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Traumatic optic neuropathy


TEN YEARS OF BLINDNESS CAUSED TRAUMATIC OPTIC NEUROPATHY OVERCOME AFTER TWO WEEKS OF TREATMENT WITH THERAPEUTIC ELECTRICAL STIMULATION

 

Vision deterioration that is caused by optic nerve damage typically shows a limited capacity for spontaneous and treatment-induced recovery. Developed traumatic optic neuropathy is a potentially blinding complication as the result of  head or orbital trauma. It was shown, that the degree of the eyesight loss does not always correlate with the severity of trauma. Optimal treatment of optic nerve injury in acute stage remains controversial and management of the patient suffering blindness or severe visual impairment secondary to traumatic optic neuropathy is complex and disputed. Corticosteroids treatment and decompression of the optic nerve have been advocated for use in patients who suffer from traumatic brain injury or eye trauma to elicit possible vision recovery. Optic nerve trauma is considered to be a focal central nervous system insult, the therapy of such may be supported by evidence for appropriate treatment modalities for other traumatic central nervous system events. Post-traumatic vision loss outcomes have not been studied prospectively, but it is known that spontaneous recovery may occur in at least a third of patients. Patients, who did not benefit from these standard approaches have practically no chance to improve eyesight and deteriorated vision estimated to be irreversible.

 


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Here the case of a 27-years-old male patient who suffered from severe unilateral traumatic optic nerve atrophy with nearly complete vision loss for more than for 10 years. There were no signs of progression or recovery of the visual field in the year prior to his treatment as revealed by standard perimetry results provided by the patient‘s ophthalmologist. Perimetric visual field examinations of the left eye documented a complete loss of vision in static near-threshold perimetry (Twinfield, Oculus, Lynnwood, WA). Subjectively the patient was able to detect some extra bright dots in the lower temporal quadrant of the left eye at the baseline.

"Visual Field diagnostic with Octopus 900 in Center for Vision Restoration"

After comprehensive examination (tests of visual acuity, static perimetry and kinetic perimetry) the patient received 10 sessions of therapeutic electrical stimulation over two weeks. VF examinations conducted immediately after therapy revealed vision improvement – mean perimetric threshold (ability to see test stimuli) was increased from 0 dB to 2.21 dB and kinetic perimetry showed increasing of eccentricity of visual field border by about 4 Grad as well. After 2 months, repeated VF examinations showed further improvement as well as stability of the prior improvements.

PARTIALLY RESTORED VISION, REVEALED BY STATIC VISUAL FIELD EXAMINATIONS, CONDUCTED AFTER THE TREATMENT

             Before                      After 2 weeks                After 8 weeks              After 1,5 year
Lesioned eye traumatic optic neuropathy lesioned eye VF dynamic-001
Fellow eye traumatic optic neuropathy fellow eye VF dynamic-001

Note:  White areas – intact vision, grey – residual vision, black area – blind areas

Subjectively after the treatment the patient reported his regained ability to use both eyes in daily life. Due to existed strabismus on his lesioned eye he noticed an increase of diplopia after the course of the treatment, which was a result of increased visual acuity. Follow up examinations confirmed the stable effect of therapeutic electrical stimulation as visual field enlargement.

Taking into account the young age of patient and the existing function of one eye it was important to exclude any side effects on his other eye. The right eye did not show any side effects after 10 sessions, also after 2 months and with 18 months follow up. Furthermore this eye revealed complete normalization for all VF areas, where before the therapy some areas with small defects were observed.


 

Written case let us make a following summaries:

Tick Severe impaired vision (blindness of the eye) caused traumatic optic neuropathy which can be improved after two weeks of treatment with repeated therapeutic electrical stimulation.
 Tick Significant increases in detection ability of the lesioned eye could be observed
 Tick Revealed positive dynamic in visual field correlated with the improvement of subjective vision, when the patient started to recognize contrast objects, which previously was not possible
 Tick The improvement of vision was stable after 18 months, supporting the use of therapeutic electrical stimulations as a treatment that elicits long lasting plasticity changes
 Tick No side effects were observed for fellow eye or the impaired eye as shown in the complete normalization of detection ability of all VF areas.

 

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