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Suggest Medication For Non-arteritic Anterior Ischemic Optic Neuropathy
Question: Doctor: XXXXXXX XXXXXXX Dash
Thank you for following up. I am not doing well. I have been diagnosed as having Non-Arteritic Anterior Ischemic Optic Neuropathy, which has resulted in the loss of acuity and central vision in my right eye, but I still have peripheral vision in my right eye. Here is a description of my recent medical background relevant to the NA-AION:
It is my understanding that NA-AION is probably caused by lowered blood pressure, especially during sleep, which prevents the optic nerve from receiving sufficient perfusion. Often, it is Diabetes, Anemia, Rheumatoid Arthritis and other vascular diseases or medications that are the cause of such ischemia. However, I don't have any such disorders that would result in lowered blood pressure. However...
When I began taking 600mg of Oxcarbazepine 2X/day about fifteen months ago for paroxysmal Neuropathic Pains that began to occur in various parts of my body, my blood pressure became elevated (140/90). Historically, my blood pressure had been 120/80 for as long as I can remember. As a result of the increase in my blood pressure, my Cardiologist recommended that I commence taking 5mg of Amlodopine Besylate, which did, in fact, lower my blood pressure back to 120/70.
My Neuropathic Pains began to go into remission in February 2017; thus, I began to wean off Oxcarbazepine in March 2017. I was not told to also wean off Amlodopine Besylate, even though the Amlodopine Besylate was commenced principally because of the elevated blood pressure that was caused by the Oxcarbazepine. It is my belief that the continuation of Amlodopine Besylate, 5 mg/day, after the cessation of Oxcarbazepine, caused a significant diminution in my blood pressure. Not so coincidentally, the NA-AION event occurred in the first week of April 2017, i.e. one week after I ceased taking Oxcarbazepine altogether. The NA-AION event resulted in blindness in my right eye.
I have been checking my blood pressure in the last two weeks to determine whether it is, indeed, "lowered." In fact, my blood pressure in the last several weeks has held steady at 105/60, i.e. unusually low for me. This may be the result of my continuing to take Amlodopine Besylate, 5mg, notwithstanding my complete discontinuance of the Oxcarbazepine, 600mg 2x/day, which was the cause of my higher blood pressure.
Also, I have been taking Tamsulosin, .4mg, in the last two to three months because of an enlarged prostate gland. This drug may also lower my blood pressure to dangerously low levels.
It is, therefore, my belief, that (1) the discontinuance of Oxcarbazepine; (2) the continuance of Amlodopine Besylate; and (3) the recent commencement of Tamsulosin (Flomax), may have been the cause of my "lowered blood pressure," and which, in turn, may have caused the blindness in my right eye.
Obviously, I want/need to protect my good left eye from having a NA-AION event in order to avoid complete blindness. Query: Should I stop taking Amlodopine Besylate and/or Tamsulosin immediately in order to reduce the likelihood of another NA-AION event? My blood pressure remains at 113/60, which is probably very low for a 73 year old man.
Is there anything else that I can do in order to reduce the likelihood of a NA-AION event in my left eye? A lengthy course of Prednisone? Please help.
Thank you for following up. I am not doing well. I have been diagnosed as having Non-Arteritic Anterior Ischemic Optic Neuropathy, which has resulted in the loss of acuity and central vision in my right eye, but I still have peripheral vision in my right eye. Here is a description of my recent medical background relevant to the NA-AION:
It is my understanding that NA-AION is probably caused by lowered blood pressure, especially during sleep, which prevents the optic nerve from receiving sufficient perfusion. Often, it is Diabetes, Anemia, Rheumatoid Arthritis and other vascular diseases or medications that are the cause of such ischemia. However, I don't have any such disorders that would result in lowered blood pressure. However...
When I began taking 600mg of Oxcarbazepine 2X/day about fifteen months ago for paroxysmal Neuropathic Pains that began to occur in various parts of my body, my blood pressure became elevated (140/90). Historically, my blood pressure had been 120/80 for as long as I can remember. As a result of the increase in my blood pressure, my Cardiologist recommended that I commence taking 5mg of Amlodopine Besylate, which did, in fact, lower my blood pressure back to 120/70.
My Neuropathic Pains began to go into remission in February 2017; thus, I began to wean off Oxcarbazepine in March 2017. I was not told to also wean off Amlodopine Besylate, even though the Amlodopine Besylate was commenced principally because of the elevated blood pressure that was caused by the Oxcarbazepine. It is my belief that the continuation of Amlodopine Besylate, 5 mg/day, after the cessation of Oxcarbazepine, caused a significant diminution in my blood pressure. Not so coincidentally, the NA-AION event occurred in the first week of April 2017, i.e. one week after I ceased taking Oxcarbazepine altogether. The NA-AION event resulted in blindness in my right eye.
I have been checking my blood pressure in the last two weeks to determine whether it is, indeed, "lowered." In fact, my blood pressure in the last several weeks has held steady at 105/60, i.e. unusually low for me. This may be the result of my continuing to take Amlodopine Besylate, 5mg, notwithstanding my complete discontinuance of the Oxcarbazepine, 600mg 2x/day, which was the cause of my higher blood pressure.
Also, I have been taking Tamsulosin, .4mg, in the last two to three months because of an enlarged prostate gland. This drug may also lower my blood pressure to dangerously low levels.
It is, therefore, my belief, that (1) the discontinuance of Oxcarbazepine; (2) the continuance of Amlodopine Besylate; and (3) the recent commencement of Tamsulosin (Flomax), may have been the cause of my "lowered blood pressure," and which, in turn, may have caused the blindness in my right eye.
Obviously, I want/need to protect my good left eye from having a NA-AION event in order to avoid complete blindness. Query: Should I stop taking Amlodopine Besylate and/or Tamsulosin immediately in order to reduce the likelihood of another NA-AION event? My blood pressure remains at 113/60, which is probably very low for a 73 year old man.
Is there anything else that I can do in order to reduce the likelihood of a NA-AION event in my left eye? A lengthy course of Prednisone? Please help.
Brief Answer:
prolonged use of steroid is the only option.
Detailed Answer:
anyway the blood pressure is normal and there is no need of taking amlodipine. for Na-anion event nothing can be done except taking steroid. dexamethasone can be taken. monitoring for side effect is to be done.if requered tapering is to be done in this way balancing is to be done central vision is also very important to manage between peripheral vision and gradual domination of central vision. there will not be complete blindness. with prolonged use of steroid masking of symptoms will take place but there is no alternative posible.this is only treatment option possible take second opinion and better to consult retina surgeon.excludehypertension and diabetis diabetic and hypertensive profile can be done and for any problem treating physician can be consulted.
prolonged use of steroid is the only option.
Detailed Answer:
anyway the blood pressure is normal and there is no need of taking amlodipine. for Na-anion event nothing can be done except taking steroid. dexamethasone can be taken. monitoring for side effect is to be done.if requered tapering is to be done in this way balancing is to be done central vision is also very important to manage between peripheral vision and gradual domination of central vision. there will not be complete blindness. with prolonged use of steroid masking of symptoms will take place but there is no alternative posible.this is only treatment option possible take second opinion and better to consult retina surgeon.excludehypertension and diabetis diabetic and hypertensive profile can be done and for any problem treating physician can be consulted.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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