October 10, 2025 • 31 mins
In this episode of The Eye-Q Podcast, I sit down with Dr. Andrew Lee, one of the world’s leading neuro-ophthalmologists, to unravel the mysteries of the optic nerve. We cover conditions like optic neuritis, optic nerve strokes, papilledema, and optic atrophy—how they’re diagnosed, what treatments exist, and when to seek a neuro-ophthalmologist. Whether you’re a patient or practitioner, this episode will expand your understanding of how the brain and eyes work together.
Dr. Andrew Lee is a world-renowned neuro-ophthalmologist, researcher, and educator with decades of experience diagnosing and treating complex eye-brain conditions. He has authored hundreds of publications and trained specialists globally, making significant contributions to advancing the field of neuro-ophthalmology. Through his clinical work and education, Dr. Lee is dedicated to helping patients and providers alike understand the intricate link between the visual system and the brain.
Andrew Lee, MD
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
And ischemia just means lack of blood flow.
So it's like a stroke in your optic nerve, stroke in old
people and inflammation in youngpeople.
And then sometimes something's pressing on the eye nerve either
directly, which we call a compressive optic neuropathy,
which means a tumor is actually pressing on your nerve, or you
have swelling of your eye nerve because you have high pressure
in your head. And that can be from a tumor or
(00:22):
it can be just from high pressure for no reason, which we
call pseudo tumor. That condition is called
papilledema. So papilledema is an optic nerve
problem where the eye nerve is swollen from increasing cranial
pressure and it can be from a tumor or something that acts
like a tumor but isn't a tumor pseudo tumor.
Welcome to the IQ Podcast. I'm Doctor Ronnie Banach, here
(00:43):
to help you boost your IQ with powerful insights that connect
your eyes, your brain, and your whole body Wellness.
Welcome back. Today I have the honor of
hosting one of the leading neuroophthalmologists in the world,
Doctor Andrew Lee. Doctor Lee has dedicated his
career to understanding and treating some of the most
(01:04):
complex conditions affecting thevisual system and the brain.
Doctor Lee is a prolific researcher, educator, and
clinician with experience in neuro ophthalmology, having
authored hundreds of publications and trained
countless specialists globally. So we are so honored to have you
here today on the ihealth Summitwith us.
So thank you for joining us, Doctor Lee.
Thanks for having me. Absolutely.
(01:26):
So just to start off, I always like to have our audience be
introduced to the topic that we're going to be talking about.
What is neuro ophthalmology? What is the subspecialty that we
both practice? So neuro ophthalmology is the
specialty that links 2 specialties, ophthalmology which
is the study of the eye and neurology which is study of the
(01:47):
brain and the nerves, both the peripheral nerves and the
central nervous system. And so neuro ophthalmology is
like a bridge between these two specialties.
And how does 1 become a neuro ophthalmologist?
What type of training does it require?
So you can become a neuro ophthalmologist either by being
a neurologist first or being an ophthalmologist first.
(02:07):
And both pathways lead after residency, which is after your
medical school to a fellowship training program in neuro
ophthalmologist. And some people do both
neurology and ophthalmology residencies and then become
neuro ophthalmologist. Yeah.
Just for some fun facts out to put out there, how many neuro
ophthalmologists are there approximately in the world or
let's say in the US? The US, we're probably between
(02:30):
4:50 and 500 depending on whether you include everybody or
just the full timers. There are many people that kind
of do a little bit of neuro ophthalmology on the side or
combine it with another subspecialty and I would say
somewhere between 4 to 500. OK.
Yeah. So there aren't that many of us
compared to some other types of specialities.
What are some of the most commonconditions as inner
(02:53):
ophthalmologist? So the most common conditions
are visual loss related to opticnerve problems.
And the optic nerve is like a cable that connects the eyeball
to the brain. And then we've got brain
problems that cause vision problems, and that's for seeing.
And that's like the brain sees 1/2 of the vision.
So the right side of your brain controls the left side of your
(03:14):
vision and the left side of yourbody and the left side of the
brain controls the right. So some people have half their
vision loss to one side or another from a stroke or tumor.
And then we've got double visionwhere people see two of
everything or their eyelid is droopy or their pupil, which is
the black part of the eye is bigger or smaller.
So those are the common things that we see, droopy eyelidosis,
(03:36):
double vision and loss of vision.
And so basically what I'm hearing is that some of the
vision problems that you see as an ophthalmologist also involve
the brain and there can there beother symptoms as well, not just
vision symptoms with some of these conditions.
Yeah. So when we have vision problems
related to the brain, they oftenhave other neurologic symptoms
(03:56):
depending on which part of the brain it whether it's related to
a systemic disorder or not. So they might have a headache in
addition to what we would see them for double vision, loss of
vision, weakness, numbness, tingling, spine symptoms or
brain symptoms or constitutionalsymptoms, which is our fancy way
of saying systemic symptoms likefever and rash and swollen lymph
(04:18):
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happens to be showing up in the eye.
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(05:22):
Yeah. So it seems like it's a wide
range of different types of conditions that can be seen in
an ophthalmologist office. But I wanted to, for the rest of
our time here today, Doctor Lee,I wanted to really focus on one
of those categories, the first category that you mentioned,
which is vision loss related to optic nerve disorders.
So for our audience, can you first describe what is the optic
(05:43):
nerve, what's its purpose? What does it do?
So the eyeballs like a camera and the full front of the eyes
like the lens of a camera. Its whole job is to focus the
beam of light onto the retina, which is like film used to be in
old cameras. Now of course, everything's
digital, but the lens is the focusing part.
And then the film or the camera itself's memory is holding what
(06:06):
the image that it is captured is.
And then that signal is sent like a cable.
So it's like the wire wired, a device with the cable optic
nerve carrying the picture, the image formed on the retina to
the brain and it's the brain that processes that image.
So the optic nerves like the cable that connects the eyeball
(06:27):
to the brain? Oh, that's absolutely
fascinating. I'm sure many people, it's, they
don't know that the eye is a direct extension of the brain
embryologically. So it's, it's really so critical
to our vision to have a healthy optic nerve.
Now, of the many different typesof optic nerve conditions that
can develop in someone, what aresome of the most common ones
(06:48):
that you see in your practice, Doctor Lee?
So when young people less than 40 say those patients are much
more likely have inflammation oftheir optic nerve and that
inflammation is called itis. So the suffix itis means
inflammation. So if it's itis in your joints,
we call it arthritis. If it's itis in your brain, we
(07:09):
call it meningitis or encephalitis.
But if it's itis in your optic nerve, we call it optic
neuritis, inflammation of the optic nerve.
That's the most common acute optic nerve problem that we see,
and that's often associated witha systemic neurologic disorder
called multiple sclerosis. But sometimes it's from things
that look like Ms., but they're mimicking Ms., or they have Ms.
(07:31):
like illnesses. And for older patients, the most
common cause of optic nerve damage is called ischemic optic
neuropathy. And ischemia just means lack of
blood flow. So it's like a stroke in your
optic nerve, broke in old peopleand inflammation in young
people. And then sometimes something's
pressing on the eye nerve eitherdirectly, which we call a
(07:51):
compressive optic neuropathy, which means the tumors actually
pressing on your nerve or you have swelling of your eye nerve
because you've high pressure in your head.
And that can be from a tumor or it can be just from high
pressure for no reason, which wecall pseudo tumor.
That condition is called papilledema.
So papilledema is an optic nerveproblem where the eye nerve is
swollen from increasing cranial pressure and it can be from a
(08:13):
tumor or something that acts like a tumor but isn't a tumor
pseudo tumor. Yeah.
So just to recap again, there are different mechanisms that
Doctor Lee described by which the optic nerve can be affected.
Could be inflammation, could be lack of oxygen or blood flow.
It could be compression or couldbe high pressure in the brain
causing optic nerve dysfunction.Let's go back to optic neuritis
(08:35):
because I know that many people may have certain symptoms,
symptoms and they start Googling, they go to doctor,
Google and they look up OK vision loss and they worry that
they may have optic neuritis in a mass.
What are some of the most commonsymptoms of optic neuritis?
And then what are the exam findings that you would expect
to see? So optic neuritis is
(08:56):
inflammation and so our inflammation words are pain and
swelling and redness, and those are the inflammation words.
So patients with inflammation ofthe optic curve, optic Ritis
often have pain with eye movement in addition to their
main complaint, which is loss oftheir center vision or their
side vision, which we call the visual field.
(09:18):
And so because so many things can cause loss of vision, even
with pain, you really need to have an eye exam to look for the
signs that it's an optic nerve problem.
That means having someone look in your eye and make sure
nothing's in the front of the eye or in the back of the eye,
like a retinal detachment. And if there's nothing in the
eye causing it, then we're goingto swing the light that we use
(09:38):
to check your pupil response. And we can see the damage
relative to the other eye of nerve damage from optic
neuritis. And that thing's called a
relative Afrin pupillar defect, which is a big long name for
relative to the other eye. We can tell when the pupil isn't
reacting as well compared to theother eye and so that finding
(09:59):
the pupil finding in the settingof acute vision loss with pain
with eye movement is the distinctive characteristic
finding of optic neuritis. And may patients have other
types of symptoms? For example, you mentioned that
their peripheral vision may be affected.
What about their color vision orperhaps their contrast?
Could that be affected as well with optic neuritis?
(10:21):
Yes, because the optic nerve carries all of those fibers, the
center vision, the side vision, the color vision and the
contrast. When you damage the optic nerve,
regardless of what the cause is,including optic neuritis, you'll
have deficiencies in any or all of those visual parameters.
Visual acuity, which is the center vision visual field,
(10:42):
which is the side vision, color vision and contrast.
So let's say someone suspects they have optic neuritis, they
have symptoms, they go to their ophthalmologist or neuro
ophthalmologist, they get the diagnosis and what happens next?
What are some tests or what elseshould the patient be doing?
So patients with optic neuritis can just have isolated optic
(11:02):
neuritis, which means it's not associated with anything, it
could be from infection or inflammation.
And so usually when asked questions about exposure to
infections, and then we're goingto do a scan called a magnetic
resonance imaging MRI. And that MRI scan is to look for
inflammation. And on MRI, the inflammation is
seen as enhancement, which is a fancy way of saying when you
(11:26):
give dye, the dye leaks out intothe optic nerve, and we can see
that leakage. And that tells us it's active
disease. And in the brain, we're looking
for the most common cause of optic Ritis, which is multiple
sclerosis, which is a fancy way of saying, yeah, neurologic
disorder of your brain and the optic nerve.
And it's from lack of the covering of the nerve.
(11:48):
Damage to the covering in the covering is called myelin.
The myelin is like insulation onyour optic nerve and other
nerves. And when you lose your myelin,
the nerve doesn't function as well.
And the most common cause of multiple areas of damage to the
myelin is called multiple sclerosis.
Now, you mentioned getting an MRI.
What if someone were to get a CAT scan?
(12:10):
Is that enough? So a CAT scan can show some
causes of optic nerve damage like a big tumor or it can show
water on your brain, hydrocephalus, but it's not
really that great for looking for the thing we're looking for
an optic neuritis, which is enhancement of the optic nerve
and multiple sclerosis lesions. So MRI is a way better scan for
(12:30):
optic neuritis. Thank you for that.
I know a lot of patients when they first come in, they get
this diagnosis of optic neuritis, they're very
frightened. And then they they look up
multiple sclerosis, they get even more frightened.
But what do you tell your patients in terms of their
ultimate outcome and treatment? And so the good part about optic
(12:50):
neuritis is the vision's going to come back regardless of
whether we give steroids or no steroids, which is the treatment
of inflammation. The vast majority of optic
neuritis and especially for multiple sclerosis, optic
neuritis giving steroids and we give it by vein rather than by
mouth and conventional doses, weget high doses intravenously is
(13:11):
just making your vision get better quicker.
So intravenous steroids is the treatment.
But even if we don't get any intravenous steroids, people
with optic neuritis tend to justget better.
It's only when it's these not Ms. causes of optic neuritis
that patients don't get better without the steroids.
And so that's why it's importantto both be tested and treated
(13:32):
for optic neuritis until we figure out are you the benign
form or are you this more dangerous worm, which is
antibodies. And antibodies are supposed to
be fighting against bacteria andviruses, but when they attack
you, we call that autoimmune disease.
So those autoimmune antibodies are the things we're going to be
looking for after you're admitted to the hospital.
(13:52):
So the going to the hospital is 2 reasons, 1 is a diagnostic
reason to get the test to make sure it's not infection to do
the MRI and a therapeutic reasonwhich is to get intravenous
steroid. Now you mentioned let's say a
patient does not want to get treated with steroids.
In what time frame can they expect to get their vision back?
Let's say this is what we call garden variety optic neuritis.
(14:15):
So that most most typical form How soon may they get their
vision back? So let's be garden variety.
Typical optic neuritis usually gets worse initially and then it
peaks at around 14 days and thenit starts to turn around.
So really we should be expectingimprovement at within weeks of
the onset of a typical optic neuritis.
(14:38):
Thank you. This has been such a fascinating
discussion. Doctor Lee, we are going to take
a very short break and we'll hear from our sponsors and then
be right back with the ihealth Summit.
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(15:47):
Welcome back to the I Health Summit.
Today we're chatting with DoctorAndrew Lee, a leading neuro
ophthalmologist, and we're talking about various different
types of optic nerve problems. Next, Doctor Lee, I would love
to get your thoughts on that other type of optic nerve
condition that you mentioned earlier in which older patients
may be affected where they may not have enough oxygen to the
(16:07):
optic nerve. Can you tell us a little bit
more about that and why it may happen to someone?
Yes. That lack of profusion or lack
of oxygen, we call that ischemia.
And so when you have an optic nerve problem from ischemia, we
call that condition ischemic optic neuropathy.
An ischemic ophthenropathy is a fancy way of saying you had a
(16:29):
stroke in your, it's not like a stroke in your brain.
It's a little vessel stroke, nota big vessel stroke.
So it is a stroke in the sense that it's ischemia, but it's not
nearly as big or severe or life threatening as the intracranial
in your brain kind of stroke. And there are two flavors of
this ischemic ophthenropathy. 1 is inflammation, which we call
(16:50):
arteritis. And that arteritis we're worried
about is in older patients who have inflammation of their
artery and that's a vasculitis, an inflammation of the vessel
wall. And that causes the stroke
because the inflammation is in the artery and the artery which
supplies the blood. And that is a uncommon form of
ischemic arthropathy, but it's the more dangerous form because
(17:12):
that one requires intravenous steroids.
And then there's this other formwhich is the not arteritis form,
which we call non arteritic ischemic optic neuropathy.
And that's the majority of patients and that's small vessel
ischemia and small vessel disease from the usual things
that cause lack of blood flow inolder patients, high blood
(17:33):
pressure, high blood sugar, diabetes, high cholesterol,
smoking and hardening of the arteries, atherosclerosis.
So these are the common things that cause the common form of
ischemic of neuropathy, non arteritic anterior ischemic of
neuropathy. That anterior is a fancy word
for saying we can see the swelling so we can act, look in
the eye and see the stroke. And so the doctor version of
(17:57):
this condition is non arteritic and arteritic anterior ischemic
of neuropathy. But we're just regular patients.
We just say you have a little light small vessel stroke in
your eye. Doctor Lee, you talked about a
couple of risk factors for this non arteritic form or what we
also call it NAION for short sometimes.
What's another risk factor? Yes.
(18:18):
So the swelling, that's the anterior part, anterior just
means it's in the front and in in this case it's in the front
part of the eye nerve right as it's connecting to the eyeball.
And if you have a small and crowded eye nerve, a little bit
of swelling in a small space canmake a big problem.
So the predisposing risk factor for NAION, the stroke and the
(18:42):
eye nerve is if you have the small and crowded nerve.
And that means a little bit of swelling can cause a big
problem. Because if the swelling doesn't
have anywhere to go, and we callthis the disk at risk, the disk
is the eye nerve itself. And the disk at risk is a small
coupless optic nerve that just doesn't have any room for
swelling. And so patients have this as a
(19:02):
predisposing risk factor and then there's a precipitating
factor. And that precipitating factor is
all those risk factors we just talked about, blood pressure,
blood sugar, diabetes, cholesterol, etcetera.
Now, what if somebody goes in for their regular checkup and
their vision is fine, They have no symptoms whatsoever, but
they're told by their eye doctorthat they have this disk at
(19:23):
risk. Should they be concerned?
Is there anything they can do toprevent an optic nerve stroke?
What are your thoughts? So a lot of people have this
small disc and they're normal. In fact, it's a normal finding.
So even though it is a predisposing factor for ischemic
OP neuropathy, patients shouldn't be worried about it
and there's nothing you can do about it.
(19:45):
However, you should be doing thethings your doctor already told
you to do regardless of the ischemic optic neuropathy disk
at risk, which is eat a good diet, moderate amount of
exercise, be a healthy person, eat right, lose weight, live a
stressful life. All the things we tell you to do
as doctors no matter what you have.
And so if you have the disk at risk, you should just be
(20:06):
following what your doctor already thinks you're doing.
Yeah. And I wanted to ask you about
another risk factor that I've seen a lot in my patients, which
is many of them with this type of optic nerve stroke, has it
have a history of snoring and some of them actually have sleep
apnea. Is that something that you've
seen as well in your patients with NAION?
(20:26):
Yes. So the sleep apnea is a problem
for patients who might have ischemia of any type because you
need the oxygen. So the whole point of breathing
is to push out the carbon dioxide and take in oxygen.
And when you don't need, we callthat apnea.
And when that apnea A means not and NIA is PNEA means breathe.
(20:47):
When you apnea, you're not breathing.
And if you don't breathe, your oxygen goes down.
And oxygen is part of the perfusion and the healthy
oxygenation of tissues is required for their function.
And so that word we call hypoxia.
So hypoxia is one of the HS of ischemic optic neuropathy.
So now you've heard about hypertension too, high blood
(21:10):
pressure, hypotension, hyperglycemia, which is the
diabetes, hyperlipidemia, which is high cholesterol.
And now we got this extra 1 hypoxia, which is lack of
oxygen, and one of the causes ofthat is obstructive sleep apnea.
So once someone's been diagnosedwith this type of optic nerve
stroke, what is the management like?
(21:32):
What is the standard of care with respect to going forward
for these patients? So even though we don't have a
good and effective treatment forthe stroke, once it happens, our
goal is trying to reduce the chance in the other eye.
So that's where we're going to contact the primary care doctor
and in conjunction with the patient, work on getting all our
HS under control, our hypertension, our hypotension,
(21:55):
our hyperglycemia, our hyperlipidemia, a sleep study.
If we're worried about the hypia, we're going to check the
blood count and make sure the haematocrit isn't too low.
And so we're going to try and address all of the treatable
risk factors, which we call vasculopathic risk factors.
We're trying to treat the risk factors to reduce the chance of
it going in the other eye. Overall, there's about a 15%,
(22:18):
one, 515% chance that you'll have ischemic orthogon the other
eye after having it in one eye. And so we'd like to try and get
that number to single digits. We cannot make it 0% chance.
There's some risk factors that are not treatable, like your age
or your genetics, your mom and dad.
We just can't change your genderand your race.
(22:39):
And so some of those things cannot be modified, but we can
modify those ages. So we direct a lot of the
encounter to educating the patient about what it is and
then trying to prevent it from going in the other eye.
Yeah, absolutely. And I know that there have been
many studies done trying to treat this type of optic nerve
stroke and unfortunately, most of them really have not proven
(23:00):
to be of any benefit. Could you say a few words about
some of the treatments that havebeen tried and maybe why they
failed for this type of optic nerve stroke?
Yeah. So ischemic optic neuropathy,
once the event occurs, the thingwe're worried about is the
tissue dies from lack of oxygen.And that happens relatively
quickly because central nervous system, including the optic
nerve, can't really survive without oxygen and blood flow
(23:23):
for very long. Part of it is a timing issue,
but part of it is we really don't have way good ways of
reversing ischemia in the optic nerve.
So the things that have been tried are blood thinners and
steroids and agents that stimulate the red cells that
called erythropoietin. All of these things have been
tried, but they really haven't panned out.
(23:45):
As you mentioned, cutting on theeye nerve called the sheeting to
let the pressure off the eye nerve, that was tried and it
really didn't work and it actually harmed some patients.
And so we don't recommend it normally.
So our focus is more aimed towards preventing fellow eye
involvement and reducing that risk and not so much on
(24:06):
treatments. And the reason the treatment
failed is basically ischemia is a stroke of your optic nerve and
we really don't have good treatments for reversing stroke
once it occurs. Yes, that's what I often times
tell my patients. Unfortunately, we can diagnose
it, but there aren't that many options to reverse the damage
that's been done. The goal is to try to protect
(24:27):
the other eye. That's really a goal, the goal.
So in our last few minutes together, Doctor Lee, I wanted
to touch a little bit upon the type of optic nerve issue that's
caused by swelling or high fluidpressure in the brain.
You mentioned earlier papill edema and pseudo tumor sphery
bride. Could you just say a few words
about that condition? Is so that word papilledema?
(24:47):
Edema is our word for swelling and the papilla is the optic
nerve head. It's the part of the eye nerve
that we can see when we look in your eye.
And so papilledema is optic nerve swelling from increased
intracranial pressure. And usually that's from
something inside your head that's causing the pressure
because the skull is a closed box.
If you have a brain tumor, you'll get high pressure.
(25:08):
If you have a brain bleed, you'll get high pressure.
If you have a blood clot, you'llhave a high pressure.
And so the main thing with papilledema is making sure that
you don't have a brain tumor. And that's the main reason for
doing the scan. In the acute setting, we're
going to be doing CAT scan, but really we're going to need an
MRI. And sometimes it's from the vein
that drains your brain is blocked.
(25:30):
And so we do an Mr. phenogram for that.
A venogram is to look at that vein and make sure it's not got
a blood clot in it. I'm going to check the blood
pressure because sometimes it's the artery that's too much blood
and not the vein being blocked. So those are the common things
that cause increase in strain ofpressure.
But sometimes there's no cause and no 'cause we call that
(25:51):
idiopathic. Idiopathic is our word for we
don't know what causes it. And the condition is called
pseudo tumor steroid because it acts like a tumor.
Pseudo means false, but it's nota tumor.
And the preferred term is idiopathic intracranial
hypertension, which is a fancy way of saying high pressure in
your head for no reason. It's a disease that affects
(26:12):
young overweight females. We really don't know why.
A lot of speculation about hormones and body habitus and
female versus male physic nominee, but we really don't
know what causes it. But it's a it's way more common.
IIH idiopathic is way more common in young obese females
than true tumor. Even though we have to make sure
(26:34):
it's not a tumor and make sure it's not a blood clot or blood
breed bleed. A lot of no 'cause idiopathic.
Yeah. And I think you meant you
touched upon that, the fact thatmany of these women are
overweight, even though we stilldon't really know what causes
IIH, we do think that weight is a significant risk factor.
And for patients who do have IIH, who are overweight or
(26:56):
perhaps obese, then weight loss is part of our treatment
regimen, correct Doctor Lee? Now that's the best long term
treatment for the disorder is weight loss.
Absolutely. And I've seen patients where in
whom they achieve weight loss and they go into remission and
their symptoms go away, their papal edema goes away and they
end up doing really well. Doctor Lee, this has been such a
(27:17):
fascinating session. You're a wealth of information.
I just wanted to finish up really quickly by asking you one
more question about one more type of optic nerve issue, which
is optic atrophy. Now I know it's a huge topic,
but a lot of patients oftentimesask me, I have this diagnosis,
optic atrophy, what does it mean?
What can I do for it? What are your thoughts on that?
(27:38):
So all of the conditions that we've been discussing, optic
neuritis, ischemic optic neuropathy, arteritic
inflammation, optic neuropathy and papilledema, all damaged
optic nerve. And if the nerve damage is
sufficiently severe, then we cansee that damage in the back of
the eye, and that's what we calloptic atrophy.
So we can see that the nerve wasdamaged.
(28:01):
Unfortunately, you can't tell what caused the damage by
looking at a nerve that's atrophic.
And so optic atrophy is a sign. It's not really a diagnosis, and
it is the final common pathway for any optic neuropathy,
regardless of whether it's ischemic or inflammatory or
infectious or papilledema from increased intracranial pressure.
(28:21):
So when patients say they have optic atrophy, all you're saying
is we know where your problem is, optic nerve.
We just don't know why your problem is.
And so optic atrophy usually requires a investigation to find
out the cause for the optic artery.
The optic artery by itself is just a sign that something
happened. Yeah, understood.
(28:42):
Now if someone has optic atrophy, can you predict what
their vision may be just lookingat them?
So we cannot predict based on the appearance of the eye nerve
what the center vision or side vision is.
That's why we always have to test patients.
Genes have some ways of measuring the thickness.
So the severity of the optic atrophy is predicted, but it's
(29:03):
not linear, which means it can look bad and still have good
vision. It can look relatively good and
have bad vision in the centers. So we would never just rely on
looking at the optic nerve to judge someone's vision.
We would actually measure their vision and measure their side
vision with the visual field. And the last question that
patients always ask me is Optic Actuary 3 reversible?
(29:26):
So optic atrophy is not currently reversible, but it's
the same for all central nervoussystem.
And central just means your brain and optic nerve is the
extension of your brain. So the brain and spinal cord,
just like patients who have injuries to their spinal cord or
brain, it doesn't really regenerate very well.
And we don't really have good treatments for optic atrophy.
But one day we will have treatments, we'll be able to
(29:48):
replace the optic nerve with a transplant and one day we'll be
able to put stem cells in there and grow a new optic nerve.
It's just not ready yet, but it's coming.
You know, that's that little bitof hope is really, I'm sure
going to inspire a lot of patients because oftentimes
patients get dejected, they havea diagnosis, their vision's not
ideal and they feel like there'snothing they can do.
(30:09):
So it's wonderful that there arethese treatments in the
pipeline. And I was telling my patients,
maybe not today, but maybe 5-10,twenty years down the road, we
will have something to offer youalong those lines of stem cells
or retinal cell transplants, etcetera.
Doctor Lee, again this has been a fascinating, wonderful
discussion. Thank you for your all your
thoughts. Is there any one last thought
(30:29):
you would like or piece of advice you would like to leave
our listeners with today? Yes, so if your doctor tells you
have an optic nerve problem and they can't figure it out, that
is what neuro ophthalmologists do every day.
So Eve, all your listeners need to know, when do I need a neuro
ophthalmologist? You need a neuro ophthalmologist
(30:50):
when it's a problem between the nerve, the neuro and the eye
ophthalmology. And if your eye doctor or your
neurologist can't figure it out,that's the time to call your
local friendly neuro ophthalmologist.
Yes, thank you. Yes.
And I highly encourage people ifthey don't have a neuro
ophthalmologist that they have ready access to, you can go to
(31:10):
the website of our society, the North North American Neuro
Ophthalmology Society, and you can find a doctor through that
website. We could, we will post the link
again. Doctor Lee, thank you so much
and I wish you a wonderful day and I wish our audience a
wonderful day as well. Thank you.
Thanks for having me. Thank you for tuning in to the
IQ Podcast. I hope you enjoyed today's
(31:30):
episode and learn something new to help you boost your IQ.
Leave us a review and share the podcast with your family and
friends. Stay connected with me for more
eye opening insights on ihealth,nutrition and lifestyle.
Until next time, keep your vision clear and your IQ sharp.
And ischemia just means lack of blood flow.
So it's like a stroke in your optic nerve, stroke in old
people and inflammation in youngpeople.
And then sometimes something's pressing on the eye nerve either
directly, which we call a compressive optic neuropathy,
which means a tumor is actually pressing on your nerve, or you
have swelling of your eye nerve because you have high pressure
in your head. And that can be from a tumor or
(00:22):
it can be just from high pressure for no reason, which we
call pseudo tumor. That condition is called
papilledema. So papilledema is an optic nerve
problem where the eye nerve is swollen from increasing cranial
pressure and it can be from a tumor or something that acts
like a tumor but isn't a tumor pseudo tumor.
Welcome to the IQ Podcast. I'm Doctor Ronnie Banach, here
(00:43):
to help you boost your IQ with powerful insights that connect
your eyes, your brain, and your whole body Wellness.
Welcome back. Today I have the honor of
hosting one of the leading neuroophthalmologists in the world,
Doctor Andrew Lee. Doctor Lee has dedicated his
career to understanding and treating some of the most
(01:04):
complex conditions affecting thevisual system and the brain.
Doctor Lee is a prolific researcher, educator, and
clinician with experience in neuro ophthalmology, having
authored hundreds of publications and trained
countless specialists globally. So we are so honored to have you
here today on the ihealth Summitwith us.
So thank you for joining us, Doctor Lee.
Thanks for having me. Absolutely.
(01:26):
So just to start off, I always like to have our audience be
introduced to the topic that we're going to be talking about.
What is neuro ophthalmology? What is the subspecialty that we
both practice? So neuro ophthalmology is the
specialty that links 2 specialties, ophthalmology which
is the study of the eye and neurology which is study of the
(01:47):
brain and the nerves, both the peripheral nerves and the
central nervous system. And so neuro ophthalmology is
like a bridge between these two specialties.
And how does 1 become a neuro ophthalmologist?
What type of training does it require?
So you can become a neuro ophthalmologist either by being
a neurologist first or being an ophthalmologist first.
(02:07):
And both pathways lead after residency, which is after your
medical school to a fellowship training program in neuro
ophthalmologist. And some people do both
neurology and ophthalmology residencies and then become
neuro ophthalmologist. Yeah.
Just for some fun facts out to put out there, how many neuro
ophthalmologists are there approximately in the world or
let's say in the US? The US, we're probably between
(02:30):
4:50 and 500 depending on whether you include everybody or
just the full timers. There are many people that kind
of do a little bit of neuro ophthalmology on the side or
combine it with another subspecialty and I would say
somewhere between 4 to 500. OK.
Yeah. So there aren't that many of us
compared to some other types of specialities.
What are some of the most commonconditions as inner
(02:53):
ophthalmologist? So the most common conditions
are visual loss related to opticnerve problems.
And the optic nerve is like a cable that connects the eyeball
to the brain. And then we've got brain
problems that cause vision problems, and that's for seeing.
And that's like the brain sees 1/2 of the vision.
So the right side of your brain controls the left side of your
(03:14):
vision and the left side of yourbody and the left side of the
brain controls the right. So some people have half their
vision loss to one side or another from a stroke or tumor.
And then we've got double visionwhere people see two of
everything or their eyelid is droopy or their pupil, which is
the black part of the eye is bigger or smaller.
So those are the common things that we see, droopy eyelidosis,
(03:36):
double vision and loss of vision.
And so basically what I'm hearing is that some of the
vision problems that you see as an ophthalmologist also involve
the brain and there can there beother symptoms as well, not just
vision symptoms with some of these conditions.
Yeah. So when we have vision problems
related to the brain, they oftenhave other neurologic symptoms
(03:56):
depending on which part of the brain it whether it's related to
a systemic disorder or not. So they might have a headache in
addition to what we would see them for double vision, loss of
vision, weakness, numbness, tingling, spine symptoms or
brain symptoms or constitutionalsymptoms, which is our fancy way
of saying systemic symptoms likefever and rash and swollen lymph
(04:18):
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happens to be showing up in the eye.
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(05:22):
Yeah. So it seems like it's a wide
range of different types of conditions that can be seen in
an ophthalmologist office. But I wanted to, for the rest of
our time here today, Doctor Lee,I wanted to really focus on one
of those categories, the first category that you mentioned,
which is vision loss related to optic nerve disorders.
So for our audience, can you first describe what is the optic
(05:43):
nerve, what's its purpose? What does it do?
So the eyeballs like a camera and the full front of the eyes
like the lens of a camera. Its whole job is to focus the
beam of light onto the retina, which is like film used to be in
old cameras. Now of course, everything's
digital, but the lens is the focusing part.
And then the film or the camera itself's memory is holding what
(06:06):
the image that it is captured is.
And then that signal is sent like a cable.
So it's like the wire wired, a device with the cable optic
nerve carrying the picture, the image formed on the retina to
the brain and it's the brain that processes that image.
So the optic nerves like the cable that connects the eyeball
(06:27):
to the brain? Oh, that's absolutely
fascinating. I'm sure many people, it's, they
don't know that the eye is a direct extension of the brain
embryologically. So it's, it's really so critical
to our vision to have a healthy optic nerve.
Now, of the many different typesof optic nerve conditions that
can develop in someone, what aresome of the most common ones
(06:48):
that you see in your practice, Doctor Lee?
So when young people less than 40 say those patients are much
more likely have inflammation oftheir optic nerve and that
inflammation is called itis. So the suffix itis means
inflammation. So if it's itis in your joints,
we call it arthritis. If it's itis in your brain, we
(07:09):
call it meningitis or encephalitis.
But if it's itis in your optic nerve, we call it optic
neuritis, inflammation of the optic nerve.
That's the most common acute optic nerve problem that we see,
and that's often associated witha systemic neurologic disorder
called multiple sclerosis. But sometimes it's from things
that look like Ms., but they're mimicking Ms., or they have Ms.
(07:31):
like illnesses. And for older patients, the most
common cause of optic nerve damage is called ischemic optic
neuropathy. And ischemia just means lack of
blood flow. So it's like a stroke in your
optic nerve, broke in old peopleand inflammation in young
people. And then sometimes something's
pressing on the eye nerve eitherdirectly, which we call a
(07:51):
compressive optic neuropathy, which means the tumors actually
pressing on your nerve or you have swelling of your eye nerve
because you've high pressure in your head.
And that can be from a tumor or it can be just from high
pressure for no reason, which wecall pseudo tumor.
That condition is called papilledema.
So papilledema is an optic nerveproblem where the eye nerve is
swollen from increasing cranial pressure and it can be from a
(08:13):
tumor or something that acts like a tumor but isn't a tumor
pseudo tumor. Yeah.
So just to recap again, there are different mechanisms that
Doctor Lee described by which the optic nerve can be affected.
Could be inflammation, could be lack of oxygen or blood flow.
It could be compression or couldbe high pressure in the brain
causing optic nerve dysfunction.Let's go back to optic neuritis
(08:35):
because I know that many people may have certain symptoms,
symptoms and they start Googling, they go to doctor,
Google and they look up OK vision loss and they worry that
they may have optic neuritis in a mass.
What are some of the most commonsymptoms of optic neuritis?
And then what are the exam findings that you would expect
to see? So optic neuritis is
(08:56):
inflammation and so our inflammation words are pain and
swelling and redness, and those are the inflammation words.
So patients with inflammation ofthe optic curve, optic Ritis
often have pain with eye movement in addition to their
main complaint, which is loss oftheir center vision or their
side vision, which we call the visual field.
(09:18):
And so because so many things can cause loss of vision, even
with pain, you really need to have an eye exam to look for the
signs that it's an optic nerve problem.
That means having someone look in your eye and make sure
nothing's in the front of the eye or in the back of the eye,
like a retinal detachment. And if there's nothing in the
eye causing it, then we're goingto swing the light that we use
(09:38):
to check your pupil response. And we can see the damage
relative to the other eye of nerve damage from optic
neuritis. And that thing's called a
relative Afrin pupillar defect, which is a big long name for
relative to the other eye. We can tell when the pupil isn't
reacting as well compared to theother eye and so that finding
(09:59):
the pupil finding in the settingof acute vision loss with pain
with eye movement is the distinctive characteristic
finding of optic neuritis. And may patients have other
types of symptoms? For example, you mentioned that
their peripheral vision may be affected.
What about their color vision orperhaps their contrast?
Could that be affected as well with optic neuritis?
(10:21):
Yes, because the optic nerve carries all of those fibers, the
center vision, the side vision, the color vision and the
contrast. When you damage the optic nerve,
regardless of what the cause is,including optic neuritis, you'll
have deficiencies in any or all of those visual parameters.
Visual acuity, which is the center vision visual field,
(10:42):
which is the side vision, color vision and contrast.
So let's say someone suspects they have optic neuritis, they
have symptoms, they go to their ophthalmologist or neuro
ophthalmologist, they get the diagnosis and what happens next?
What are some tests or what elseshould the patient be doing?
So patients with optic neuritis can just have isolated optic
(11:02):
neuritis, which means it's not associated with anything, it
could be from infection or inflammation.
And so usually when asked questions about exposure to
infections, and then we're goingto do a scan called a magnetic
resonance imaging MRI. And that MRI scan is to look for
inflammation. And on MRI, the inflammation is
seen as enhancement, which is a fancy way of saying when you
(11:26):
give dye, the dye leaks out intothe optic nerve, and we can see
that leakage. And that tells us it's active
disease. And in the brain, we're looking
for the most common cause of optic Ritis, which is multiple
sclerosis, which is a fancy way of saying, yeah, neurologic
disorder of your brain and the optic nerve.
And it's from lack of the covering of the nerve.
(11:48):
Damage to the covering in the covering is called myelin.
The myelin is like insulation onyour optic nerve and other
nerves. And when you lose your myelin,
the nerve doesn't function as well.
And the most common cause of multiple areas of damage to the
myelin is called multiple sclerosis.
Now, you mentioned getting an MRI.
What if someone were to get a CAT scan?
(12:10):
Is that enough? So a CAT scan can show some
causes of optic nerve damage like a big tumor or it can show
water on your brain, hydrocephalus, but it's not
really that great for looking for the thing we're looking for
an optic neuritis, which is enhancement of the optic nerve
and multiple sclerosis lesions. So MRI is a way better scan for
(12:30):
optic neuritis. Thank you for that.
I know a lot of patients when they first come in, they get
this diagnosis of optic neuritis, they're very
frightened. And then they they look up
multiple sclerosis, they get even more frightened.
But what do you tell your patients in terms of their
ultimate outcome and treatment? And so the good part about optic
(12:50):
neuritis is the vision's going to come back regardless of
whether we give steroids or no steroids, which is the treatment
of inflammation. The vast majority of optic
neuritis and especially for multiple sclerosis, optic
neuritis giving steroids and we give it by vein rather than by
mouth and conventional doses, weget high doses intravenously is
(13:11):
just making your vision get better quicker.
So intravenous steroids is the treatment.
But even if we don't get any intravenous steroids, people
with optic neuritis tend to justget better.
It's only when it's these not Ms. causes of optic neuritis
that patients don't get better without the steroids.
And so that's why it's importantto both be tested and treated
(13:32):
for optic neuritis until we figure out are you the benign
form or are you this more dangerous worm, which is
antibodies. And antibodies are supposed to
be fighting against bacteria andviruses, but when they attack
you, we call that autoimmune disease.
So those autoimmune antibodies are the things we're going to be
looking for after you're admitted to the hospital.
(13:52):
So the going to the hospital is 2 reasons, 1 is a diagnostic
reason to get the test to make sure it's not infection to do
the MRI and a therapeutic reasonwhich is to get intravenous
steroid. Now you mentioned let's say a
patient does not want to get treated with steroids.
In what time frame can they expect to get their vision back?
Let's say this is what we call garden variety optic neuritis.
(14:15):
So that most most typical form How soon may they get their
vision back? So let's be garden variety.
Typical optic neuritis usually gets worse initially and then it
peaks at around 14 days and thenit starts to turn around.
So really we should be expectingimprovement at within weeks of
the onset of a typical optic neuritis.
(14:38):
Thank you. This has been such a fascinating
discussion. Doctor Lee, we are going to take
a very short break and we'll hear from our sponsors and then
be right back with the ihealth Summit.
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(15:47):
Welcome back to the I Health Summit.
Today we're chatting with DoctorAndrew Lee, a leading neuro
ophthalmologist, and we're talking about various different
types of optic nerve problems. Next, Doctor Lee, I would love
to get your thoughts on that other type of optic nerve
condition that you mentioned earlier in which older patients
may be affected where they may not have enough oxygen to the
(16:07):
optic nerve. Can you tell us a little bit
more about that and why it may happen to someone?
Yes. That lack of profusion or lack
of oxygen, we call that ischemia.
And so when you have an optic nerve problem from ischemia, we
call that condition ischemic optic neuropathy.
An ischemic ophthenropathy is a fancy way of saying you had a
(16:29):
stroke in your, it's not like a stroke in your brain.
It's a little vessel stroke, nota big vessel stroke.
So it is a stroke in the sense that it's ischemia, but it's not
nearly as big or severe or life threatening as the intracranial
in your brain kind of stroke. And there are two flavors of
this ischemic ophthenropathy. 1 is inflammation, which we call
(16:50):
arteritis. And that arteritis we're worried
about is in older patients who have inflammation of their
artery and that's a vasculitis, an inflammation of the vessel
wall. And that causes the stroke
because the inflammation is in the artery and the artery which
supplies the blood. And that is a uncommon form of
ischemic arthropathy, but it's the more dangerous form because
(17:12):
that one requires intravenous steroids.
And then there's this other formwhich is the not arteritis form,
which we call non arteritic ischemic optic neuropathy.
And that's the majority of patients and that's small vessel
ischemia and small vessel disease from the usual things
that cause lack of blood flow inolder patients, high blood
(17:33):
pressure, high blood sugar, diabetes, high cholesterol,
smoking and hardening of the arteries, atherosclerosis.
So these are the common things that cause the common form of
ischemic of neuropathy, non arteritic anterior ischemic of
neuropathy. That anterior is a fancy word
for saying we can see the swelling so we can act, look in
the eye and see the stroke. And so the doctor version of
(17:57):
this condition is non arteritic and arteritic anterior ischemic
of neuropathy. But we're just regular patients.
We just say you have a little light small vessel stroke in
your eye. Doctor Lee, you talked about a
couple of risk factors for this non arteritic form or what we
also call it NAION for short sometimes.
What's another risk factor? Yes.
(18:18):
So the swelling, that's the anterior part, anterior just
means it's in the front and in in this case it's in the front
part of the eye nerve right as it's connecting to the eyeball.
And if you have a small and crowded eye nerve, a little bit
of swelling in a small space canmake a big problem.
So the predisposing risk factor for NAION, the stroke and the
(18:42):
eye nerve is if you have the small and crowded nerve.
And that means a little bit of swelling can cause a big
problem. Because if the swelling doesn't
have anywhere to go, and we callthis the disk at risk, the disk
is the eye nerve itself. And the disk at risk is a small
coupless optic nerve that just doesn't have any room for
swelling. And so patients have this as a
(19:02):
predisposing risk factor and then there's a precipitating
factor. And that precipitating factor is
all those risk factors we just talked about, blood pressure,
blood sugar, diabetes, cholesterol, etcetera.
Now, what if somebody goes in for their regular checkup and
their vision is fine, They have no symptoms whatsoever, but
they're told by their eye doctorthat they have this disk at
(19:23):
risk. Should they be concerned?
Is there anything they can do toprevent an optic nerve stroke?
What are your thoughts? So a lot of people have this
small disc and they're normal. In fact, it's a normal finding.
So even though it is a predisposing factor for ischemic
OP neuropathy, patients shouldn't be worried about it
and there's nothing you can do about it.
(19:45):
However, you should be doing thethings your doctor already told
you to do regardless of the ischemic optic neuropathy disk
at risk, which is eat a good diet, moderate amount of
exercise, be a healthy person, eat right, lose weight, live a
stressful life. All the things we tell you to do
as doctors no matter what you have.
And so if you have the disk at risk, you should just be
(20:06):
following what your doctor already thinks you're doing.
Yeah. And I wanted to ask you about
another risk factor that I've seen a lot in my patients, which
is many of them with this type of optic nerve stroke, has it
have a history of snoring and some of them actually have sleep
apnea. Is that something that you've
seen as well in your patients with NAION?
(20:26):
Yes. So the sleep apnea is a problem
for patients who might have ischemia of any type because you
need the oxygen. So the whole point of breathing
is to push out the carbon dioxide and take in oxygen.
And when you don't need, we callthat apnea.
And when that apnea A means not and NIA is PNEA means breathe.
(20:47):
When you apnea, you're not breathing.
And if you don't breathe, your oxygen goes down.
And oxygen is part of the perfusion and the healthy
oxygenation of tissues is required for their function.
And so that word we call hypoxia.
So hypoxia is one of the HS of ischemic optic neuropathy.
So now you've heard about hypertension too, high blood
(21:10):
pressure, hypotension, hyperglycemia, which is the
diabetes, hyperlipidemia, which is high cholesterol.
And now we got this extra 1 hypoxia, which is lack of
oxygen, and one of the causes ofthat is obstructive sleep apnea.
So once someone's been diagnosedwith this type of optic nerve
stroke, what is the management like?
(21:32):
What is the standard of care with respect to going forward
for these patients? So even though we don't have a
good and effective treatment forthe stroke, once it happens, our
goal is trying to reduce the chance in the other eye.
So that's where we're going to contact the primary care doctor
and in conjunction with the patient, work on getting all our
HS under control, our hypertension, our hypotension,
(21:55):
our hyperglycemia, our hyperlipidemia, a sleep study.
If we're worried about the hypia, we're going to check the
blood count and make sure the haematocrit isn't too low.
And so we're going to try and address all of the treatable
risk factors, which we call vasculopathic risk factors.
We're trying to treat the risk factors to reduce the chance of
it going in the other eye. Overall, there's about a 15%,
(22:18):
one, 515% chance that you'll have ischemic orthogon the other
eye after having it in one eye. And so we'd like to try and get
that number to single digits. We cannot make it 0% chance.
There's some risk factors that are not treatable, like your age
or your genetics, your mom and dad.
We just can't change your genderand your race.
(22:39):
And so some of those things cannot be modified, but we can
modify those ages. So we direct a lot of the
encounter to educating the patient about what it is and
then trying to prevent it from going in the other eye.
Yeah, absolutely. And I know that there have been
many studies done trying to treat this type of optic nerve
stroke and unfortunately, most of them really have not proven
(23:00):
to be of any benefit. Could you say a few words about
some of the treatments that havebeen tried and maybe why they
failed for this type of optic nerve stroke?
Yeah. So ischemic optic neuropathy,
once the event occurs, the thingwe're worried about is the
tissue dies from lack of oxygen.And that happens relatively
quickly because central nervous system, including the optic
nerve, can't really survive without oxygen and blood flow
(23:23):
for very long. Part of it is a timing issue,
but part of it is we really don't have way good ways of
reversing ischemia in the optic nerve.
So the things that have been tried are blood thinners and
steroids and agents that stimulate the red cells that
called erythropoietin. All of these things have been
tried, but they really haven't panned out.
(23:45):
As you mentioned, cutting on theeye nerve called the sheeting to
let the pressure off the eye nerve, that was tried and it
really didn't work and it actually harmed some patients.
And so we don't recommend it normally.
So our focus is more aimed towards preventing fellow eye
involvement and reducing that risk and not so much on
(24:06):
treatments. And the reason the treatment
failed is basically ischemia is a stroke of your optic nerve and
we really don't have good treatments for reversing stroke
once it occurs. Yes, that's what I often times
tell my patients. Unfortunately, we can diagnose
it, but there aren't that many options to reverse the damage
that's been done. The goal is to try to protect
(24:27):
the other eye. That's really a goal, the goal.
So in our last few minutes together, Doctor Lee, I wanted
to touch a little bit upon the type of optic nerve issue that's
caused by swelling or high fluidpressure in the brain.
You mentioned earlier papill edema and pseudo tumor sphery
bride. Could you just say a few words
about that condition? Is so that word papilledema?
(24:47):
Edema is our word for swelling and the papilla is the optic
nerve head. It's the part of the eye nerve
that we can see when we look in your eye.
And so papilledema is optic nerve swelling from increased
intracranial pressure. And usually that's from
something inside your head that's causing the pressure
because the skull is a closed box.
If you have a brain tumor, you'll get high pressure.
(25:08):
If you have a brain bleed, you'll get high pressure.
If you have a blood clot, you'llhave a high pressure.
And so the main thing with papilledema is making sure that
you don't have a brain tumor. And that's the main reason for
doing the scan. In the acute setting, we're
going to be doing CAT scan, but really we're going to need an
MRI. And sometimes it's from the vein
that drains your brain is blocked.
(25:30):
And so we do an Mr. phenogram for that.
A venogram is to look at that vein and make sure it's not got
a blood clot in it. I'm going to check the blood
pressure because sometimes it's the artery that's too much blood
and not the vein being blocked. So those are the common things
that cause increase in strain ofpressure.
But sometimes there's no cause and no 'cause we call that
(25:51):
idiopathic. Idiopathic is our word for we
don't know what causes it. And the condition is called
pseudo tumor steroid because it acts like a tumor.
Pseudo means false, but it's nota tumor.
And the preferred term is idiopathic intracranial
hypertension, which is a fancy way of saying high pressure in
your head for no reason. It's a disease that affects
(26:12):
young overweight females. We really don't know why.
A lot of speculation about hormones and body habitus and
female versus male physic nominee, but we really don't
know what causes it. But it's a it's way more common.
IIH idiopathic is way more common in young obese females
than true tumor. Even though we have to make sure
(26:34):
it's not a tumor and make sure it's not a blood clot or blood
breed bleed. A lot of no 'cause idiopathic.
Yeah. And I think you meant you
touched upon that, the fact thatmany of these women are
overweight, even though we stilldon't really know what causes
IIH, we do think that weight is a significant risk factor.
And for patients who do have IIH, who are overweight or
(26:56):
perhaps obese, then weight loss is part of our treatment
regimen, correct Doctor Lee? Now that's the best long term
treatment for the disorder is weight loss.
Absolutely. And I've seen patients where in
whom they achieve weight loss and they go into remission and
their symptoms go away, their papal edema goes away and they
end up doing really well. Doctor Lee, this has been such a
(27:17):
fascinating session. You're a wealth of information.
I just wanted to finish up really quickly by asking you one
more question about one more type of optic nerve issue, which
is optic atrophy. Now I know it's a huge topic,
but a lot of patients oftentimesask me, I have this diagnosis,
optic atrophy, what does it mean?
What can I do for it? What are your thoughts on that?
(27:38):
So all of the conditions that we've been discussing, optic
neuritis, ischemic optic neuropathy, arteritic
inflammation, optic neuropathy and papilledema, all damaged
optic nerve. And if the nerve damage is
sufficiently severe, then we cansee that damage in the back of
the eye, and that's what we calloptic atrophy.
So we can see that the nerve wasdamaged.
(28:01):
Unfortunately, you can't tell what caused the damage by
looking at a nerve that's atrophic.
And so optic atrophy is a sign. It's not really a diagnosis, and
it is the final common pathway for any optic neuropathy,
regardless of whether it's ischemic or inflammatory or
infectious or papilledema from increased intracranial pressure.
(28:21):
So when patients say they have optic atrophy, all you're saying
is we know where your problem is, optic nerve.
We just don't know why your problem is.
And so optic atrophy usually requires a investigation to find
out the cause for the optic artery.
The optic artery by itself is just a sign that something
happened. Yeah, understood.
(28:42):
Now if someone has optic atrophy, can you predict what
their vision may be just lookingat them?
So we cannot predict based on the appearance of the eye nerve
what the center vision or side vision is.
That's why we always have to test patients.
Genes have some ways of measuring the thickness.
So the severity of the optic atrophy is predicted, but it's
(29:03):
not linear, which means it can look bad and still have good
vision. It can look relatively good and
have bad vision in the centers. So we would never just rely on
looking at the optic nerve to judge someone's vision.
We would actually measure their vision and measure their side
vision with the visual field. And the last question that
patients always ask me is Optic Actuary 3 reversible?
(29:26):
So optic atrophy is not currently reversible, but it's
the same for all central nervoussystem.
And central just means your brain and optic nerve is the
extension of your brain. So the brain and spinal cord,
just like patients who have injuries to their spinal cord or
brain, it doesn't really regenerate very well.
And we don't really have good treatments for optic atrophy.
But one day we will have treatments, we'll be able to
(29:48):
replace the optic nerve with a transplant and one day we'll be
able to put stem cells in there and grow a new optic nerve.
It's just not ready yet, but it's coming.
You know, that's that little bitof hope is really, I'm sure
going to inspire a lot of patients because oftentimes
patients get dejected, they havea diagnosis, their vision's not
ideal and they feel like there'snothing they can do.
(30:09):
So it's wonderful that there arethese treatments in the
pipeline. And I was telling my patients,
maybe not today, but maybe 5-10,twenty years down the road, we
will have something to offer youalong those lines of stem cells
or retinal cell transplants, etcetera.
Doctor Lee, again this has been a fascinating, wonderful
discussion. Thank you for your all your
thoughts. Is there any one last thought
(30:29):
you would like or piece of advice you would like to leave
our listeners with today? Yes, so if your doctor tells you
have an optic nerve problem and they can't figure it out, that
is what neuro ophthalmologists do every day.
So Eve, all your listeners need to know, when do I need a neuro
ophthalmologist? You need a neuro ophthalmologist
(30:50):
when it's a problem between the nerve, the neuro and the eye
ophthalmology. And if your eye doctor or your
neurologist can't figure it out,that's the time to call your
local friendly neuro ophthalmologist.
Yes, thank you. Yes.
And I highly encourage people ifthey don't have a neuro
ophthalmologist that they have ready access to, you can go to
(31:10):
the website of our society, the North North American Neuro
Ophthalmology Society, and you can find a doctor through that
website. We could, we will post the link
again. Doctor Lee, thank you so much
and I wish you a wonderful day and I wish our audience a
wonderful day as well. Thank you.
Thanks for having me. Thank you for tuning in to the
IQ Podcast. I hope you enjoyed today's
(31:30):
episode and learn something new to help you boost your IQ.
Leave us a review and share the podcast with your family and
friends. Stay connected with me for more
eye opening insights on ihealth,nutrition and lifestyle.
Until next time, keep your vision clear and your IQ sharp.
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