A case of hypoxemia, optic nerve atrophy and non-refractive visual loss

A patient with symmetrical onset of diminished visual acuity, bilateral optic nerve atrophy and chronic hypoxemia, in whom extensive laboratory and radiologic studies failed to disclose an etiology, is presented. Ophthalmologic evaluation was unrevealing. Results of electroretinographic (ERG) studies performed with and without supplemental oxygen on this patient support the hypothesis that optic nerve atrophy, and hence visual acuity loss, may well represent sequelae of chronic, hypoxic retinal cell injury. Given the prevalence of chronic lung disease, we propose that this mechanism of non-refractive visual loss may be more common than is presently appreciated and warrant more aggressive treatment of the chronic hypoxemic state.