Eye Care Expert Forum
Elevated Optic Nerve
About This Forum:

Our Ask-A-Doctor Eye Care Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Elevated Optic Nerve

I originally posted this question in the medical community support forum by mistake.

About a month ago, I went for a simple eye exam at a local optometrist for the first time since 2003. I am 28 years old and have never had any eye or vision issues; I am overweight but have never been diagnosed with high blood pressure.

The optometrist dilated my eyes, which I had never had done before, and after the examination she asked if I ever had headaches, which I rarely do. I might have 1-2 headaches a month at most that I would attribute to eye strain (I look at a computer for 7+ hours a day at work) or sinus pain. She advised me that my optic nerves appeared to be elevated, which wasn't uncommon in women under 40, but that mine were "a little more elevated" and she'd like to refer me to an opthamologist. She gave me incredibly vague, danced-around answers when I asked her what could cause the elevation of my optic nerve(s) and said that "worst-worst-worse case scenario could be a brain tumor."

I already struggle with some anxiety issues, and I was incredibly alarmed at this suggestion. After speaking with my husband, parents and psychiatrist, they all supported getting a second opinion. I currently have two appointments scheduled at Wake Forest Baptist Medical Center's Eye Center about three weeks apart - the first being a second-opinion optometry appointment, and the later appointment with a neuro-opthamologist.

Is it worth the expense and stress to go forward with the second-opinion appointment with the Eye Center's optometrist, or should I wait to see the neuro-opthamologist? I received virtually no suggestions or assistance from the first optometry exam, so I'm not sure what to expect for the neuro-opthamology appointment in the first place. What would this exam entail? - i.e., would my eyes be dilated again, should I be prepared for some kind of procedure/scan that day, etc.

I would appreciate any guidance. Thanks so much.
Related Discussions
1573381_tn?1296151159
Sorry about the late answer but I did this once already and the system went down and it didn't post.  Possibilities are:
1) Pseudotumor Cerebri: elevated pressure around the brain which could lead to headaches and peripheral vision loss.  Although it could sometimes be associated with high intake of vitamin A or other medications, it most often is a disease of young overweight women.  If this is suspected, you will need a CT scan and possibly an MRI/A to rule out some bad stuff (brain tumor, blockage of the blood drainage sinuses, etc).
2)  Optic nerve drusen: this is a congenital condition where there are calcium deposits in the nerve that make it look artificially elevated.  Unfortunately, optometrist don't see this often in their training and easily misdiagnose it for elevation of the nerve associated with high pressure around the brain.  The neuro-ophthalmologist will easily make this distinction.
You should skip the second optometrist appointment as that will be a waste of your time and wait to see the neuroophthalmologist.  In the meantime, call your primary care doctor and have him order a CT scan of your head to make sure it is not the unlikely brain tumor.  You should also start a healthy diet and exercise plan as weight loss would be the cure (YES, CURE!) for pseudotumor cerebri.  If you get the CT scan and feel like you still can't wait to see the neuroophthalmologist, make the second opinion with an ophthalmologist and not another optometrist.  Let me know what happens please.

HV
5 Comments
Blank
Avatar_f_tn
I had the appointment with the neuro-opthamologist on Friday morning. Dr. Timothy Martin at Wake Forest Baptist Medical Center's Eye Center was incredibly sympathetic, attentive and helpful. I did forego a second optometrist appointment and waited until this past Friday to see the neuro-opthamologist.

I had several tests all in succession of one another so I didn't have to make subsequent appointments, including photography and an ultrasound of my eyes. Dr. Martin mentioned both of the possibilities above before I had these tests. After assessing the results of the photography and ultrasound, Dr. Martin was able to rule out drusen and said everything else looked completely normal, as well as the pressure of my eyes during the glaucoma tests. He said that the elevation of my optic disc may just be "how I'm put together," but could also be elevated due to increased pressure in my intercranial fluid and recommended an MRI just to "clear the air."

To date I still don't experience unusual headaches or migraines, and the fluid may not be draining at the rate it's being produced (that's probably not the correct terminology or description) which could be contributing to the elevation of my optic disc. The MRI will show whether something else is increasing the pressure, and Dr. Martin did mention that if they eventually wanted to measure the pressure in my intercranial fluid, he may recommend a lumber puncture. I had the MRI this morning, both with and without contrast, and Dr. Martin should be reviewing the results and getting in touch with me within a few days.

Although this whole process has been unsettling for me, I appreciate the attentiveness of the staff who has seen me at Wake Forest Baptist Medical Center, and they certainly have done all that they can to answer my questions and put my mind at ease. I am anticipating the results of my MRI and will most likely be returning to the Eye Center in a few months to have the elevation of my optic disc reassessed to have a better idea of whether it's "how I'm put together," as Dr. Martin put it. I have my heart set on weight loss as well, which I hope to achieve regardless of the results of my MRI or cause of the elevation.

Thank you for your guidance. I really do appreciate it.
Blank
1573381_tn?1296151159
Thank you for letting me know.  I'm happy you are being well taken care of.  The weight loss thing is a win-win no matter what is going on and may prevent you from having to have a lumbar puncture.  Good luck and please update us as to how things end up.

HV
Blank
Avatar_f_tn
My 23 year old daughter was having blurred vision to her left eye about 1 month ago.  She went to the ophthalmologist and he saw a problem in her left eye so he had a retinal specialist in the same office look at her and he said she had optical neuritis.  After a MRI and lab tests everything came back negative.  She saw the same retinal specialist 10 days later for follow up and he thought she could possibly have a detached retina in her left eye.  Also said there was bleeding to the back of the left eye. He wasn't sure what she had so he sent us to another retinal specialist 2 hours away.  He diagnosed her with lattice degeneration to both eyes, a detached left retina.  He said at a later date would need to see a neuro ophthalmologist to the cause of the optical neuritis.  He said the surgery could not wait.  She had a buckle and vitrectomy and gas bubble on her left eye and laser surgery on her right eye because of so much thinning.  She had the surgery yesterday and he said all went well and that it was good they did laser  the right eye as it was just starting to detach.  Today she went for her post op visit.  The right eye looked fine but he said the left eye pressure was 47 and was too high so he inserted a needle into the left eye to release some of the gas pressure. We will be following up in 2 more days.  He said my daughter should have felt really sick with eye pressure that high but actually she was feeling fine.  We are concerned because we really don't know how to tell her eye pressure is fine when she displays no physical symptoms.  We are concerned and didn't have much time for more opinions.  She needed surgery right away and had to trust someone.  Do these events appear to be the way things are supposed to go.  We are so concerned that she will go blind.  Her post op eye drops are gentamycin, atropine and prednisone eye drops.  Please any comments or suggestions would really be appreciated.
Blank
1573381_tn?1296151159
Unfortunately, high pressure after retina surgery does sometimes happen.  As long as everything else in the surgery went fine, follow the surgeon's recommendations.  Make sure she keeps head positioning too if that was recommended and that she uses all the drops they have recommended.  I'd be more concerned about why the first retina specialist did not figure out for sure that she had a retinal detachment.

HV
Blank
Continue discussion Blank
This Forum's Experts
233488_tn?1310696703
John C Hagan III, MD, FACS, FAAOBlank
Discover Vision Centers of Kansas City
Kansas City, MO
2078052_tn?1331936700
Doreen Fazio, M.D.Blank
Amerisight Institute and Valley Eye Center
Van Nuys, CA
1731421_tn?1358826971
Timothy D McGarity, M.D.Blank
Timothy D. McGarity, M.D. P.C.
Columbia, MO
711220_tn?1251894727
Ray T Oyakawa, MDBlank
Sharper Vision Centers
Torrance, CA
1573381_tn?1296151159
Houman Vosoghi, MDBlank
Valley Eye Center/Darin Eye Center
Van Nuys, CA
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating: What Your Closet ...
Jul 09 by Roger Gould, M.D.Blank