PHOENIX — Vitamin B12 malabsorption following gastric bypass surgery can cause bilateral optic atrophy, according to a poster presentation here at Academy 2012.
The poster, presented by lead author Tina R. Porzukowiak, OD, FAAO, described a case where a 61-year-old Caucasian female presented with blurred vision. Her history included congenital nystagmus, diabetes mellitus, hypercholesterolemia, triglyceridemia and gastroesophageal reflux disease, and at the time she was on furosemide, amlodipine besylate, simvastatin, sitagliptin phosphate and omeprazole. She had no allergies and denied the use of alcohol and tobacco or substance abuse, the poster said.
Her best-corrected visual acuity was 20/200 OD and 20/60 OS. Confrontation visual field revealed a marked constriction in both eyes. The optic nerve cup-to-disc ratio was 0.3/0.3 OD with 1+ to 2+ temporal pallor and 0.45/0.45 OS with 2+ to 3+ temporal pallor.
The patient’s primary care provider initiated vitamin B12 injections of 1 cc intramuscularly once a month, and 6 months later the patient’s visual acuity was stable at 20/200 OD and 20/50 OS. Her visual field had expanded 20° from baseline and she reported improved energy and concentration, according to the poster.
“The importance of eye care provider awareness of the ocular manifestations of vitamin B12 deficiency, particularly as it pertains to gastric bypass surgery, is essential to detect and prevent permanent visual loss,” the authors said. “Patient education on the importance of post-surgical lifetime vitamin supplementation is imperative in addition to routine serology to monitor for vitamin deficiencies.”