Optic atrophy is understood in medicine to be the degradation of the optic nerve cells, as can occur in the context of various primary diseases. The autoimmune disease multiple sclerosis is one of the most common causes of optic nerve inflammation and the resulting octic atrophy. Treatment for atrophy depends on the cause.
What is Optic Atrophy?
Optic atrophy is a degenerative disease of the optic nerve. Along the optic nerve, the nerve cells break down as part of the disease. Cell loss can lead to blindness. Optic atrophy is one of the most common causes of blindness. In adolescents and children, the disease usually progresses much faster and more severely than in older people. Depending on the cause and appearance, several forms of atrophy are distinguished. See usvsukenglish for What does the abbreviation HM stand for.
Simple optic atrophy is characterized by sharp borders and is usually non-inflammatory. The secondary forms, on the other hand, are often preceded by inflammation. Incomplete atrophy degrades the optic nerve only in sections and is characterized by temporal papillae pallor. The hereditary form, which can occur as part of various hereditary diseases, must be distinguished from these three forms. The nerve tissue atrophy is either unilateral or bilateral. The nerve fibers can also be affected by the breakdown processes, as can the surrounding myelin sheath.
Causes
In principle, all lesions and diseases of the optic nerve can cause the atrophy. Increased intracranial pressure with papilla congestion is just as likely a trigger as a traumatic optic nerve lesion or glaucoma. Just as often, the degenerative manifestation is preceded by optic neuritis or ischemia.
Nerve compressions are also conceivable, for example in the context of a superior orbital fissure syndrome, a meningioma of the optic nerve sheath or a tumor in the optic nerve crossing. Toxic causes caused by alcohol, tobacco, quinine, arsenic, lead or bromine must be distinguished from these causes. The hereditary form of optic atrophy can in turn occur in the context of diseases such as Behr syndrome I, sensory motor neuropathy VI, limb girdle dystrophy 2O or Tay-Sachs syndrome, Cohen syndrome and metachromatic leukodystrophy. If primary atrophy is present, malfunctions in the subcellular tissue are to be named as the cause.
Symptoms, Ailments & Signs
The symptoms of optic atrophy differ depending on the cause. The cause decides, for example, whether the optic nerve degenerates unilaterally or bilaterally. The subjective perception of the symptoms is also different and ranges from subjectively felt asymptomatic to reduced visual acuity and visual field defects. The visual field defects are the most characteristic symptom of the disease.
These failures have different characteristics. They are mostly due to an increasing loss of central visual acuity, which can escalate to the point of blindness. The color perception of those affected is often disturbed. The same applies to the dark adaptation of the eyes. Sometimes there is also a disorder of the pupillary reaction. Hereditary disorders in particular have a progressive course, which often ends in amaurosis. Patients usually do not complain of pain. Especially in the case of inflammation-related atrophies, slight pain cannot be ruled out.
Diagnosis & course of disease
The diagnosis of optic nerve atrophy includes the anamnesis, visual acuity testing and perimetry. Funduscopies can also help the doctor make a diagnosis. The optic nerve and orbital or intracranial structures are visualized using an imaging technique such as MRI. Possible causes such as masses can be read from the imaging. The fundus is examined via ophthalmoscopy.
With this procedure, optic nerve atrophy usually shows pallor associated with discoloration of the papilla. The course of the disease depends on the cause. In the case of hereditary progressive forms of atrophy, a rather unfavorable prognosis is often to be expected. This form often leads to blindness.
Damage to the optic nerve that has already occurred is irreversible. Under certain circumstances, depending on the cause of the disease, further damage can be prevented in the future. Optic atrophy as a symptom of various diseases sometimes has diagnostic value for the doctor.
Complications
As a rule, the complications and also the symptoms of optic atrophy depend very much on their cause. In any case, those affected suffer from visual problems with this disease. The optic nerve and the associated cells are degraded, which can lead to visual problems or, in the worst case, a complete loss of vision.
Losses in the visual field can also occur as a result of optic atrophy and continue to significantly reduce the patient’s quality of life. Likewise, blindness can lead to a disturbed perception of the different colors. However, there is no particular pain or other complications. Especially in young people or children, blindness can lead to severe mental health problems and depression.
For this reason, they are also dependent on psychological treatment in the case of optic atrophy. However, life expectancy itself is not affected by optic atrophy. Direct treatment is not possible. Vision cannot be restored, especially after going blind. If the optic nerve atrophy occurs due to inflammation, it can be treated with antibiotics. Tumors are removed using radiation therapy.
When should you go to the doctor?
If there is a loss of nerve cells on the optic nerve in one eye, a doctor’s visit is essential. The right contact person is an ophthalmologist. Optic atrophy leads to a loss of visual field in both mild and severe cases. There is a loss of visual acuity. Regardless of whether the sequelae are serious or not, a doctor’s visit is advisable because the optic atrophy is progressive.
The diagnosis cannot be made without examining the fundus of the eye. The search for the cause of the disease then begins. Optic atrophy is triggered by a variety of causes such as inflammation of the optic nerve, increased intracranial pressure, but also chronic alcohol or tobacco intoxication. It is important to also treat the causes of the optic atrophy. Therefore, they must be identified whenever possible. Whether the atrophy of the nerve cells occurred as a result of or during another disease is of secondary importance for the treatment.
An MRI scan may provide information about how far the optic atrophy has progressed. Blindness occurs at the end of the progressive degeneration of the nerve cells. The problem is that optic atrophy can also occur in children. In this case, the damage to the nerve cells is usually rapid. Therefore, the ophthalmologist should be consulted earlier in children than in adults. Early detection and immediate treatment play a key role in optic nerve degeneration.
Treatment & Therapy
Since damage to the central nerves is irreversible, there is no complete cure for an optic atrophy that has already occurred. The treatment depends on the causative disease. While some hereditary forms of atrophy are untreatable, other causes of degeneration can be treated or even cured. Inflammation of the optic nerves in particular can usually be treated at least symptomatically.
In most cases, the autoimmune disease multiple sclerosis is the primary disease associated with optic nerve inflammation. However, an inflammatory MS attack on the optic nerve can often be interrupted by medication such as cortisone in order to save the nerve. However, the recurrence of the inflammation cannot be ruled out. In the case of bacterial infections of the optic nerve, the doctor administers antibiotics that pass through the liquor and thus controls the damage to the optic nerve.
Causative tumors are removed as far as possible or treated with radiation therapy. If, on the other hand, increased intracranial pressure has caused the optic atrophy, a reduction in pressure is induced, for example by draining the cerebrospinal fluid. In the case of causal glaucoma, drug therapies and laser treatments are possible therapeutic options.
Outlook & Forecast
In the case of optic atrophy, it is important to treat the underlying disease as quickly as possible. This is the only way to avoid irreparable damage. As a result, the prognosis in the absence of treatment is unfavorable. Damage to the optic nerve is irreparable. They ensure that the ability to see is permanently severely restricted.
However, the question now is which factors caused optic atrophy. All treatment options, and also the prognosis to be expected, are defined by the triggering underlying disease. These can be tumors, increased intracranial pressure, alcohol poisoning, viral diseases of the eye or other triggers.
Due to the variety of triggers, an identical prognosis cannot be given for all cases. The prognosis initially depends on the general state of health of the eye. It is also important to treat the triggering disease quickly and successfully, which is affecting the optic nerve.
The treatment of a viral disease is lengthy. According to a study, Leber’s hereditary optic neuropathy can be successful with the drug idebenone. This is proof that an early and consistent treatment of the underlying disease can minimize the extent of the optic atrophy it causes. The death of the nerve cells on the optic nerve cannot be prevented. However, if treatment is started early, the usual vision can be largely retained.
Prevention
Optic atrophy cannot usually be prevented. This is especially true when the degenerative phenomenon occurs as part of hereditary diseases or multiple sclerosis.
Aftercare
In most cases, those affected with optic atrophy have very few follow-up measures available. First and foremost, with this disease, a doctor must be contacted at an early stage so that other compilations or further deterioration of the symptoms do not occur. As a rule, self-healing cannot occur, so that those affected by this disease are always dependent on medical examination and treatment.
The sooner a doctor is consulted, the better the further progression of the disease. Those affected depend on the intake of different medications. It is always important to ensure the right dosage with regular intake in order to alleviate the symptoms permanently and, above all, in the long term.
Regular check-ups and examinations by a doctor are also very important, as they monitor and control the current state of the body. In many cases, however, those affected are dependent on the help and care of their own families. Loving conversations are also very important here, as this can prevent depressive moods or other mental illnesses.
You can do that yourself
Patients with optic atrophy must wear appropriate visual aids. In order to preserve or even improve the eyesight, vision training and targeted protection of the eyes are recommended. If you sit in front of the screen for several hours a day, you should take a break once or twice every hour. Eye drops can help relax the eyes. Affected people should talk to their doctor about supportive measures and implement them in a targeted manner. Optic course atrophy cannot be treated causally, but the measures mentioned can stabilize vision and thus improve well-being in the long term.
People who, despite wearing glasses, suffer from visual disturbances or other complaints such as headaches or dizziness should inform their doctor. There may be another condition that needs to be diagnosed. In the case of optic atrophy, the eyes should also not be exposed to strong external stimuli such as direct sunlight or draughts. Hygiene measures such as regular dusting and weekly change of bed linen help to protect the eyes and prevent further deterioration of vision.
In addition to glasses, contact lenses or an operation in which the eyesight is improved via laser treatment are also possible. After such a procedure, it is important to follow the doctor’s instructions to avoid permanent damage to the eye and to ensure optimal recovery.
