OpenHealth Q&A

Bilateral Ischemic Optic Neuropathy Leading to Vision Impairment

**Patient Profile:** A 36-year-old female, weighing 175 lbs and standing 5'6”, of Caucasian descent. **Main Concern:** The patient is experiencing Bilateral Ischemic Optic Neuropathy with a noticeable loss of vision in the left eye, particularly affecting the inferior nasal region. This condition presented acutely in May 2025, following earlier indications of peripheral vision complications in the right eye that were first recorded in December 2024. # ACTIVE MEDICAL CONDITIONS 1. **Bilateral Ischemic Optic Neuropathy** (diagnosed on May 17, 2025) 2. **Hashimoto's Disease** (Chronic Thyroiditis) - diagnosed 7 years prior 3. **Migraines** (recorded May 16, 2025) 4. **Increased White Blood Cell Count** (noted May 16, 2025) 5. **Visual Disturbances** (documented May 15, 2025) 6. **ADHD** - receiving treatment 7. **Depression/Anxiety** - undergoing treatment # SIGNIFICANT PAST MEDICAL HISTORY - **Five miscarriages/stillbirths** accompanied by placental clots, indicating a hypercoagulable condition. There were two successful pregnancies achieved while on Fragmin throughout. Despite no formal diagnosis of a clotting disorder, visual evidence of a clot in the placenta was observed, leading specialists to recommend its use. - **Colectomy history** - may suggest the presence of inflammatory bowel disease (IBD). - **Pseudocholinesterase deficiency** - **Febrile seizures** - resolved by the age of six. - **Childhood malaria** contracted during travels, successfully treated. # FAMILY MEDICAL HISTORY - **Mother:** Suffering from diabetes. - **Father:** Managing hypertension. - **Maternal Grandparents:** Have histories of macular degeneration, diabetes, breast cancer, and bone cancer. # ENVIRONMENTAL HISTORY - **Parental exposure to radium** post-Chernobyl disaster in Poland, occurring two years prior to the patient’s birth. - **Born in Poland** and immigrated to Australia at the age of two. - **Currently resides near a forest reserve**, presenting potential exposure to ticks. # CURRENT MEDICATIONS (as of May 2025) | Medication | Dosage | Purpose | Date Started | | --- | --- | --- | --- | | Levothyroxine | 137 mcg daily | Management of Hashimoto's Disease | Long-term | | Sertraline | 100 mg evening | Treatment for Depression/Anxiety | Long-term | | Trazodone | 50 mg nightly | Aid for Sleep/Depression | Long-term | | Dextroamphetamine-Amphetamine | 10 mg twice daily | Treatment for ADHD | Started 04/09/2025 | | Phentermine | 37.5 mg in the morning | Weight loss | Ongoing | | Prednisone | Tapering dose | Treatment for optic neuropathy | From 05/18/2025 | | Ubrelvy (Ubrogepant) | 50 mg as needed | Migraine relief | As needed | # RECENT DIAGNOSTIC EVALUATION (May 2025) ## Vision Assessment - **Visual Field Findings:** - Right eye: MD -4.44 - Left eye: MD -6.14 (indicating more severe impairment) - **OCT Findings:** Some thickening of the retinal nerve fiber layer (RNFL), with no signs of optic disc drusen observed. ## Laboratory Results ### Positive/Abnormal Findings: - **ANA:** Positive at a dilution of 1:640 (noted speckled pattern). - **Elevated White Blood Cell Count.** ### Negative Findings: - **Autoimmune Panel:** Lupus markers were negative, and complement levels remained normal. - **Antiphospholipid Syndrome Tests:** Comprehensive testing yielded negative results. - **Infectious Disease Panel:** Negative results for HIV, Lyme disease, and the JC virus. - **Hypercoagulable Workup:** Previous testing in 2015, 2017, and 2025 resulted negative. - **Autoimmune Encephalopathy Panel:** Negative results on CSF assessment. ## Imaging Results - **MRI of the Brain/Orbits:** No acute anomalies present; optic nerves appeared to be of normal size. - **MRA of the Head:** Intracranial vasculature was unremarkable. - **MRV of the Head:** No venous sinus thrombosis detected. - **MRI of the Thoracic Spine:** No signs of demyelination or multiple sclerosis changes. - **CT of the Sinuses:** Minor thickening observed in the right maxillary sinus only. - **Chest X-ray:** Results were normal. # CLINICAL TIMELINE **December 2024:** The patient experienced initial blurring of peripheral vision in the right eye; an optometrist noted bilateral optic papilledema, despite the right eye being the only affected one. The patient was referred to the emergency room where lumbar puncture and MRI tests returned negative. The vision issue resolved naturally within weeks without intervention. **February 2025:** During an ophthalmologic assessment, OCT and visual field tests were conducted, leading to a suspicion of Pseudotumor cerebri due to inconclusive MRI and lumbar puncture results. **May 2025:** Noticeable acute deterioration was observed, and the left eye experienced significant vision loss. A neuro-ophthalmology evaluation indicated suspected optic neuritis in the left eye and the patient was referred to the emergency department for further assessment. **Current state:** The patient is in the process of tapering prednisone and has recently begun aspirin therapy (325 mg), with ongoing evaluations continuing.

Answers (1)

6/21/2025, 8:50:54 PM

OpenHealth AI

I'm sorry to hear about your experience with bilateral ischemic optic neuropathy and the associated vision changes. It's understandable to feel concerned about these issues, especially given the complexity of your medical history and current symptoms.

Main Points:

1. Bilateral ischemic optic neuropathy can lead to vision impairment, and your symptoms appear to warrant careful management.
2. Prioritize self-care measures while continuing your current treatments, as recommended.
3. Regular monitoring of vision and overall health is essential in conjunction with your ongoing medications.

Explanation:

Bilateral ischemic optic neuropathy is a condition where the blood supply to the optic nerve is compromised, leading to vision loss. Given your recent and acute onset of symptoms, as well as the presence of other underlying health issues (like Hashimoto's disease), managing this condition proactively is crucial. While tapering prednisone and ongoing aspirin therapy may be beneficial, there are important lifestyle aspects to consider that can help support your overall health and well-being.

Next Steps:

1. Visual Health:

   • Routine Eye Examinations: Continue to see your eye specialist regularly for assessments of vision changes. Document any fluctuations in your eyesight.
   • Symptom Monitoring: Keep a journal of your visual symptoms, noting any changes in blurriness or loss of vision. This can help your healthcare provider adjust your treatment if needed.

2. Healthy Lifestyle:

   • Diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Omega-3 fatty acids, found in fish or flaxseed, may support optic nerve health.
   • Hydration: Drink plenty of water to maintain hydration, which is beneficial for overall health and can aid in effective blood circulation.

3. Medication Management:

   • Adhere to Prescribed Treatment: Follow the tapering schedule for prednisone and continue aspirin therapy as instructed. Discuss any side effects or concerns with your healthcare provider.
   • Review Medications Regularly: Have a dialogue with your healthcare provider about the current medications and their effectiveness for your condition, especially as you manage migraines and depression.

4. Monitoring and Support:

   • Regular Follow-ups: Schedule regular follow-ups with your healthcare provider to assess progress and managing the implications of your complex medical history.
   • Seek Support: Consider engaging with a mental health professional to support your mental health during this challenging time. This may help alleviate anxiety and depression associated with health concerns.

5. Lifestyle Adjustments for Overall Well-being:

   • Exercise: Engage in regular physical activity that is approved for your situation. This can enhance circulation, promote overall health, and may improve mood.
   • Stress Management: Techniques like mindfulness, meditation, or yoga can reduce stress, which may contribute positively to overall health.

If your vision worsens or if new symptoms emerge, re-evaluate your situation promptly. Please feel free to reach out for more tailored support or additional questions as you navigate these complexities.