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Optic Atrophy Medication

  • Author: Rashmin Gandhi, MBBS, FRCS(Edin), FRCS(Glasg); Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Sep 12, 2014

Vitamin, Water Soluble

Class Summary

Essential to normal metabolism and DNA synthesis.

Cyanocobalamin (Nascobal)


Deoxyadenosylcobalamin and hydroxocobalamin are active forms of vitamin B-12 in humans. Vitamin B-12 synthesized by microbes but not by humans or plants. Deficiency may result from intrinsic factor deficiency (pernicious anemia), partial or total gastrectomy, or distal ileum diseases. Deficiency initially and typically manifests as macrocytic anemia, although neurologic symptoms may be present. Can also cause confusion or delirium in elderly patients.

Essential for normal erythropoiesis. Required for healthy neuronal functions and normal functions of rapidly growing cells.

Contributor Information and Disclosures

Rashmin Gandhi, MBBS, FRCS(Edin), FRCS(Glasg) Faculty, Departments of Ocular Physiology and Neuro-ophthalmology, Elite School of Optometry; Faculty, CU Shah Ophthalmic Postgraduate Center, Consulting Staff, Department of Ophthalmology, Sankara Nethralaya Hospital

Rashmin Gandhi, MBBS, FRCS(Edin), FRCS(Glasg) is a member of the following medical societies: American Academy of Ophthalmology, All India Ophthalmological Society

Disclosure: Nothing to disclose.


Gangaprasad Muthaiah Amula, MBBS, DNB, FRCS(Glasg) FICO, FMRF, Consultant, L V Prasad Eye Institute, India

Gangaprasad Muthaiah Amula, MBBS, DNB, FRCS(Glasg) is a member of the following medical societies: All India Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.


Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

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Normal optic nerve histopathology.
Glaucomatous optic atrophy histopathology.
Healthy optic disc.
Nonarteritic anterior ischemic optic neuropathy.
Arteritic anterior ischemic optic neuropathy, cilioretinal artery occlusion.
Primary optic atrophy.
Optic atrophy following papilledema (secondary).
Glaucomatous optic atrophy.
Juvenile open-angle glaucoma (JOAG) with optic pallor.
Consecutive optic atrophy following panretinal photocoagulation (PRP).
Table. Various Common Groups of Disorders Presenting with Optic Atrophy






Age15-50 yApproximately 70 ySixth decadeVaries based on cause
SexMultiple sclerosis F>MF>MF=MVaries based on cause
Visual acuityVaries from mild blurring (34%) and moderate loss of acuity (12%) to severe or total loss of light perception (complete blindness) in 54% of cases, to no light perception. The loss of vision is acute and progressive.--Vision usually recovers within 2 mo< 20/200 (6/60)>20/200 (6/60)Varies from mild blurring to no light perception
Color visionColor vision > vision lossColor vision loss = vision lossColor vision loss = vision lossColor vision = vision loss
MotilityPainful movement in cases of retrobulbar neuritisNormalNormalDepends on the site of compression
NystagmusIn multiple sclerosis, vertical nystagmus (upbeating or downbeating) may be seenNoNoSee-saw nystagmus in optic chiasm compression
Optic discTemporal pallorPallid disc edemaSegmental disc edema Bow-tie pallor seen in optic chiasm compression; varies in other instances

Electrophysiologic study

VEP-increased latency <†>VEP-reduced amplitudeVEP-reduced amplitudeReduced VEP amplitude


In multiple sclerosis, hyperechoic lesions are seen in the brain on MRI--For exact location of compression
Other associations Headache, scalp tenderness, jaw claudication 

Hypertension and diabetes

Headache, vomiting, and focal neurologic deficits
*RAPD - Relative afferent pupil defect

<†>VEP - Visual-evoked potential

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