Optic Nerve Atrophy

OPTIC NERVE ATROPHY (ONA)
D
efinition

The Optic nerve disease may affect one or both eyes. The Optic Nerve consists of about a million of small nerve fibers that carry images of what the eye sees to the brain.  Small photoreceptor cells of the retina are in control of sensing light and transmit those impulses to the optic nerve from where it is carried on to the brain, and where that visual information is interpreted, resulting in that we can see our surrounding.

As nerve fibers become damaged, then brain stop receiving vision information correctly and eyes sight becomes blurred. Optic Nerve Atrophy is also called optic atrophy or optic neuropathy.

When the optic nerve or its pathways to the brain is damaged, different types of vision loss occur. Possible causes of Optic atrophy may come from direct trauma, pressure on or toxic damage to the nerve, and nutritional deficiencies, although very often no apparent reason can be identified.

When reviewing Optic Nerve diseases, we also have to observe “Hereditary, Genetic or developmental anomalies” of the Optic Nerve like:

  • Congenital optic atrophy, which is usually hereditary.
  • Optic Nerve Hypoplasia (ONH) which is an undeveloped optic nerve.
  • Leber's Hereditary Optic Neuropathy is suspected of being X-linked and has an unclear mode of inheritance. It rarely affects women but is more common in 20-30-year-old males.

The acquired type of optic atrophy may be the result of pressure against the optic nerve, trauma, glaucoma, metabolic diseases, like, e.g., diabetes, or toxicity due to alcohol, tobacco, or other poisons intake.

The second most common cause of blindness in the world, Glaucoma, is caused by high eye pressure which is a slowly progressing eye disease damaging the optic nerve fibers and may cause a reduction in the visual field. If untreated, glaucoma may eventually lead to optic atrophy and blindness. However, with early detection and treatment, you can often protect your eyes against severe vision loss.

Another vision-related disease, the Optic Neuritis (ON) is also called optic papillitis and retrobulbar neuritis. Optic neuritis is an inflammation of the optic nerve, and the most common cause for it is multiple sclerosis.

Ischemic optic neuropathies (IONs) is a severely blinding disease as a result of the interrupted arterial blood supply to the optic nerve. There are mainly two types one IONs, the anterior ischemic optic neuropathy (AION) and the posterior ischemic optic neuropathy (PION).

The Anterior Ischemic Optic Neuropathy (AION) is a potentially devastating vision disease that occurs in the middle-aged and the elderly.  Ischemia or poor circulation to the blood vessels that supply the front or anterior portion of the optic nerve may cause a stroke of the Optic Nerve.

Symptoms

The optic nerve disorder is caused by the following two main factors:

  • Developmental (genetic or abnormal development)
  • Acquired factors (trauma or disease)

The symptoms described above may not necessarily indicate that a patient has optic nerve atrophy.  If a person experiences one or more of these symptoms, we suggest contacting your ophthalmologist for a thorough exam.

  • Declined brightness in one eye relative to the other.
  • Blurred vision.
  • The decrease in the visual function like decreases in side (peripheral) vision, decrease in sharpness and clarity of vision (visual acuity) or
  • Poor constriction of the pupil in the light.
  • Change in the optic disc.

It is essential to review also associated symptoms which might point towards an underlying cause. Some of those symptoms may indicate the underlying cause of ONA:

  • Especially in older patients, the previous history of diplopia, temporal pain, jaw claudication, fatigue, weight loss, transient visual loss, as well as myalgia suggests arteritic ischaemic optic neuropathy due to giant cell arteritis.
  • In young patients, the previous history of eye pain, ataxia or weakness suggests demyelination and paraesthesiae.
  • In older patient, the previous history of temporal pain, jaw claudication, fatigue, weight loss, a transient visual loss, diplopia, and myalgia suggests arteritic ischaemic optic neuropathy due to giant cell arteritis.
  • Medication history should be well reviewed, because of some prescription drugs which potentially may be toxic to the optic nerve (e.g., ethambutol, amiodarone, alcohol, methotrexate, ciclosporin).
  • History of diabetes, hypercholesterolemia, and hypertension is common in patients with non-arteritic anterior optic neuropathy.
  • Complete family history may be reviewed in case of hereditary autosomal and mitochondrial optic neuropathies.

The optic nerve fiber is made of Axons from the retinal ganglion cells and typically do not regenerate after an injury, resulting in a permanent visual loss.

Treatment
Traditional Treatment

There is, unfortunately, no effective treatment for optic atrophy, and once the nerve fibers in the optic nerve are lost they with conventional treatment will never heal or grow back. Early diagnosis and treatment of the underlying causes of optic atrophy, however, may help prevent further damage from the disease.

Deficiencies in protein,  vitamin B12, B vitamins, and folic acid as a  result of poor nutrition, starvation, poor absorption or alcoholism, may cause Nutritional Optic Neuropathy.  Drinking alcohol contributes to poor absorption of vitamin B12. Vitamin B12 deficiency damages the nerves. Treatment with oral B12 supplementation and intramuscular B12 may dramatically improve vision.

Investigational non-invasive brain stimulation so-called rTMS Therapy may be used to modulate neural activity in CNS and PNS, but early results are not conclusive for the treatment of neurological disorders.

CellularStem Treatment Protocol

The eye is an intricated organ with many receptors and neurons conducting signals to the brain for processing, and cells are continually renewed and neovascularized. Nerve atrophy or ischemic condition, i.e., the restricted flow of blood leads over time to vision impairment.

Stem cells being present in the region of the eye typically can repair and renew those affected tissues, but due to factors, we have not yet fully understood they don’t function or are less efficient in the regeneration of such a condition.

Injected new Mesenchymal Stem Cells from the umbilical cord are however cells which can differentiate into nerve cells, immunomodulate, and neovascularize, i.e., rebuild blood vessels and have shown to be capable of overcoming these problems.

These newly injected Mesenchymal stem cells furthermore may also activate the differentiation of existing local stem cells and support other related cells to form new or repair optic nerve cells through regeneration.

Basic procedure

Medical intervention with umbilical cord-derived mesenchymal stem cells includes Intravenous injection (IV), Lumbar Puncture (LP) and Retrobulbar (RB) injections.  This is a general statement about the procedure and mode of injection and may change according to the condition of the patient as well as the actual medical review.

Treatment costs

Please note that treatment costs, besides the selection of treatment options, also is depending on the medical history and condition. For further details we suggest to kindly complete our Patient Application Form, - see under contact - stipulating your condition and treatment request, and send it to our Delhi or Europe office. We actively strive to reply to any request either immediate or latest within two working days with details.

Quality of Stem Cells

Licensed physicians administer the stem cells intravenously (IV) and into the affected area. Stem cells may also be applied in certain circumstances, intrathecally and intramuscularly. Stem cells used are certified by the lab providing the cells to our partner clinics.

Medical Procedure Treatment
Side effects and Follow up

When it comes to side effects, our patients have not experienced serious side effects from the stem cells treatment, and we are monitoring the well-being of our patients in the first 24 to 48 hours by a dedicated patient coordinator.

Our stem cell treatment furthermore, does not end with the procedure in our partner clinics. We continuously care about how you are doing after you return home. Therefore, we will monitor your post-treatment progress on a regular basis. The proper follow-up, i.e., 1, 3, 6, 12, 24 months, to review the progress at the patient also helps us to evaluate the effectiveness of our investigational treatments and improve our protocols based on observed outcomes further.

Clinical Trials, Studies & General Information

According to ClinicalTrials.gov statistic, in October 2017 there had been 297 trials for Optic Nerve studies registered. 12 studies are related to stem cell treatment.

https://clinicaltrials.gov/ct2/results?cond=Optic+Nerve+Diseases+and+stem+cells&term=&cntry1=&state1=&Search=Search

Slide Show About Optic Nerve Diseases By: Sumayya Naseem Optometrist
https://www.slideshare.net/SumayyaNaseem/optic-nerve-diseases-by-sumayya-naseem-optometrist

OPTIC NERVE  - Stem Cell Research & Medical Publication

Cambridge Ophthalmological Symposium

Stem cells to replace the optic nerve by H A Quigley  & D S Iglesia
Eye (2004) 18, 1085–1088 (2004) doi:10.1038/sj.eye.6701577

https://www.nature.com/articles/6701577

OPTIC NERVE  - Stem Cell Research & Medical Publication

PLoS One. 2015; 10(5): e0126949. Published online 2015 May 20. doi:  10.1371/journal.pone.0126949  PMCID: PMC4438867

Low Intensity Repetitive Transcranial Magnetic Stimulation Does Not Induce Cell Survival or Regeneration in a Mouse Optic Nerve Crush Model

Alexander D. TangKalina MakowieckiCarole Bartlett, and Jennifer Rodger*

Rafael Linden, Academic Editor

OPTIC NERVE  - Stem Cell Research & Medical Publication

Expert Rev Ophthalmol. Author manuscript; available in PMC 2012 Feb 1.

Published in final edited form. Expert Rev Ophthalmol. 2011 Apr 1; 6(2): 165–174. doi:  10.1586/eop.11.3  -  PMCID: PMC3114633

Stem cell therapy for glaucoma: possibilities and practicalities
Thomas V Johnson,1,2 Natalie D Bull,1,3 and Keith R Martin1,3,4,†

OPTIC NERVE  - Stem Cell Research & Medical Publication

Stem Cells International - Volume 2016 (2016), Article ID 8304879,
Stem Cell Therapy for Treatment of Ocular Disorders
Padma Priya Sivan,1,2 Sakinah Syed,1 Pooi-Ling Mok,3,4 Akon Higuchi,5,6,7  Kadarkarai Murugan,8,9 Abdullah A. Alarfaj,6 Murugan A. Munusamy,6 Rukman Awang Hamat,1 Akihiro Umezawa,7 and Suresh Kumar1

https://www.hindawi.com/journals/sci/2016/8304879/

OPTIC NERVE  - Stem Cell Research & Medical Publication
Journal of Stem Cell and Regenerative Biology
Cell Replacement Therapy for Optic Nerve Disorders

Ravi Kant Upadhyay - Department of Zoology, D.D.U Gorakhpur University, Gorakhpur, India

https://www.ommegaonline.org/article-details/Cell%20Replacement%20Therapy%20for%20Optic%20Nerve%20Disorders/1541

OPTIC NERVE  - Stem Cell Research & Medical Publication
Lab Reports Progress in Optic Nerve Regeneration

Benowitz and colleagues have discovered a naturally occurring growth factor called

oncomodulin

that stimulates regeneration of injured nerve fibers, known as axons, in the central nervous system.

https://www.glaucoma.org/research/update-on-optic-nerve-regeneration.php