This case involves a 35-year-old female patient who presented with blurry vision in her left eye after a lengthy sinus infection. The patient’s ophthalmologist diagnosed her with a swollen optic nerve and determined that the nerve would heal on its own in 8-10 months. The patient made a request for a prescription for steroids but the physician denied the request claiming the case was not extreme enough to merit steroids. 4 months later, the patient began to have complications in her right eye. She returned to her ophthalmologist and he promptly wrote her a prescription for intravenous steroids and referred her for treatment at the hospital. The patient underwent a series of tests at the hospital and was informed that the damage to her right eye stemmed from lack of treatment on her left eye. In spite of eventual steroid treatment, the patient lost sight in both eyes. It was alleged that these complications could have been avoided if the patient’s ophthalmologist had treated her with steroids months sooner. An expert in ophthalmology was sought to review the records and determine if the correct diagnosis was made and if anything could have prevented this patient’s eventual prognosis.
Question(s) For Expert Witness
- 1. How often do you diagnose patients with a swollen optic nerve?
- 2. What are the treatment options for a swollen optic nerve?
Expert Witness Response E-006715
I am the director of a university neuro-ophthalmology practice. I have published a significant number of articles on this topic and have a total of 210 peer-reviewed publications and also have federal funding for research in this area. I would say that I see at least 20-40 patients/year with this problem. For patients who present with vision loss and a swollen optic nerve and the task is to diagnose the cause and initiate treatment if indicated. I participate in the same process when reviewing cases that are seen by my other colleagues who are neuro-ophthalmologists in our university practice each morning. The options for treatment depend on the cause of the swollen optic nerve (e.g. ischemia, inflammatory, raised intracranial pressure, compression, genetic). Treatment depends on the individual diagnosis and could involve doing nothing or treating with steroids or surgery in the case of papilledema or compression. We usually follow patients with visual function tests including visual field testing and retinal/optic nerve imaging with fundus photos and optical coherence tomography to assess whether or not there is any improvement. We also assess risk factors that might be modifiable to reduce the risk of the other eye being infected.