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Delayed visual decline in patients with "stable" optic neuropathy
Jonathan W Kim1, Joseph F Rizzo, Simmons Lessell
1The Massachusetts Eye and Ear Infirmary and the Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Background:
Histological studies on the human optic nerve have documented decreasing axonal nerve fiber counts with age. In patients with optic atrophy, a nonpathological dropout of ganglion cell axons as part of the normal aging process may become clinically significant.
Objective:
To describe the occurrence of delayed visual loss in patients with presumably "stable" optic neuropathy.
Methods:
We reviewed the medical records of 3 patients who experienced slowly progressive visual loss in adulthood after suffering childhood optic nerve injury.
Results:
All 3 patients had a monophasic illness in childhood that caused bilateral optic atrophy and visual impairment. Following decades of stability, each suffered a gradual, symptomatic visual decline that extended over years. No new ophthalmologic, systemic, or neurologic disorder was found that explained the visual decline in any of these patients.
Conclusion:
We hypothesize that the late visual decline in these 3 patients resulted from deleterious effects of age-related axonal loss on an already depleted population of neurons.
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