NANOSNET

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha
------------------------------

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha
------------------------------

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha
------------------------------

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

Thanks Dr Kay!
Now we too will look at the rate of oedema resolution in GLP1 associated NAION, and also if the disc was small and at risk , time of onset ( morning/ evening/random)etc

We can create a proforma ( questionnaire ) to fill when we see these cases. The senior neuroophthalmologists ( Some understand the optic disc perfusion with great insights) can guide the proforma creation. If we want to understand the pathophysiology some key questions in the history and examination in every case need to be recorded.

most of the papers are retrospective studies. This way it can be analysed proactively.

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha
------------------------------

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha
------------------------------

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone

What if the patients who get better actually have papillitis and not NAION or incipient NAION? Right drug for the wrong indication.

Woah!
Neurobiology, molecular research input!

Minocycline 100 mg per day for how long? It's much safer than steroids.Hope it doesn't cause IIH as doxy in some.

Please keep the ideas coming , we are taking notes!

Thanks!

(Dr Kay's case) I was wondering if the swelling in the incipient NAION eye resolve with steroids before going on to develop the field defect? Usually, every kind of swelling responds to steroids structurally if not functionally, unless it's a pseudooedema or true papilloedema or an infiltration.

If it's due to GLP1 use we may learn something about the pathogenesis from this interesting case.  

------------------------------
Shikha

Original Message:
Sent: 11-06-2025 20:45
From: Matthew Kay
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

Original Message:
Sent: 11/6/2025 7:48:00 PM
From: Larry Frohman
Subject: Looking for any brilliant ideas on how to prevent second eye visual loss

A healthy 68 yo woman with absolutely no vascular risk factors and a recent hemoglobin A1c of 4.7 was sent into our emergency room this evening by an ophthalmologist for a diagnosis of a swollen disc

She happens to be one of our emergency room attendings

she awoke this morning with unilateral visual loss, which turns out to be an altitudinal field defect in that eye. This is painless. She has no giant cell symptoms. The work up is pending, but the other eye which she feels is normal and which had a normal visual field today has pallid edema as well.

She is 20/25 in each eye

And of course she started wegovy five months ago


We will get the scans and the blood work, but I'm rather certain this is going to be GLP1 induced simultaneous ischemic optic neuropathy with one eye being sub clinical at this point

I was going to give her solumedrol while waiting for the work up and to hopefully minimize the edema in the second eye as well as aspirin

She turns out to be aspirin and NSAID allergic so I'm going to give her 400 of Trental

I don't think we know the natural history of a potentially Wegovy induced case where both eyes are swollen and only one eye has symptoms

If any of you have seen this profile, please let me know and more important if anyone has a good idea on how to protect the swollen yet visually normal eye I'd like to hear from you

Thanks

Sent from my iPhone