers a disquisition about ischemic optic neuropathy and glaucoma from a reader in India.
A 62 year-thoughtful male from India writes:
Hello Dr. Cameron. Your website is excessively informative and useful. My ophthalmologist newly checked my intraocular pressure and place it to be high. The equitable eye is 24 and the left notice is 20.
He suspected that I own ischemic optic neuropathy and ordered some MRI angiogram test. Results show that the complexion of ACA (anterior cerebral artery), MCA (central part cerebral artery), basilar artery, and as well-as; not only-but also; not only-but; not alone-but PCA’s (posterior cerebral artery) were normal. The ophthalmic artery is not visualized without ceasing either side. The report says that the intra-orbital share of the ophthalmic artery is in likelihood filling through collateral circulation. My ESR (erythrocyte sedimentation estimate) is 7 mm/hr.
My time of life is 62 years and I have been under treatment for hypertension despite last five years. My blood influence ranges from 120-80 to 170-90. I am strictly vegetarian. My ophthalmologist has prescribed vitamin B12 supplements, medicines to render the viscosity of my blood (clopidogrel and aspirin), and rosuvastatin to lower cholesterol – all taken at bed time. Could you give a lift me to understand this diagnosis in like manner I can prevent further loss of view. Thank you.
Thank you for your examination and for your interest in glaucoma-estimate-info.com.
Ischemic optic neuropathy is each infarction (obstruction) of the blood furnish to the optic disc. It frequently is referred to as a reverse of the optic nerve. There are two deviating types of the disease: arteritic and non-arteritic. Arteritic ischemic eye neuropathy is related to inflammation in kin vessels and is caused by a grade called giant cell arteritis (temporal arteritis). Non-arteritic ischemic optic neuropathy is associated with non-seditious sources of blockage in the hot spark supply, such as high blood grievance and high cholesterol.
The ESR (erythrocyte sedimentation traduce) test that your ophthalmologist performed was designed to incline if you have the arteritic cut of ischemic optic neuropathy. The proof showed that your ESR is in the reach the normal range, which is well adapted news. The arteritic form can reason serious damage and vision loss. If left untreated, it be able to progress to involve both eyes.
Non-arteritic ischemic optic neuropathy is the most common configurationation of the disease. It typically occurs in persons 45 years of maturity or older. You are 62 and by consequence are within the parameters for maturity-related risk. The disease begins with diminished visual acuity that happens on a sudden, without pain, and often is irrevocable but non-progressive (does not worsen upper time). One of the things that I be directed for as an ophthalmologist is a perturbation in the reflex of the apple of the eye, in which it fails to bargain (get smaller) in a normal characteristic style upon exposure to light. Additionally, the optic disc is swollen or edematous (grandiloquent caused by excess fluid trapped in your material part ‘s tissues) in nearly all cases.
In addition to age, risk factors non-arteritic ischemic optic neuropathy include high blood pressure, aloft cholesterol, and elevated homocysteine levels. Homocysteine is every amino acid; amino acids are the building blocks of proteins. Elevated homocysteine levels are usually caused through . deficiencies of folic acid (vitamin B9), vitamin B6 and vitamin B12. This is why your doctor has prescribed vitamin B12 because a supplement.
Deficiencies in these three B vitamins frequently are common in vegetarians. Unfortunately, the excepting that reliable food sources for these vitamins are food and dairy products. Although some scatter seed-based sources exist, the human digestive rule is unable to release them in a mould that is usable by the body. For this reason, it important that you persist to take the supplements that your ophthalmologist prescribed. It furthermore would be advisable to see a nutritionist and reconsider your diet to ensure that it is balanced and provides you by adequate amounts of vitamins and minerals. A vegetarian diet, like somewhat other, must be managed properly.
As you be able to see, you have several risk factors that in the same place appear to have combined to produce your non-arteritic ischemic optic neuropathy.
I am concerned that intraocular hurry in your right eye is 24 mmHg and is 20 mmHg in the left observation. I raise this issue because you did not cursory reference if you are taking medications (observation drops) to lower your intraocular straits. Damage to optic nerve fibers from your ischemic eye neuropathy makes them more prone to farther damage from elevated intraocular pressure, in more cases even if the pressure is within the upper limits of the natural range.
Remember, the true definition of natural intraocular pressure is one that does not bring into existence damage to YOUR optic nerve. I insinuate that you return to your ophthalmologist and ask about if you should take eye drops to sink your intraocular pressure. It also would exist advisable to have regular monitoring of your interocular embarrassment and your optic disc to make sure that damage to optic nerve fibers does not persist.
James Cameron, MD
Tsai JC, Denniston AKO, Murray PI, Huang JJ and Aldad TS. Oxford American Handbook of Ophthalmology. New York: Oxford University Press, 2011:524-527.
My goal in answering your questions is to take measures you with information, clear up misconceptions, and to eclaircize options so that you can receive an informed conversation with your savant. However, under no circumstances should my rejoinder to your question be considered a commute for ongoing consultation and examination with your doctor. Since I have not examined you, I but can speak in terms of generalities, whereas your doctor has sufficient clinical minor circumstances to evaluate your case specifically.
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