Randall Veeh-Non-arteritic Anterior Ischemic Optic Neuropathy-(USA)

Name: Randall Veeh   
Sex: Male
Country: USA
Age: 59 years
Diagnosis: 1. Non-arteritic Anterior Ischemic Optic Neuropathy(NAION) 2. Hypertension level 1 3. Sleep Apnea Syndrome 4. Hyperlipemia
Date: Apr. 19th, 2015
Days Admitted to Hospital: 20 days

Before treatment:
The patient had blurring of vision in right eye with no reason and this was accompanied with visual field defect. He was diagnosed as Non-arteritic Anterior Ischemic Optic Neuropathy(NAION) at a local hospital 2 years ago, untreated, and the disease got worse. His left eye had the same problem 9 months ago. He bought a new pair of glass 6 months ago and he could see clearer, but his condition got worse 3 moth ago. His vision decreased. He developed fear for light. He cound’t adapt to changes of light, his color discrimination was worse. He could’t distinguished similar colors. He wanted a better treatment so he came to our hospital and was diagnosed as Non-arteritic Anterior Ischemic Optic Neuropathy(NAION).

His spirit was good. His weight was normal. His diet and sleeping were good. His urination and defecation were normal. He had sleep apnea syndrome, so he started using Non-invasive ventilator during sleep 4 months ago. 

Admission PE:
Bp: 140/90mmHg, Hr: 64/min, Br: 20/min. Bt: 36.6 degrees. He’s growth and body type were normal. His skin mucosa was intact without yellow stains or petechia. His thorax was symmetrical. The respiration of both lungs was clear, without moist rales. The heart sound was strong, and the cardiac rhythm was regular, and there was no obvious murmur in the valves. The abdomen was flat and soft with no oppressing pain or rebound tenderness. There was no masses. The liver and spleen were normal.

Nervous System Examination:
He was alert and his speech was clear. His memory, orientation and calculation ability were normal. The diameter of both pupils was 3.0mms and both pupils were insensitive to direct and indirect light reflex. His color discrimination was a little weak, he could hardly discriminate similar colors. His eyes were photophobic and unable to adapt in dark. Through use of an ophthalmoscope: The color of both bottoms of eyes was orange. The right optic papilla was more dropsically than the left one. The boundary of macular area was not clear. AV ratio was 1:3. Visual acuity test (3-meter visual acuity test chart): right eye: 0.05, left eye: 0.09. Both eyes vision: 0.10. The movement of eyeballs to each side was good. Visual field examination: left eye was normal, right eye only had upside visual field. The nasal visual field was 15 degrees. The temporal field was 30 degrees. Downside visual field was 17 degrees. There was no obvious nystagmus. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. The teeth were symmetrical and the tongue was centred. There was free movement in the neck. The muscle tension of all four limbs was almost normal. The muscle power of all four limbs was at level 5. The abdominal reflex was abnormal. The tendon reflexes in four limbs were normal. The sucking reflex was negative, the palm jaw reflex was positive. The bilateral Hoffmann’s sign and both lower limbs pathologic reflex were negative. The deep and shallow sensation was normal. The coordinated movements were normal.

Treatment:
We gave him a complete examination. He received treatment to improve the blood circulation and also to increase blood supply to provide nourishment, restrain atherosclerosis and stabilized blood pressure. He also had rehabilitation exercise.

Post-treatment:
After the treatment, his condition was better. Visual acuity test (3-meter visual acuity test chart): right eye: 0.1, left eye: 0.14. Both eyes: 0.15. It was improved to 20-40%. His downside visual field and temporal field were improved, temporal field was 48 degrees, and downside visual field was 37 degrees. Through use of an ophthalmoscope: The color of both bottoms of eyes was more orange than before. The right optic papilla was less dropsy and the exudation was less. The left optic papilla was not dropsy. The boundary of macular area was not clear in right eye, it was clear in left eye. AV ratio was 2:4. The vein of right eye was thickening than before.

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