Selective diet induced nutritional optic neuropathy in developmentally normal children

• Published in: American journal of ophthalmology case reports 2025-03, Vol.37, p.102234, Article 102234
• Main Authors: Teng, Rhea W., Heidary, Gena, Gise, Ryan A.
• Format: Article
• Language: English
• Subjects: ARFID; Avoidant/restrictive food intake disorder; Case Report; Nutrient deficiency; Optic nerve atrophy; Optic neuropathy; Vitamin deficiency
• ISSN: 2451-9936; 2451-9936
• DOI: 10.1016/j.ajoc.2024.102234

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. 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 %). 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.