Patient's question:
BR>At the age of 37, hypertension was discovered, and at 56, glaucoma recurred. After surgical treatment, it has been maintained to this day. Currently, both eyes have a visual acuity of less than 0.4. In the past two years, optic atrophy has occurred, and vision has further declined. There is concern about blindness. Is there a treatment plan available?Doctor's answer:
1. Meaning: Optic atrophy is a manifestation of degeneration of optic nerve fibers, with the main symptoms being visual impairment and pale optic disc color. The lesion is located in the retina, and when it involves ganglion cells, it can result in atrophy from the retina towards the intracranial direction, known as ascending optic atrophy, where the signs of optic disc atrophy generally appear more rapidly. If the lesion is located in the optic nerve, optic chiasm, and optic tract, it can cause atrophy that develops from the intracranial direction towards the retina, known as descending optic atrophy, where the signs of optic disc atrophy typically appear after 1 to 3 months.2. Diagnosis: For the early diagnosis of optic atrophy, simply judging from the appearance of the optic disc can sometimes be difficult, because the color and margins of the optic disc vary greatly in normal individuals. For example, myopic eyes have slightly paler optic disc colors compared to emmetropic eyes, infants have slightly paler disc colors than adults, and patients with anemia and leukemia have non-atrophic but paler optic discs compared to normal individuals. In hyperopic eyes, the margins of the optic disc may also be unclear in some cases. Therefore, some believe that the number of small vessels on the optic disc margins may help in diagnosing whether optic atrophy is present. These small vessels (referring to those that are difficult to distinguish as arteries or veins) are typically 9-10 in normal individuals, and if they decrease to fewer than 7, it may indicate optic atrophy. Additionally, using a red-free ophthalmoscope to examine the fundus shows that normal optic nerve fibers appear as fine white lines, while atrophic optic nerve fibers often appear as chaotic speckles. Visual field changes are usually concentric constriction, particularly with the nasal peripheral visual field being affected earliest. In some cases, the peripheral visual field may initially show wedge-shaped defects, which then expand towards the center, eventually resulting in concentric constriction. Furthermore, depending on the location of the lesion, various shapes of visual field defects or scotomas may also appear.
3. Treatment Measures: Etiological treatment is the primary approach. Conditions such as glaucoma, intracranial tumors, and alcoholic or toxic optic atrophy can be improved or the progression of atrophic lesions can be halted to varying degrees through corresponding etiological treatments. Secondary treatment may involve a combination of traditional Chinese and Western medicine. Once optic atrophy has developed, it is almost impossible to cure it completely, but the residual nerve fibers can fully recover or maintain their function. Therefore, it is essential to instill confidence in patients and encourage them to persist with treatment. Due to the lack of strict double-blind trials for various medications (and sometimes impractical), it is difficult to determine which drugs or methods are definitively effective. Commonly used medications include neurotrophic agents such as vitamin B1, B12, ATP, and coenzyme A, as well as vasodilators and blood-activating agents like niacin, hydralazine, vitamin E, pentoxifylline, and compound Danshen. In recent years, methods such as hyperbaric oxygen therapy, extracorporeal counterpulsation, and acupoint injection of 654-2 have shown certain effects. Traditional Chinese medicine formulas like Bu Zhong Yi Qi Tang and acupuncture treatment have long been proven effective and can continue to be used and further developed. It should also be noted that smoking and drinking strong alcohol should be avoided, physical fitness should be enhanced, and exercises such as health-preserving exercises and Qigong may also be effective in some cases. Reference