Thursday, April 11, 2024

Loss Of Vision Is Caused By Deficiency Of

Vitamin B12 Deficiency Optic Neuropathy: A Teaching Case Report

Live Class Retinopathy Of Prematurity by Dr. Sai Suguna

Amber R. Scharnweber, OD, FAAO, ABCMO, and Richard J. Zimbalist, OD, FAAO


Optic neuropathy is a rare complication of vitamin B12 deficiency. Incomplete treatment of vitamin B12 deficiency with oral B12 supplementation coupled with oral folic acid can aggravate neurological impairment secondary to vitamin B12 deficiency if the B12 deficiency is not corrected first. The patient in this teaching case report developed painless, progressive vision loss with temporal optic disc pallor and central scotomas after oral replacement of B12 and folic acid. The patient experienced significant visual recovery after implementation of parenteral B12 therapy followed by oral folic acid supplementation. This teaching case highlights the diagnosis, pathogenesis and treatment of vitamin B12 deficiency optic neuropathy.

Key Words: vitamin B12 deficiency, optic neuropathy, pernicious anemia, folate deficiency, optic atrophy, cobalamin


Case Description

A 63-year-old Caucasian male presented to the eye clinic for a second opinion regarding cataract surgery in February 2011 following a gradual decline in his vision over the previous two months. He received new glasses from a private provider in December 2010 but continued to experience decreased visual acuity. He was also referred to a private ophthalmologist for cataract surgery, but the procedure was not performed as it was believed that the lenticular changes were not the primary etiology of his visual loss.

Table 1.

Is Vision Loss Curable

The outlook for vision loss varies from case to case, depending on the underlying cause and the nature of the vision loss.

Some causes of vision loss, such as migraine or keratitis, can be temporary or treatable. Other causes, such as glaucoma or macular degeneration, are not curable. However, some treatments can prevent further loss of vision.

Q Why Choose Narayana Health For Eye Problems

  • Your eyes are precious and you want to give them the best possible care by choosing the best eye hospital in India. If you agree, then you know that it is important to seek the best eye specialist in India. Narayana Hospital focuses on providing the best eye care for a range of different eye conditions. You can get your eyes examined by the best eye specialist in Bangalore by booking an appointment. Narayana Hospital specializes in a range of treatments including those for glaucoma, cataracts, anterior segment surgery, refractive surgery, and pediatric ophthalmology.
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    What Complications Can Occur Due To Vitamin A Deficiency

    Vitamin A deficiency can lead to many complications, including:

    • Eye problems: Vitamin A is a key factor in many functions of your eyes. Vision loss and blindness can occur.
    • Skin issues: A lack of vitamin A can cause dry, scaly and/or itchy skin.
    • Infertility: Vitamin A plays an important role in your reproductive system. Vitamin A deficiency can lead to trouble conceiving and infertility.
    • Growth issues: Vitamin A deficiency can cause delayed growth and development in children.
    • Respiratory tract infections: Vitamin A deficiency can cause problems with your immune system. This can lead to infections in your chest and throat.

    Q How Many People Are Affected By Blindness

    Vitamin A deficiency causes, signs, symptoms, prevention and treatment
  • About 350 million people all over the globe are affected by some form of visual impairment where they cannot see either partially or completely. 50 million people out of the 350 million are completely blind whereby they cannot tell light from dark. A high percentage of blindness occurs in people who are 50 years old or older. Although in developing nations, blindness can occur at a lower age due to inadequate medical care which means the inability to get the proper treatment on time.
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    When Is Vision Loss An Emergency

    Clinicians consider sudden vision loss to be a medical emergency. Seek emergency care or call 911 for any symptoms of vision impairment, or changes to vision, that occur suddenly.

    Additionally, seek emergency care for:

    • vision changes or symptoms that occur alongside other symptoms of illness, such as:
    • unexplained severe headache
    • loss of balance or coordination
  • vision changes or symptoms if you have any other underlying conditions
  • possible or suspected injury to the eye or surrounding area
  • What’s It Like To Be Visually Impaired

    Just as you don’t think about your eye color every day, people with visual impairment don’t always think about their condition every day either.

    Someone with sight problems can become isolated from others more easily, though. If a visually impaired person asks for assistance, don’t hesitate to help. But someone who uses a cane or a guide dog is probably self-sufficient and may not need help.

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    /7ways To Achieve Vitamin A And B12 Sufficiency

    Cheese, eggs, oily fish, fortified low-fat spreads, milk and yogurt and liver products are some of the best food sources of vitamin A, as per the NHS.

    “You can also get vitamin A by including good sources of beta-carotene in your diet, as the body can convert this into retinol,” the UK health agency adds.

    Yellow, red and green vegetables, such as spinach, carrots, sweet potatoes and red peppers and yellow fruit, such as mango, papaya and apricots are good sources of beta-carotene.

    As far as vitamin B12 is concerned, you can get sufficient amounts of it through animal food products like beef, pork, ham, poultry, lamb, fish , seafood like shellfish and crab, dairy products like eggs, milk, cheese and yogurt.

    Q Is Sudden Blindness A Sign Of Stroke

    Live class on Retinopathy Of Prematurity by Dr Suguna
  • Most strokes affect one side of the brain. If the right occipital lobe is injured, the left field of vision in each eye may be affected. A stroke that affects the left occipital lobe may disturb the right field of vision in each eye. Rarely, both sides of the brain are affected, but this can result in blindness.
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    Global Patterns In Vision Loss Burden Due To Vitamin A Deficiency From 1990 To 2017

    Published online by Cambridge University Press: 29 March 2021

    Yufeng Xu
    Affiliation:Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
    Yi Shan
    Affiliation:Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
    Xiling Lin
    Affiliation:Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
    Qi Miao
    Affiliation:Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
    Lixia Lou
    Affiliation:Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
    Yijie Wang
    Affiliation:Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China
    Juan Ye*
    Affiliation:Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China

    How Is Low Vision Diagnosed

    An eye exam by your eye care specialist can diagnose low vision. You should make an appointment with your eye doctor if your vision difficulties are preventing you from daily activities like travel, cooking, work and school. The tests the eye doctor will perform include the use of lighting, magnifiers and special charts to help test visual acuity, depth perception and visual field.

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    /7vitamin Deficiencies May Give Light To Various Health Problems

    In total, your body requires 13 essential vitamins, which you can get from different food sources. Each vitamin has a different set of roles to play, which is why vitamin deficiencies can cause different health challenges and cause various symptoms.

    Vitamin deficiency in general means low levels or insufficient amount of vitamin in the body. It can manifest in the form of several symptoms ranging from fatigue, weakness, dizziness, irritability to loss of bone density, easy or frequent bruising to skin colour changes.

    Furthermore, being deficient in certain vitamins also predisposes you to various infections and illnesses, including depression.

    Differential For Night Blindness

    8 Important Complications Of Hypertension
    • 5 million children affected world-wide every year
    • WHO predicts 228 million children affected worldwide
    • Found predominantly in India, Nepal, Bangladesh, Indonesia, the Philippine, Burma, and Vietnam
    • Occurs in the developed world from malnutrition, malabsorption from bowel or bariatric surgery, and poor vitamin metabolism from liver disease


    • Oral vitamin A 10,000-20,000 IU daily
    • Intramuscular vitamin A for severe cases
  • Braunstein A, Trief D, Wang N, Chang S, Tsang S. Vitamin A deficiency in New York. The Lancet 2010 376:267.
  • Chae T, Foroozan R. Vitamin A deficiency in patients with a remote history of intestinal surgery. British Journal of Ophthalmology 2006 90:955-956.
  • Genead M. Fishman G. Lindeman M. Fundus white spots and acquired night blindness due to vitamin A deficiency. Doc Ophthalmol 2009 119:229233.
  • Lee, W. Hamiton S, Harris J, Schwab I. Ocular Complication of Hypovitaminosis A after Bariatric Surgery. Ophthalmology 2005 112:1031-1034.
  • Smith J, Steinemann TL. Vitamin A deficiency and the eye. Int Ophthalmol Clin 2000 40:83-91.
  • Sommer A. Xerophthalmia, Keratomalacia and Nutritional Blindness. International Ophthalmology 1990 14:195-199.
  • World Health Organization. Management of severe malnutrition: a manual for physicians and other senior health workers. 1999:17-18. Available at
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    What Are The Causes Of Vision Loss

    • short-sightedness
    • astigmatism, or presbyopia .

    These errors are easily correctable with eyeglasses, contact lenses, or refractive surgeries such as LASEK.

    The normal eye creates a clear image by bending or reflecting light in order to focus it onto the retina.

    Refractive errors occur when a component of the eyes optical system fails to focus the optical image. Presbyopia occurs when the lens loses its normal accommodating power and can no longer focus on objects viewed at arms length or closer. Aside from errors of refraction, when someone complains of loss of vision, several factors have to be considered

    Signs Of Vitamin B12 Deficiency

  • Pin and needle prick in an arm or leg
  • Changes in thinking, feeling and behaviour
  • Loss of concentration and feeling faint
  • Light yellowing of the skin
  • Irritability and depression
  • For vitamin B12, you take ham, poultry, sheep, fish , seafood such as shellfish and crab, and dairy products such as eggs, milk, cheese and yoghurt.

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    /7how To Know If You Have Low Vitamin Levels In The Body

    The best way to find out if you have vitamin deficiencies is through a blood test. Although you can also get a saliva test, blood tests are more accurate and reliable.

    If you develop any symptoms or signs of vitamin deficiencies, visit your nearest hospital and get yourself diagnosed. Talk to your physician about your diet and whether or not you should resort to supplements.

    Temporary Partial Vision Loss

    Peripheral vision

    If you have partial vision loss, the causes include:

    Migraines: These are, by far, the most common cause of short-term, partial vision loss. When you get a migraine, you may have âauraâ that affects the vision in both of your eyes. You may see flashing lights, shimmering spots, or blind spots.

    A retinal migraine affects only one eye. This rare condition causes partial or total blindness for a short period, usually 10 to 30 minutes. It typically comes before or during a headache. It is totally harmless to you and your vision.

    Retinal vasospasm: Like migraine, this condition can cause temporary vision loss. Treatment can fully restore your sight.

    When a blood vessel in your retina tightens, it causes a vasospasm. This cuts down on blood flow, which can bring on temporary vision loss in one eye. Various conditions can lead to a vasospasm. These include a retinal migraine, atherosclerosis, and high blood pressure.

    If you have a retinal vasospasm, your doctor may recommend aspirin or a type of medicine called a calcium-channel blocker to relieve it. Youâll also work with your doctor to manage whatever caused the retinal vasospasm in the first place.

    This disease causes inflammation in the linings of your arteries, particularly those in your head. Symptoms include head pain, scalp tenderness, jaw pain, fever, and fatigue. Giant cell arteritis also triggers vision loss, usually in one eye. Without treatment, it can result in permanent blindness in a week or two.

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    /7role Of Vitamins And Minerals

    Vitamins and minerals are essential nutrients that facilitate healthy functioning of the body. From helping to combat infections to increasing our bone strength to regulating our brain and hormonal functions, nutrients play a very important role in maintaining our overall wellness.

    According to the United Kingdom’s National Health Services , vitamins and minerals are nutrients your body needs in small amounts to work properly and stay healthy.

    “Most people should get all the nutrients they need by having a varied and balanced diet, although some people may need to take extra supplements,” the health body states.

    What Causes A Vitamin Deficiency

    The most common cause of any vitamin deficiency is decreased intake of the vitamin through the diet. These vitamins are not sufficiently produced naturally and must be gotten through consuming food with the needed vitamins.

    Any diet that is lacking in a major food group may put the individual at risk of developing a vitamin deficiency.

    Depending on the vitamin, a specific food type may provide a substantial amount of the dietary requirement.

    Other causes of vitamin deficiencies include gastrointestinal conditions which impair the absorption of vitamins from the stomach and the intestines.

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    What Causes Low Vision

    There may be one or more causes of low vision. These are usually the result of disorders or injuries affecting the eye or a disorder such as diabetes that affects the entire body. Some of the most common causes of low vision include age-related macular degeneration, diabetes and glaucoma. Low vision may also result from cancer of the eye, albinism, brain injury or inherited disorders of the eye including retinitis pigmentosa. If you have these disorders or are at risk for them, you are also at greater risk for low vision.

    Q What Are The Symptoms Of Sudden Blindness In Adults

    Retina Health Center how diabetes effects eyes
  • If you are suffering from Sudden Blindness then you might be unable to identify different shapes in your surroundings. You might only see shadows instead of the actual object. Another symptom is tunnel vision, in which you can only see things that are in your central part of your vision rather than your peripheral vision. You might experience a cloudy vision when you have Sudden Blindness. Some people experience poor night vision if they have Sudden Blindness. If you feel discomfort of any type and have any kind of discharge from your eyes, then it can be a sign of an eye problem. The symptoms can vary. You can have only one symptom or you can have several symptoms of Sudden Blindness. The cause of the blindness determines the symptoms that you will experience. The key is to know if something seems off and then contact emergency care immediately if you feel that you have any symptoms of Sudden Blindness.
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    Q Should I Wait For The Vision To Return If I Think I Have Sudden Blindness

  • No. You should never delay getting emergency care if you feel you experience Sudden Blindness. You should ask someone to take you to the emergency care as soon as you think that you have sudden vision loss. If you wait for too long, then there might be permanent damage to the eye which will cause further complications for you. The chances are much higher for you to get back your vision if you get appropriate treatment on time
  • How A Vitamin A Deficiency Causes Vision Loss

    Cian, a young teenager from Perth, started to lose his vision at 14. He visited many specialists, and was tested for a range of diseases. No one found a cause. At a loss, a family member flew Cian from Perth to Sydney to see the Save Sight Institute’s Professor Stephanie Watson.

    Professor Watson immediately diagnosed Cian with Vitamin A deficiency. Vitamin A deficiency is a rare diagnosis in developed countries like Australia. In the developed world, Vitamin A deficiency usually occurs after other medical complications. Cians Vitamin A deficiency was due to his diet. Cian was a fussy eater since the age of 5, he had been living on chicken, bread, chips, and coke.

    Vitamin A deficiency can lead to blindness, infections and death. Today, 228 million children lack enough Vitamin A. That makes Vitamin A deficiency the most common form of childhood blindness. Vitamin A deficiency causes eye diseases in 5 to 10 million children a year. Of those, five hundred thousand go blind because of a lack of Vitamin A.

    Vitamin A, a fat-soluble vitamin, is found in dairy products. Vitamin A also occurs in some fruits and green leafy vegetables. It has two roles in the eye it helps the retina convert light to a visual signal in the retina. It also ensures correct maturation of the ocular surface cells.

    Vitamin A deficiency also affects mood and general health with anaemia a frequent association.

    In Australia, doctors should examine a patients diet if there is an unexplained visual loss.

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    When To See A Doctor

    It is always advisable to receive a comprehensive eye examination with an optometrist for everyone below the age of 40 if there are no symptoms or history of eye diseases in the family.

    For people above the age of 40, or in case of systemic diseases including diabetes or hypertension, an annual or semiannual eye examination is required. In case you developed any symptom of visual loss, you should always be seen by a doctor to investigate the cause. One of the significant problems with the loss of vision is that patients will not notice until it is too late. Also, be aware that reduced peripheral vision may affect your ability to drive safely.

    Suppose the cause was just a refractive error that is correctable by glasses or contacts.

    In that case, this is a very benign problem, except in children where it is important to correct refractive errors as soon as possible, so they do not develop lazy eyes, or amblyopia.

    Sudden loss of vision, on the other hand, is considered a medical emergency.

    Anyone with sudden vision loss over minutes, hours, or days should immediately seek medical attention. An ophthalmologists examination and investigations are a must to save vision before irreversible neurological damage can occur. If you, or someone you know experiences sudden blurriness of vision, they have to immediately go to the nearest emergency room to be evaluated by an ophthalmologist.

    1. Flashes of light, floaters, or gray shadow

    2. Sudden loss of vision in one eye

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