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Eye and Vision Care

Untreatable, Unexplained Sudden Vision Loss?

01/26/2010

Question:

My father, age 58, loss the majority of his vision in right eye in approx 1993. The deterioration occurred practically overnight. There was no discovery of why. In 2007, he experienced something similar in the left eye, where the deterioration was about 100% in 3 days. He can see light, but no vision, but a small peripheral of the light . Within a couple of weeks, he gained 20/-60 in his right eye, but can’t see anything below eye level…the peripheral vision is gone. He has been to numerous professionals, including Retinal specialist, Neuro Ophthalmologist, Mayo Clinic, Vanderbilt. No one can explain what it is, or why it possibly occurred. Earlier in 2009, he had a legion to show on a brain scan, but it subsided, and there was no explanation of that either. He has been on medication for cholesterol (Lipitor 20mg) and blood pressure (Metoprolol 25mg), since bypass surgery in 2003. Although he has never, and still does not have high blood pressure or cholesterol.

Macular Degeneration, Strokes, blood infections , diabetes, brain swelling have all been ruled out. They have all said there may have been a swelling of the optical nerve, but it is not swollen now. They have also all said for his age he is a healthy person, even after bypass.

Prior to this last vision loss, he was in the hospital in Jan 2008 for cellulites His loss began about 2 weeks after leaving the hospital. Every professional has also ruled that there is no correlation between the two events.

I find all of this very confusing. I cannot believe that in the 21st century there is simply "no answer" to this sudden loss. Is there ANYTHING you would recommend me to further research? And, is there ANYWHERE he can go for actual answers?

Thank you very much for your time.

Very Concerned Daughter

Answer:

Wow, this presentation is very unusual. In addition, since some of the best doctors in America have already seen your father, I doubt that I can add anything to their hands-on examinations.

It does sound like an optic nerve disease. That would explain its sudden onset and resultant loss of peripheral vision. Retrobulbar neuritis (RBN) and anterior ischemic optic neuropathy (AION) would be two possible explanations. You can google these words to see if his risk factors match any for these two possible diagnoses. Also, I've never heard of prescribing hypertension and cholesterol medications without first establishing a specific diagnosis for those systemic diseases.

The fact that he had bypass surgery leads me to believe he may have or have had carotid artery disease. The carotid arteries are in the neck and transmit blood to the brain; one branch of it on each side feeds the eye. If the carotids are even partially blocked, that can cause blockage "downstream" in the eye, which can lead to optic nerve damage.

Regardless of the root cause(s), your father is a healthy middle-aged man who would benefit from low vision rehabilitation. If you have not already done so, ask your eye doctor for a referral to a low vision clinic in your area.

 

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Response by:

Robert D Newcomb, OD, MPH, FAAO Robert D Newcomb, OD, MPH, FAAO
Professor Emeritus of Clinical Optometry
College of Optometry
The Ohio State University