Optic Nerve Atrophy: Causes, Risks, and Treatment Options

Q: Optic Nerve Atrophy: Causes, Risks, and Treatment Options

Hello, A-Wen： After an injury to the optic nerve, recovery is unlikely, and therefore, it cannot be treated. <br>However, you mentioned that your vision is still relatively good, which may indicate that your vision has not been significantly affected. <br>However, the OCT results

Optic nerve atrophy

I am 45 years old.
When I was 10, my brother hit me in the left eye with a slingshot, which likely caused a bruise that obscured my cornea, resulting in loss of vision.
I later underwent surgery to remove the bruise and suture the wound.
I would like to ask:
1.
A few days ago, I had an optical coherence tomography (OCT) nerve examination at the ophthalmologist, and the results showed that the length of the nerve fibers in my injured left eye is about 2/3 that of my right eye.
Does this indicate that there is a problem with the nerve in the left eye, possibly atrophy?
2.
Given that it has been nearly 40 years since the injury and my vision has been fine, how could there be atrophy now? If there is nerve atrophy, will it continue to worsen and lead to blindness? Could both eyes go blind? (I am very worried about losing my vision, to the point of being anxious.)
3.
If there is nerve atrophy, what treatment options are available now?
4.
I already have cataracts in my left eye, and I have had previous surgery.
If I undergo cataract surgery, will there be specific risks involved? Will the prognosis be worse if I have cataract surgery under these circumstances? Thank you very much for your response, Doctor.

Awen, 40~49 year old female. Ask Date: 2021/06/17

Dr. Gao Pilin reply Ophthalmology

Hello, A-Wen: After an injury to the optic nerve, recovery is unlikely, and therefore, it cannot be treated.
However, you mentioned that your vision is still relatively good, which may indicate that your vision has not been significantly affected.
However, the OCT results show some signs of nerve atrophy, which may suggest some impact on your visual field.
The other eye should not be affected.
If there has been an injury to the eye and cataract surgery is performed, the vision may not be as clear as in a normal eye, but it should be an improvement compared to the current state.
If your doctor recommends surgery, they have likely assessed the risks, so you can feel reassured.
If the doctor does not recommend it, it indicates a higher risk with uncertain prognosis.
Online answers can only serve as a reference; it is essential to seek medical care at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Best regards, Gao Pi-Lin.

Reply Date: 2021/06/17

More Info

Optic nerve atrophy is a condition characterized by the degeneration of the optic nerve, which can lead to vision loss. Understanding the causes, risks, and treatment options for this condition is crucial, especially for someone with a history of eye trauma like yourself.
1. Understanding Optic Nerve Atrophy: The optic nerve is responsible for transmitting visual information from the retina to the brain. Damage to this nerve can occur due to various reasons, including trauma, ischemia (lack of blood flow), inflammation, or diseases such as glaucoma. In your case, the injury from the slingshot at the age of 10 may have caused some initial damage that could have led to a gradual degeneration of the optic nerve over the years. The fact that the length of the optic nerve in your injured eye is about two-thirds of that in the uninjured eye suggests that there may indeed be some atrophy present.

2. Delayed Onset of Symptoms: It is not uncommon for symptoms of optic nerve atrophy to manifest many years after the initial injury. The optic nerve can sometimes compensate for damage, and symptoms may not appear until the compensatory mechanisms are overwhelmed. While optic nerve atrophy can lead to progressive vision loss, it does not always result in complete blindness. The extent of vision loss depends on the degree of nerve damage and whether other factors, such as the health of the retina and the presence of other ocular conditions, are involved.

3. Treatment Options: Currently, there is no definitive treatment to reverse optic nerve atrophy. However, managing underlying conditions, such as controlling intraocular pressure in glaucoma or addressing any systemic health issues, can help prevent further deterioration. In some cases, rehabilitation strategies, such as vision therapy or the use of visual aids, may assist in maximizing remaining vision. Additionally, nutritional support, including antioxidants and vitamins, may be beneficial, although scientific evidence is limited.

4. Cataract Surgery Risks: Given your history of trauma and the presence of cataracts in the injured eye, cataract surgery may carry additional risks. The previous surgery you underwent to clear the blood and repair the wound may have altered the anatomy of your eye, potentially complicating future surgeries. However, many patients with a history of eye trauma successfully undergo cataract surgery with good outcomes. It is essential to have a thorough preoperative evaluation by an experienced ophthalmologist who can assess the risks and benefits specific to your situation.

In conclusion, while your concerns about potential vision loss are valid, it is important to approach the situation with a balanced perspective. Regular follow-ups with your eye care specialist are crucial for monitoring your condition and addressing any changes in your vision. They can provide personalized advice and treatment options tailored to your specific needs. If you have not already done so, consider seeking a second opinion or consulting a specialist in ocular trauma or neuro-ophthalmology for further evaluation and management.

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