How to treat optic nerve damage in a geriatric patient?

Question

Hello doctor,

My mother, is 76 years old, currently suffering from low, blurry vision (both near sight and far sight). Her BP, sugar, and thyroid are normal.

A year before, she was critically suffered from urosepsis with AKI, DM II, pleural effusion, etc. but recovered. Though she has the first stage of renal failure and ventricular ectopic in ECG now. Recently she visited an eye hospital where she was told that her eye problem is mainly due to gradual damage of optical nerve, which is irreversible and the doctor cannot do much. In this respect, she was tested with digital fundus photography and OCT (Retina -Tessellated fundus in the right eye, FR dull in left eye).

As per doctor's mention, I come to know that she has some cataract in the right eye (nuclear sclerosis grade II diagnosed in both eye) which need to operate soon for better vision, but I am not sure about it as it is not written in prescription as a diagnosis. She is advised to take a drop of Bimatoprost 0.01 percent in both eyes every day to control optical damage. Now, I like to know is this medicine helpful if she complains with optical nerve damage without glaucoma or cataract.

Is there any other solution to save her vision or further damage at least.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns.

I am very sorry to hear about your mother's eye changes. I am afraid that the changes in the optic nerve are indeed irreversible and according to the reports is near total. This is known by the part of the reports that say CDR 0.9 in both eyes. To explain it in a very simple manner, the eye is like a camera, both have lenses, and just like the camera has a film, the eye has the retina.

If there is a problem in both the lens and the film, simply changing the lens would not improve the quality of the picture as the film (retina) is also compromised. But in few cases may improve to a limited, yet unknown extent. The problem also gets compounded with her poor general condition with heart problems along with the recent sepsis. So operating on her cataract is quite risky.

Regarding the eye drops, Brimonidine eye drops have been known to help in neuroprotection and may help in the preservation of whatever optic nerve function is left, theoretically. So this would be the thought process behind this plan of management given to the overall condition.

As far as the next step in managing, it depends on the daily activities of your mother and if at all she feels her current vision is not enough for her to carry out the daily routine activities.

I hope it helps.

In case you need more information, please let me know.

Thank you.