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Francinia McCartney, Meghan Berkenstock, Jessica M Ackert; Vitamin A Deficiency as a cause of Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6231. doi: https://doi.org/.
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Optic neuropathy often presents as gradual, bilateral, painless vision loss. Causes are varied and include medication related etiologies, ingestion of exogenous materials, neoplastic disease, and vitamin deficiencies. The non-specific clinical presentation coupled with diverse causes can lead to diagnostic challenges. Here we present a cohort of 4 patients, all Nepalese females previously housed in one refugee camp in Nepal, who presented with complaints of poor vision. All were found to have a nutritionally derived optic neuropathy.
Retrospective case review
All patients presented with complaints of painless, bilateral vision loss over the preceding months. Visual acuity at presentation ranged from 20/20 (eccentrically) to 20/100. There were no pupillary abnormalities noted. Ophthalmoscopy revealed variable, and often times subtle, temporal pallor of the optic nerve. OCT imaging showed RNFL thinning in all patients. Humphrey visual field testing consistently revealed bilateral central scotomas. Mean deviations ranged from -4.10 to- 6.58. An exhaustive work-up including imaging was done in all patients, and was notable only for low Vitamin A levels.
The diagnosis of optic neuropathy was made based on bilateral vision impairment, impaired color vision, and central scotomas. All patients were found to have low vitamin A levels. Nutritional optic neuropathies are uncommon and this cluster of optic neuropathy is associated with vitamin A deficiency. Our small case series highlights the importance of maintaining a high index of suspicion for nutritionally derived optic neuropathies in at risk populations. Early diagnosis and treatment are necessary to preserve vision and prevent further visual field defects. All patients have been started on Vitamin A supplementation with stability of their vision and visual fields.
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