Protecting Remaining Optic Nerve: Strategies for Vision Preservation

Protection of the remaining optic nerve?

Q: How can I preserve the remaining optic nerve? Hello, Dr.
Gao.
I know that some people have already asked questions regarding the optic nerve.
Since treatment has been ineffective, I have been encouraged by your detailed and compassionate responses to patients.
Holding onto a glimmer of hope, I am reaching out to you.
About three years ago, I experienced issues with high intraocular pressure and iritis in my left eye.
I consulted many doctors who prescribed medications to lower the eye pressure and treat the iritis.
Initially, there was some improvement, but eventually, the pressure became uncontrollable, and the doctors were at a loss.
My eye pressure fluctuated, and my vision became blurry.
Later, it was discovered at National Taiwan University that I had corneal damage diagnosed as a cytomegalovirus (CMV) infection attacking the cornea, causing dead corneal cells to block the aqueous humor drainage, leading to increased eye pressure and subsequent optic nerve head cupping (80% damaged).
NTU provided antiviral eye drops and additional medications to lower the eye pressure.
During my follow-up visits every three months, my eye pressure remained normal (the affected left eye now has a lower pressure than the normal right eye, 9 vs.
11).
I underwent a CMV test (confirming the infection), annual corneal cell count tests, fundus photography, visual field tests, and optical coherence tomography (OCT).
I even had an immune system evaluation, which was normal.
I initially hoped that with controlled eye pressure, I could maintain the remaining visual field, but the optic nerve has continued to deteriorate.
My own perception, visual field tests, and OCT all indicate that the optic nerve in my left eye is still worsening.
Three years ago, I could not see clearly with my left eye, but I could identify large objects such as furniture, people, and vehicles.
Although it was very challenging, I could still read with my left eye.
Now, I can no longer read with my left eye at all; it is noticeably blurry.
Recently, I consulted a neuro-ophthalmologist at the Veterans General Hospital, and from what the doctor said, it seems there is no hope left.
The doctors at both teaching hospitals are very busy and also seem to be out of options...
I feel so frustrated! I know that damaged nerves cannot be repaired, but I truly want to preserve the remaining vision in my left eye.
I kindly ask Dr.
Gao to take a moment from your busy schedule to consider whether there might be other reasons for the deterioration of the optic nerve (given that my eye pressure has been normal for the past two years).
Is there any way to delay the complete loss of vision in my left eye for as long as possible? I am willing to cooperate with any method and try anything.
Alternatively, is there another doctor I could consult? Thank you, Dr.
Gao! Mr.
Gao

Gu Jia Gua Ren, 40~49 year old female. Ask Date: 2015/04/24

Dr. Gao Pilin reply Ophthalmology

Dear Mr.
Gao,
I regret to inform you that there is currently no method to completely halt the degeneration of the optic nerve.
However, research indicates that the glaucoma medication, Aifumu (also known as Latanoprost), has protective effects on the optic nerve.
If you wish to protect your optic nerve, you might consider trying this medication.
Additionally, regular monitoring of intraocular pressure, visual fields, and optical coherence tomography of the optic nerve is also important.
We hope that in the future, a medication that can regenerate the optic nerve will be developed, which would be a great blessing for us all.
Thank you for your letter, and I hope to have the opportunity to assist you.
Sincerely,
Pi-Lin Gao

Reply Date: 2015/04/24

More Info

Protecting the remaining optic nerve and preserving vision is a significant concern for individuals experiencing optic nerve damage. Based on the information provided, it seems that you have been through a challenging journey with your eye health, particularly with issues related to high intraocular pressure, iritis, and viral infections affecting your cornea. Here are some strategies and considerations that may help in preserving your remaining vision and protecting your optic nerve.

Understanding the Condition
Firstly, it is essential to understand that optic nerve damage can be irreversible. Once the nerve fibers are damaged, they do not regenerate. However, there are steps you can take to protect the remaining healthy nerve fibers and potentially slow down further deterioration.

Regular Monitoring and Follow-up
1. Regular Eye Exams: Consistent follow-up with your ophthalmologist is crucial. Regular eye exams, including visual field tests and optical coherence tomography (OCT), can help monitor any changes in your optic nerve and overall eye health. This will allow for timely interventions if any deterioration is noted.

2. Intraocular Pressure Management: Since you have a history of high intraocular pressure (IOP), it is vital to keep it under control. Medications such as prostaglandin analogs, beta-blockers, or carbonic anhydrase inhibitors may be prescribed to help manage IOP. Regular monitoring of your IOP is essential, as fluctuations can lead to further optic nerve damage.

Medication and Treatment Options
3. Neuroprotective Agents: Some studies suggest that certain medications, such as neuroprotective agents, may help protect the optic nerve. For instance, the use of topical medications like brimonidine (Alphagan) has shown potential in protecting retinal ganglion cells. Discuss with your ophthalmologist whether these options are suitable for your condition.

4. Anti-inflammatory Treatments: Given your history of iritis, ensuring that any inflammation is adequately managed is crucial. Corticosteroids or other anti-inflammatory medications may be necessary to control any ongoing inflammation that could affect the optic nerve.

Lifestyle Modifications
5. Healthy Lifestyle Choices: Adopting a healthy lifestyle can have a positive impact on your overall eye health. This includes:
- Diet: Consuming a diet rich in antioxidants, omega-3 fatty acids, and vitamins A, C, and E can support eye health. Foods like leafy greens, fish, nuts, and fruits are beneficial.

- Hydration: Staying well-hydrated can help maintain optimal eye function.

- Exercise: Regular physical activity can improve blood circulation, including to the eyes, which may help in maintaining optic nerve health.

6. Protective Eyewear: If you are exposed to bright lights or screens for extended periods, consider using protective eyewear or blue light filters to reduce strain on your eyes.

Psychological Support
7. Emotional Well-being: Coping with vision loss can be emotionally challenging. Seeking support from counseling or support groups can be beneficial. Connecting with others who have similar experiences can provide comfort and practical advice.

Research and Future Options
8. Stay Informed on Research: The field of ophthalmology is continually evolving, with ongoing research into optic nerve regeneration and neuroprotection. Stay in touch with your healthcare provider about any new treatments or clinical trials that may become available.

Conclusion
While the prognosis for damaged optic nerves can be discouraging, taking proactive steps can help protect your remaining vision and maintain your quality of life. Collaborate closely with your healthcare team, adhere to treatment plans, and consider lifestyle changes that support eye health. Remember, while the damaged nerve may not heal, preserving the function of the remaining healthy nerve fibers is possible with diligent care and monitoring.

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