optic nerve damage

[landw]

I have been treated for glaucoma for several years (eye drops to keep the intraocular eye pressure low (11-12 mmHg) for the better part of my treatment. About a year ago I had cataract surgery in 1 eye and post-surgery my vision was significantly reduced in that eye. I was seen by several glaucoma and retinal specialists at UCSF who noted that my optic nerve behind that eye had been "compromised." They suggested that I possibly had a temporary ischemic event that affected the nerve...I had MRI's and MRA's soon afterwords that showed no evidence of that supposed occurrence. Otherwise, they had no real shared awareness of what could have happened. Since my last visit to my opthalmologist a couple of months ago, the vision in that eye has been reduced even more (the doctor says that I have only about 5% vision remaining). At this point I'm mostly concerned about the other eye. The doctor suggested that a small tissue condition might be present, partly related to my recent cholesterol level of 259. I've read Uffe Ravnskov's and others' review of the literature about cholesterol effects but don't know if this level of cholesterol could have any effect on the possible small vessel condition related to my optic nerve. Comments or other direction would be greatly appreciated. Thanks!

[Michael J Kutryb, MD]

The MRI or MRA would likely not show the type of damage that you may have.  It sounds like you have possibly the  combination of chronic glaucoma with a pale, ischemic, weakened optic nerve ALONG with a worsened circulation, worsened optic nerve health which occured around the time of your cataract surgery. You may even have had ischemic optic neuropathy which may be related to poor microcirculation (yes, definitely worsed by high cholesterol, smoking, hypertension.)  Glaucoma in many cases has a circulatory component and the blood flow in the small vessels may be compromised for many reasons adding to the  pressure effect and the possible congenital weakness  of the nerve to begin with in certain individuals.  It's quite complicated, but I'm sure your ophthalmologists will have a handle on it.

[landw]

Is ischemic optic neuropathy measurable/ diagnosable or is it an inferred condition from other observations/symptoms? If treating my "high" cholesterol with statins or other medications is definitely conclusive, I would use it to possibly "save" the other eye; if not, I am very reluctant to use this type of treatment because of the definite side effects (liver problems, future cancers, etc.) observed in research by Ravnskov et al. Again, thanks for your advice and info.