Selective diet induced nutritional optic neuropathy in developmentally normal children

Abstract

Purpose: Nutritional deficiencies in developed countries are a rare but potentially intervenable cause of optic neuropathy in pediatric populations. To date, much of the literature on nutritional optic neuropathy has focused on children with developmental delay, however, a growing body of evidence supports other underreported risk factors.

Observations: We describe three pediatric patients with normal neurodevelopment, who presented with decreased vision and were subsequently found to have optic neuropathy attributed to vitamin deficiencies, predominantly vitamin B12. We review previous literature on nutritional optic neuropathy in pediatric patients, revealing that most published cases were associated with autism (17/25, 68 %).

Conclusions and importance: An increasing number of cases, including our own, describe patients without autism who develop nutritional optic neuropathy due to restricted diets related to traumatic food-related events, multiple food allergies, or from an unknown cause. Altogether, our findings highlight the importance of a thorough diet and allergy review in pediatric patients with optic atrophy.

Keywords: ARFID; Avoidant/restrictive food intake disorder; Nutrient deficiency; Optic nerve atrophy; Optic neuropathy; Vitamin deficiency.

Fig. 1

Case 1: 15-year-old male with one year of progressively blurry vision. A. Humphrey automated perimetry in each eye reliable and full at presentation. B. Fundus photos showing mild temporal disc pallor in both eyes (white arrows). C. Optical coherence tomography (OCT)-retinal nerve fiber layer (RNFL) from presentation demonstrating a borderline normal for age average RNFL with marked thinning of the papillomacular bundle in both eyes (blue arrows). D. OCT-ganglion cell layer (GCL) confirms generalized thinning and early optic atrophy in both eyes. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 1

Case 1: 15-year-old male with one year of progressively blurry vision. A. Humphrey automated perimetry in each eye reliable and full at presentation. B. Fundus photos showing mild temporal disc pallor in both eyes (white arrows). C. Optical coherence tomography (OCT)-retinal nerve fiber layer (RNFL) from presentation demonstrating a borderline normal for age average RNFL with marked thinning of the papillomacular bundle in both eyes (blue arrows). D. OCT-ganglion cell layer (GCL) confirms generalized thinning and early optic atrophy in both eyes. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)