2007 review: Nutritional optic neuropathies

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2007 review: Nutritional optic neuropathies

Post by jimmylegs » Thu Sep 13, 2018 8:03 am

i noticed this in passing early last year - posting again, with more detail:

Nutritional optic neuropathies (2007)
https://www.sciencedirect.com/science/a ... 0X07004595

Nutritional deficiency may be the cause of a genuine optic neuropathy, sometimes associated with involvement of the peripheral nervous system. Nutritional optic neuropathies are usually bilateral, painless, chronic, insidious and slowly progressive. Most often, they present as a non-specific retrobulbar optic neuropathy. The differential diagnosis with other causes of optic nerve involvement, in particular of toxic origin, may be particularly difficult. Nutritional deficits are often associated with toxic effects from alcohol and tobacco; therefore, the separation of the nutritional and toxic components is often illusory and artificial. The pathophysiological mechanisms involved in nutritional - and toxic - optic neuropathies affect biochemical pathways involved in cell energetic production, correction of oxidative stress and quenching of free radicals. The recognition of these mechanisms could provide future therapeutic alternatives. Currently, the treatment is limited to the intensive use of vitamins with variable results in individual cases, and to the implementation of preventive measures, when feasible.
3. Etiologies of nutritional optic neuropathies
The role of the nutritional factors in the causation of nutritional optic neuropathies has been known for many years [2]. Following the World War II, epidemic outbreaks of
neuropathies were mentioned. Their origin remained poorly explained for a long time. Nevertheless, the existence of food deprivation causing deficiencies of proteins, anti-oxidants, B-group vitamins, is generally considered the main cause of these outbreaks, eventually in association with toxic factors. Such nutritional deficits can result in numerous ophthalmic (i.e., keratitis, retinopathies) and neuroophthalmologic pathologies [19]. We will review the role of vitamin deficits in the genesis of iatrogenic neuroophthalmologic complications, as well as the role of certain substances in triggering hereditary optic neuropathies [20–22].

3.1. Toxic and nutritional causes
An epidemic of optic neuropathy associated to peripheral neuropathy occurred in Cuba in 1991, demonstrating the interactions between nutritional deficits and toxic exposure. The cases of optic neuropathy were similar to those observed during war times [23]. Although, the main cause of the Cuban epidemic could be traced to malnutrition secondary to the economic problems met by this country, numerous studies achieved to understand the mechanisms of this epidemic equally pointed the role of excessive use of tobacco and of alcohol [7,9]. Susceptibility to the optic neuropathy increased with low serum levels of carotenoids principally lycopene, or low consumption of animal protein and B-group vitamins [7,8,24]. The protective effect of lycopene, a strong antioxidant of plant origin, is superior to all other carotenoids. A diet rich in riboflavin, a cofactor in the synthesis of glutathione, also a powerful intracellular anti-oxidant, was also associated with decrease risk of neuropathy [25]

3.2. Pure nutritional deficiencies
There are authentic instances of optic neuropathies that appear as a result of pure nutritional imbalances [5,6]. Thus, optic neuropathies have been reported in strict vegan patients without intake of vitamin supplements. Certain weight reduction methods may result in deficits of protein, vitamins and anti-oxidants and can be complicated by optic neuropathy. The clinical picture is characterized by decrease of visual acuity without abnormalities of the ocular fundus. Nevertheless, questioning allows sometimes the discovery of associated etiologies, including in the first place toxic ingestion [22]. More rarely, the vitamin deficits are secondary to different pathologies, such as beriberi due to thiamin (vitamin B1) deficiency, pernicious anemia with abnormal vitamin B12 levels, or intestinal pathologies that cause malabsorption [6,32].
Authentic optic neuropathies of diabetic origin have been reported [33] and several publications confirm their occurrence. These neuropathies are manifested by decreased vision, often asymmetric in the initial stages.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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