June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Use of TimololTM and Natural Supplements in the Management of Visual Field Loss in Advanced Optic Nerve Head Drusen
Author Affiliations & Notes
  • Mustafa Jaffry
    Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Ashley Leto
    Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Bernard Szirth
    Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Albert S Khouri
    Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Footnotes
    Commercial Relationships   Mustafa Jaffry, None; Ashley Leto, None; Bernard Szirth, None; Albert Khouri, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2400. doi:
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      Mustafa Jaffry, Ashley Leto, Bernard Szirth, Albert S Khouri; Use of TimololTM and Natural Supplements in the Management of Visual Field Loss in Advanced Optic Nerve Head Drusen. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2400.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Optic Nerve Head Drusen (ONHD) are calcified deposits of axonal debris that lie within the optic nerve head. Incidentally found in 2-3% of the population, there are three types of ONHD described: superficial, buried, and pearl. Over time, ONHD progress toward the surface of the optic nerve, causing severe damage and visual field (VF) loss. There are no established treatment modalities for ONHD associated VF defects. We hypothesize that TimololTM and natural supplements may play a role in reducing the development of VF defects.

Methods : Three ONHD patients were evaluated. Visual acuity, non-contact puff tonometry, color and fundus autofluorescence (FAF) photography using a non-mydriatic retinal camera were captured. VF was assessed via 60-4 and 10-2 threshold tests on a Zeiss Humphrey Field Analyzer. Ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness were assessed using Ocular Coherence Tomography (OCT) on an OptoVue RTVue XR Avanti. Subject 1 is a 52 y/o female with long standing OU pearl ONHD. FAF demonstrated hyperfluorescent signals encircling the optic nerve head (Figure 1) and VF testing demonstrated significant peripheral losses OU with visual field index of 8% OD and 21% OS. A daily regimen of 1000mg Citrus Bioflavonoid Complex, AREDS2 supplements and 1053mg turmeric, which have been found to have anti-inflammatory and antioxidant effects on the retina, was started. TimololTM 0.01%, once nightly, was initiated to prevent nocturnal IOP elevation.

Results : After 10 months, IOP decreased from 18mmHg to 14mmHg OU, and VF stabilization was observed. OCT showed a 4.3% increase in RNFL, no change in GCC OS, and a 32% decrease in RNFL with a 14% increase in GCC OD (Figure 2). Subject 2 is a 24 y/o female with pearl ONHD of comparable volume to subject 1 and has no observable VF, RNFL, or GCC changes due to her young age. Subject 3 is a 24 y/o female with buried ONHD OS and peripheral VF loss, RNFL thinning, and GCC loss.

Conclusions : Our findings suggest that early intervention directed at lowering IOP along with neuroprotective supplements may have a role in delaying VF loss, observed through stability on structural testing, albeit over a short period. Lower IOP may slow damage in ONHD patients, especially by preventing nocturnal IOP elevation. These findings suggest that a prospective clinical trial should be considered for patients with advanced ONHD.

This is a 2021 ARVO Annual Meeting abstract.

 

 

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