Are there any treatments available for damaged optic nerves?

Hi Damen

Unfortunately at this time there is really no treatment to improve vision that has been affected by optic nerve damage.

There are many diseases that can affect the optic nerves, and any treatment or management done would depend on what it is. In most cases, the treatment or management aims to limit the damage or prevent it from getting worse, rather than to improve vision.

This is particularly true for traumatic optic neuropathy. In the past, people have investigated the use of high dose steroids in the immediate post injury period, but the results are controversial with no benefit found in the IONTS study. Surgery may be considered but only in the immediate post injury period if there is a bony fragment pressing on the optic nerve.

If your vision is affected badly enough, then the best course of action is to have a low vision clinic assessment and consider getting some low vision aids. These can make a big difference to quality of life in many cases.

I'm sorry to hear about your recent trauma and resultant traumatic optic neuropathy. Unfortunately these may result in significant impairment of visual function.

Its important to establish that the diagnosis is correct. This would also involve a high-resolution MRI of the optic nerve especially the intra-canalicular portion. This is to ensure that any reversible cause for the optic neuropathy may be addressed (including bone fragment, hematoma etc).

In the initial period, minimising damage to the optic nerve from secondary trauma (swelling etc) is important, and many treatments have been recommended, but as you can imagine due to the difficulty in conducting a randomised-controlled trial of the various treatment options, that all treatment options are based on small, poorly designed studies, or anecdotal case-reports.

The main treatment options involve either moderate, high-dose or mega-dose steroids in isolation or together with optic nerve decompression surgery.

All treatment options involve some degree of risk or side-effects and unfortunately none demonstrate significant efficacy over other treatment options.

The good news is that a significant number of patients do report spontaneous recovery from traumatic optic neuropathy, whether treatment was administered or not. However the decision to treat or not should ultimately be made together with your treating ophthalmologist after consideration of your individual factors.

ESG