Cure for ischemic optic neuropathy

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Ischemic optic neuropathy is a condition that presents with sudden onset of one-sided (unilateral) reduced vision.

The condition is the result of decreased blood flow to the optic nerve (ischemia). There are two major categories of ischemic optic neuropathy: arteritic and non-arteritic ischemic optic neuropathy.

Non-arteritic ischemic optic neuropathy is due to cardiovascular disease. Patients at greatest risk have a history of high blood pressure, elevated cholesterol, smoking, diabetes, or combinations of these. Acutely, there is an abnormal pupil, a swollen optic nerve (disc edema), and peripheral or central vision loss (or both). About 70% of cases are not progressive, i.e., the vision remains stable but reduced.

No treatment is available. About 35% of patients will eventually develop bilateral ischemic optic neuropathy. Better control of underlying medical conditions that are associated with the disorder is indicated.

Arteritic ischemic optic neuropathy is caused by inflammation of vessels supplying blood to the optic nerve. The prime example is giant cell arteritis (temporal arteritis). This presents with

sudden and severe vision loss in one eye, pain in the jaw with chewing, tenderness in the temple, and fatigue. Patients often have polymyalgia rheumatica, a painful generalized form of arthritis. A blood test, the erythrocyte sedimentation rate, is significantly elevated with temporal arteritis. A temporal artery biopsy is advised to confirm the diagnosis. This is important, because treatment of temporal arteritis requires treatment with high dose corticosteroids for a year or longer. If steroid therapy is not instituted, the likelihood of blindness in the affected eye is 100 per cent and the risk of the opposite eye becoming involved is 66%.

Unfortunately, treatment with steroids does not bring back the visual loss that has already occurred. It may prevent ischemic optic neuropathy in the opposite eye. Patients may require other medications such as azathioprine or methotrexate in addition to steroids.

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