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Macular Hole
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Macular Hole


  I am a 57 year old female.  Two weeks ago my local optometrist
  did an eye exam and told me I had a swollen optic nerve and referred
  me to an opthamalogist/neurologist who diagnosed ION.  I had done
  some research and asked if he planned to start steroids.  He said
  not until after some more tests.  He then scheduled a flourescine
  angiagram for today and an MRI.  After the angiagram, the Dr.
  said I had a macular hole and wanted to schedule surgery as
  soon as possible.  I have this scheduled for the 16th.  1st Q.
  Is there a relation between the edema of the optic nerve and
  a macular hole?  Why did two doctors see one thing and not the
  other?  The neuralogist has since concurred with the Retina
  specialist.  2nd Q.  Is it possible that I did have edema, no
  longer have edema, and the surgery is repairing "fire" damage without
  putting out the "spark" that is causing the fire?  Thanks for
  your input.  FW
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Elizabeth,
It is very difficult to provide diagnostic opinions without actually examining you.  Instead, I will provide some background on these conditions.
A swollen optic nerve can be caused my many things.  Two common possibilities are ischemic optic neuropathy (ION) and optic neuritis.  ION is like a mini stroke of the optic nerve and occurs more commonly in people with vascular risk factors such as high blood pressure and smokers.  There is no real treatment for this condition unless it is a particular subtype called arteritic ischemic optic neuropathy which requires steroid treatment.  Optic neuritis is an inflammation of the optic nerve.  This usually is associated with pain on eye movements and tends to get better on its own.  Steroids can shorten the recovery time and in patients with certain MRI findings can reduce the risk of developing multiple sclerosis.  In this condition, steroids are initially given IV and then by mouth.
A macular hole is a hole in the are of the retina responsible for best vision.  Sometime a small hole may be difficult to diagnose by looking in but can be easier found with an angiogram.  If the hole is closed surgically, there is a chance of improving vision.
You should discuss these issues with your ophthalmologist to confirm which of these diagnosis you actually have.  It is unusual for either ION or optic neuritis to cause a macular hole.  You should also discuss the risks, benefits and alternatives to surgery with your ophthalmologist.
I am sorry I cannot provide more specific information about your case.
This information is provided for educational purposes only.  Please consult your physician for diagnostic and treatment options.
Sincerely,
HFHS MD - NI
*Keyword: ischemic optic neuropathy, optic neuritis, macular hole.




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