Neuro-ophthalmologist Appointment

After continued left peripheral blurriness, I was sent to one of the two neuro-ophthlamologists in Las Vegas.  This doctor appointment occurs in two portions, which typically occur on two separate days.  The first appointment consists of a number of visual tests and the second, the actual visit with the physician.  

The vision testing included a typical vision acuity exam, color blindness exam, a depth perception exam, eye pressure test, visual field exam (Humphrey Visual Field - HCF), and an OCT (optical coherence test).  Interestingly, during this appointment, there was a fire on the first floor of the building and we were evacuated.  I was rescheduled later that week to complete my examinations.

During my first visit at the neuro-ophthalmologist, the majority of my initial examinations were normal at first glance; however, with testing in the future, it became evident that my visual field exam had early signs of an enlarged left blind spot.  Important to note, that blind spots are normal and we have one on each eye; however, the other eye is able to see in that area so it does not cause issues.  Additionally, my first OCT (which takes a picture of the retina) showed a decrease in the optic nerve thickness which was below normal at 65 microns (normal is 70-100) and significantly lower than my other eye which had a thickness of 104 microns.

During my visit with the physician, she listened carefully, took what I was experiencing seriously, and gave words of encouragement.  If anyone is reading from Las Vegas or the surrounding area and would like a recommendation, please message me and I will forward you her office info.  Due to the reduced optic nerve thickness, she ordered a ton of bloodwork to add to the bloodwork that I had during my hospitalization to help elucidate the cause of the optic nerve atrophy.  Ultimately, they took 14 vials of blood and I was tested for the most common causes of optic nerve atrophy including:  infectious, autoimmune, immune related, hematologic, metabolic, cancer, and vitamin deficiencies.  As well as, a MRI of the eye orbit was ordered.  

When I returned in two weeks, my eye exam showed an enlarged blind spot on the left, which with foresight was minimally evident at the first visit.  For the most part the blood work was normal.  I already knew that I had latent TB (tuberculosis) which was detected again (travel to India yearly), but additionally, I had a folic acid deficiency and some mild leukocytosis (indicative of inflammation) with high lymphocytes (antibodies) and eosinophils (allergy responders).  Of note, latent TB just means that you have been exposed to the bacteria and are at risk for a future infection if your immune system is decreased.  

The MRI of the orbit showed that I had tortuous optic nerves (zig zagged nerves) and fluid buildup around them.  This indicated that the pressure in my brain (intracranial pressure) was likely too high so she ordered a stat lumbar puncture (spinal tap) in the outpatient setting.  At this point in time, my physician was concerned that the TB was active in my brain causing the increased pressure and the optic nerve atrophy.  The other possibility was idiopathic intracranial hypertension (also called pseudotumor cerebri), which is an increased pressure in the brain for an unknown reason but would account for the enlarged blind spot and the MRI results.

More to come on these tests, optic nerve atrophy, and the next steps.

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