NANOSNET

Doubt related to PDE5 inhibitor.

How large are the scotomas?

Did he have prior toxic exposure or cause for vitamin deficiency when vision loss started?

Most smokers drink alcohol. Did he previously drink alcohol or take disulfiram to encourage abstinence?

Best, 

Drew

He had bilateral small central scotoma.

He first noticed decreased vision when getting glasses 3 years ago, and his vision has been declining gradually, but it has improved a little this year, especially for the right eye, from the worst 20/40 to 20/30. He smokes one pack of cigarettes every day. He doesn't drink alcohol and takes no other recreational drugs. No toxic exposure or any cause for nutritional diseases. He has regular meals and exercises regularly. He only took medicine for the flu or COVID-19 medications when he was sick. During the period when he noticed his vision declining, he developed anxiety due to heavy work pressure, but he did not take any psychiatric medications and improved through exercises like running. 

In addition, he was found to have ocular hypertension at that time, with an IOP of 25 mmHg, and he never had eyedrops for it. This year, he started using brimonidine, and his intraocular pressure has been kept below 20 mmHg. 

He had bilateral small central scotoma.

He first noticed decreased vision when getting glasses 3 years ago, and his vision has been declining gradually, but it has improved a little this year, especially for the right eye, from the worst 20/40 to 20/30. He smokes one pack of cigarettes every day. He doesn't drink alcohol and takes no other recreational drugs. No toxic exposure or any cause for nutritional diseases. He has regular meals and exercises regularly. He only took medicine for the flu or COVID-19 medications when he was sick. During the period when he noticed his vision declining, he developed anxiety due to heavy work pressure, but he did not take any psychiatric medications and improved through exercises like running. 

In addition, he was found to have ocular hypertension at that time, with an IOP of 25 mmHg, and he never had eyedrops for it. This year, he started using brimonidine, and his intraocular pressure has been kept below 20 mmHg. 

He had bilateral small central scotoma.

He first noticed decreased vision when getting glasses 3 years ago, and his vision has been declining gradually, but it has improved a little this year, especially for the right eye, from the worst 20/40 to 20/30. He smokes one pack of cigarettes every day. He doesn't drink alcohol and takes no other recreational drugs. No toxic exposure or any cause for nutritional diseases. He has regular meals and exercises regularly. He only took medicine for the flu or COVID-19 medications when he was sick. During the period when he noticed his vision declining, he developed anxiety due to heavy work pressure, but he did not take any psychiatric medications and improved through exercises like running. 

In addition, he was found to have ocular hypertension at that time, with an IOP of 25 mmHg, and he never had eyedrops for it. This year, he started using brimonidine, and his intraocular pressure has been kept below 20 mmHg. 

He had bilateral small central scotoma.

He first noticed decreased vision when getting glasses 3 years ago, and his vision has been declining gradually, but it has improved a little this year, especially for the right eye, from the worst 20/40 to 20/30. He smokes one pack of cigarettes every day. He doesn't drink alcohol and takes no other recreational drugs. No toxic exposure or any cause for nutritional diseases. He has regular meals and exercises regularly. He only took medicine for the flu or COVID-19 medications when he was sick. During the period when he noticed his vision declining, he developed anxiety due to heavy work pressure, but he did not take any psychiatric medications and improved through exercises like running. 

In addition, he was found to have ocular hypertension at that time, with an IOP of 25 mmHg, and he never had eyedrops for it. This year, he started using brimonidine, and his intraocular pressure has been kept below 20 mmHg. 

He had bilateral small central scotoma.

He first noticed decreased vision when getting glasses 3 years ago, and his vision has been declining gradually, but it has improved a little this year, especially for the right eye, from the worst 20/40 to 20/30. He smokes one pack of cigarettes every day. He doesn't drink alcohol and takes no other recreational drugs. No toxic exposure or any cause for nutritional diseases. He has regular meals and exercises regularly. He only took medicine for the flu or COVID-19 medications when he was sick. During the period when he noticed his vision declining, he developed anxiety due to heavy work pressure, but he did not take any psychiatric medications and improved through exercises like running. 

In addition, he was found to have ocular hypertension at that time, with an IOP of 25 mmHg, and he never had eyedrops for it. This year, he started using brimonidine, and his intraocular pressure has been kept below 20 mmHg. 

Doubt related to PDE5 inhibitor.

How large are the scotomas?

Did he have prior toxic exposure or cause for vitamin deficiency when vision loss started?

Most smokers drink alcohol. Did he previously drink alcohol or take disulfiram to encourage abstinence?

Best, 

Drew

Thanks for all the replies.

Folate 2.57ng/ml（Reference values > 4ng/ml),  methylmalonic acid 19.56 ng/ml (<47.2 ng/ml), Vitamin B12 was not tested because there is no such test in the local hospital, but the malonic acid level is normal.

Macular line scan showed symmetrical MME, and that' s why I suspect he had optic neuropathy. THe outer retina looks normal.

FAF and FFA were all normal. ffERG was normal. mfERG was not performed.

The RNFL and GCA of Zeiss OCT and Humphrey VF were uploaded. I'm not sure if you can see it.

For HVF parameters: OD fixation loss 9/14, False POS 30%, False NEG 10%, Fovea 14dB,  OS Fixation loss 4/14, False POS 14%, False NEG 3%, Fovea 33dB

He had bilateral small central scotoma.

He first noticed decreased vision when getting glasses 3 years ago, and his vision has been declining gradually, but it has improved a little this year, especially for the right eye, from the worst 20/40 to 20/30. He smokes one pack of cigarettes every day. He doesn't drink alcohol and takes no other recreational drugs. No toxic exposure or any cause for nutritional diseases. He has regular meals and exercises regularly. He only took medicine for the flu or COVID-19 medications when he was sick. During the period when he noticed his vision declining, he developed anxiety due to heavy work pressure, but he did not take any psychiatric medications and improved through exercises like running. 

In addition, he was found to have ocular hypertension at that time, with an IOP of 25 mmHg, and he never had eyedrops for it. This year, he started using brimonidine, and his intraocular pressure has been kept below 20 mmHg.