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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye Physician and Surgeon
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For about two months I have been dealing with progressive vision

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For about two months I have been dealing with progressive vision loss in the left eye. It began as a noticable blind spot located lateral to the midline. My next symptom was lateral "shimmering", which has now encompassed by entire left eye's periphery. I describe my current left eye vision as mottled. I still have the shimmering sensation in bright light. Indoors my vision is more hazy. At night I can only see things that have direct light upon them, everything else dissapears. There is no pain with eye movement, but as the day progresses I do feel some pain in the eye. Recently I have been noticing increasing floaters. I have had an MRI. I have seen two opthamologists and have done 5 visual field tests, which show worsening visual field. The original diagnosis was optic neuritis. I had 3 days of IV steroids followed by oral prednisone. My symptoms have worsened steadily despite the treatments. I am now seeing the shimmering in the left peripheral side of my right eye. I have an appointment with Mayo Clinic next week and am hopeful for some answers. Does anyone have an insight
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. James replied 4 years ago.
What has been said regarding the retina? Were you notied to have an "APD". What blood test have been ordered? Is the field loss in both eyes?

How old are you? Any medical problems?
Customer: replied 4 years ago.
There has been no indication of detachment. I am reviewing my medical record and see that Dr. Radke has an impression of peri-papillary atrophy. What is APD? I have had CBC, Herpes, Lymes, and one other I cant remember what is called. I will see If I can find it in my records. I am 32. Thanks,

Ryan
Expert:  Dr. James replied 4 years ago.
An APD tells about damage to the optic nerve. It would be positive or negative in the pupil exam. Is the peripheral loss in both eyes? Any family history of blindness?
Customer: replied 4 years ago.
Dr. Nelson one time referred to a Markus Gun (?) response when checking the pupil, but Dr. Radke did not notice this.
Customer: replied 4 years ago.
The peripheral loss has so far been in the left eye, very bad at night but worsening during the day as well. My father's grandmother was dx with glaucoma. His sister does not like to drive at night, I always thought it was just related to fear, but now I wonder if she has night vision issues. I am a paramedic, so feel free to speak in medical terms.

Thanks,

Ryan
Expert:  Dr. James replied 4 years ago.
Yes, a Marcus Gunn pupil is the same thing as an APD. This finding is suggestive of a problem with the optic nerve. Optic neuritis typically is associated with eye pain behind the eyeball with movement. Vision typically returns in about 4-6 weeks, however, with or without steroid treatment.

Optic neuropathy is another generally term for optic nerve degeneration but not associated iwth inflammation. Tumors compressing on the nerve can do this (something an MRI would pick up). You should have gotten imaging of the area around the eyeball, so the scans should have included the "orbits".

You may have something called LHON or Leber's hereditary optic neuropathy. This is a genetic disease inherited through the mother's genes. This usually affects one optic nerve, then the other a few weeks later. The appearance of the nerve is distinct. You may have a varient of this that is not typical. Genetic testing is available.

Optic neuropathy can be due to toxicity or nutritional defiency. Medications such as ethambutol, tobacco, Vitamin B6/B12 defienciency, alcohol. These things would tend to be more bilateral.

Unfortunately, optic neuropathy is a diagnosis that has obvious vision loss, but difficult to find an exact cause. What I mentioned above will likely be considered as possibility. You may undergo a repeat CT scan including the orbits, possible DNA testing, and other blood testing.

Glaucoma would be fairly easy to diagnose in patients with advance field loss. You are also very young for glaucoma. It is unlikely that.

I am unable to give you a clear diagnosis, but hopefully, this answer will give you a framework when considering all the possibilities. Best of luck to you. Please remember to press accept. Smile
Customer: replied 4 years ago.
Thank you. In further review of my records, I note that the MRI results specify "brain, with and without contrast". Would this normally include the orbits? That was the intended focus, but nothing in the report specifically reports on the orbits, only the brain is mentioned.
Expert:  Dr. James replied 4 years ago.
Orbit generally needs to be ordered separately. Because it is a fairly small space, the parameters are difference, and the xray technician needs to make sure it is imaged with thin enough cuts. CT of the orbits is usually adquate.

For unilateral vision loss, CT and/or MRI of the orbits would be helpful.
Customer: replied 4 years ago.
One last post and I will accept. Thank you for your help. I have been concerned about the quality of care I have recieved and am unsure about my visual future. If you happen to know Dr. J. Leavitt at Mayo in Rochester, let her know I will be visiting her. Have a good night,

Thanks,

Ryan
Expert:  Dr. James replied 4 years ago.
I do not know of Dr. Leavitt. I do know that Mayo is an excellent place and should receive quality care without a doubt.

Dr. Leavitt is also a neuro-ophthalmologist, which is exactly the sub-specialist you would need to see. You are in good hands. I wish you the best, Ryan.

http://www.mayoclinic.org/bio/11449829.html

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
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