Hello Penny777,
While I was able to find a few isolated cases where prednisone (A
corticosteroid) seemed to incease visual acuity, it is short lived and
does not work for everyone. Prednisone is not a good choice for long
term therapy due to its various side effects, which are found below.
Whether or not your RP is genetic or secondary may affect whether
prednisone temporarily affects visual acuity.
I have posted what I found below. There is scant information, as
prednisone has not been found to be a safe and effective treatment for
RP. At first the idea seemed plausible to me, as prednisone is an
anti-inflammatory, but then I learned differently. The next statement
explains that RP is NOT an inflammatory process. Still, it seems that
the anti-inflammatory properties of prednisone may affect swelling of
other parts of the eye, seemingly reducing the effects of the
degenerating retina. (I have included a link to a picture of a
degenerated retina further down in the answer)
?Although the word retinitis means inflammation, retinitis
pigmentosa-disease is not an inflammation but a degeneration of the
retina.?
http://www.lea-test.fi/en/eyes/dgenerat.html
?Prednisone is in a class of medications called corticosteroids. It
works to treat patients with low levels of corticosteroids by
replacing steroids that are normally produced naturally by the body.
It works to treat other conditions by reducing swelling and redness
and by changing the way the immune system works.?
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601102.html
You can see here that prednisone definitely has an effect on the eyes:
?Prednisone may cause side effects. Tell your doctor if any of these
symptoms are severe or do not go away:
? headache
? dizziness
? difficulty falling asleep or staying asleep
? inappropriate happiness
? extreme changes in mood
? changes in personality
? bulging eyes
? acne
? thin, fragile skin
? red or purple blotches or lines under the skin
? slowed healing of cuts and bruises
? increased hair growth
? changes in the way fat is spread around the body
? extreme tiredness
? weak muscles
? irregular or absent menstrual periods
? decreased sexual desire
? heartburn
? increased sweating
Some side effects can be serious. If you experience any of the
following symptoms, call your doctor immediately:
? vision problems
? eye pain, redness, or tearing?
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601102.html
?Steroids - may produce posterior subcapsular cataracts. Steroids
work by mimicking the action of the body's own hormones to help
control inflammation. They are usually prescribed for diseases such as
rheumatoid arthritis, Crohn's Disease,and lupus. Long- term steroid
use can cause posterior subcapsular cataracts and increases in
intraocular pressure. These cataracts will develop in up to 50 per
cent of people taking 10 to 15 milligrams of prednisone daily for one
to two years. These cataracts are very dense and can cause a rapid
loss of vision. They will not go away even after you stop the
medication and will have to be surgically removed. Though not as
common as cataracts, sustained treatment of steroids can cause a rise
in intraocular pressure leading to glaucoma, though after the steroid
use is stopped the intraocular pressure will return to normal.?
http://www.naturaleyecare.com/prev-harm.asp
?Steroid drops may interfere with your body's ability to heal a
scratched cornea. The steroid drops also interfere with your body's
ability to resolve an infection such a herpes infection on the surface
of the eye. Although, it is important to start steroid drop at the
earliest evidence of iritis, it is also important that infection or
damage to the cornea are not present. An allergic reaction to a
steroid drops is rare, but allergies can develop to some of the
preservatives present in the drops.?
http://www.ohsuhealth.com/cei/eye_health/dis_inflamm_tx.asp
TA, Triamcinolone acetonide, is a form of steroid that is used for
treating some diseases of eye blood vessels.
?Triamcinolone acetonide is a type of medicine known as a
corticosteroid. Corticosteroids are hormones produced naturally by the
adrenal glands which have many important functions on every organ
system. Corticosteroids affect the strength of heart muscle and its
response to natural chemicals affecting heart rate. They affect the
water and salt balance in the body and also enable the body to cope
with stress.?
http://www.tiscali.co.uk/lifestyle/healthfitness/health_advice/netdoctor/archive/100003380.html
?Triamcinolone acetonide (TA) is a glucocorticoid that is rapidly
becoming a primary treatment for eye disease associated with
permeability and proliferation of blood vessels. Intravitreal TA is
reported to reduce visual loss from subfoveal diabetic macular edema
and is used as combination therapy with ocular photodynamic therapy
for exudative age-related macular degeneration. The preliminary
success of these results in humans suggests that TA may be an exciting
new treatment for premature infants at high risk from
sight-threatening retinal detachment due the effects of blood vessel
permeability and proliferation associated with retinopathy of
prematurity (ROP). Studies underway in the laboratory of Jonathan E.
Sears, M.D., are directed at defining the mechanism by which
glucocorticoids inhibit pathologic angiogenesis and vasopermeability.
The long-term aim of this work is to develop steroid-like agents for
treating ROP in the absence of common, deleterious steroid side
effects.?
http://www.lerner.ccf.org/eye/
?Often, during an ophthalmologic exam, a change in the appearance
of the retina may indicate RP but such other tests as an
electroretinogram (ERG) may be necessary to confirm the diagnosis. An
ERG measures the electrical activity of the retina when exposed to
light stimulus. Drops are first placed in the eyes to dilate the
pupils. Anesthetic drops are administered to the eye just before a
contact lens attached to electrodes is placed on the cornea of the
eye. The electrodes record the responses of the retina as lights are
flashed in both dark and light environmental conditions.
There is no cure or treatment for retinitis pigmentosa (RP). Vitamin A
therapy, topical treatment with DMSO, and light deprivation have been
investigated as cures, but results have not been as promising.
Research thought to be the most promising involves nutritional
therapy, retinal cell transplantaion, and gene therapy.
Some have been helped with vitamins A and E because RP is sometimes
associated with a number of lipid disorders in which the body is
unable to process certain fats. Taking the vitamins has slowed down or
even stopped the spread of RP in some cases while others have shown no
improvement.?
http://www.innvista.com/HEALTH/ailments/eyeail/retinpig.htm
Look under ?Treatments? on this page:
? ?In patients who present with antiretinal antibodies,
immunosuppressive agents (including steroids) have been used with
anecdotal success.?
http://www.emedicine.com/oph/topic704.htm
?A 14-year-old girl complained of a sudden decrease in right visual
acuity. The patient had night blindness, a mottled retina but no
pigments, extinguished scotopic electroretinographic response, central
scotoma in the right eye and rhegmatogenous retinal detachment. She
had initially received laser photocoagulation around the retinal tear
and then corticosteroid therapy, cryoretinopexy and segmental
buckling. Her right visual acuity increased to 1.0. The association of
retinitis pigmentosa sine pigmento, retrobulbar optic neuritis and
rhegmatogenous retinal detachment, as demonstrated in our patient, may
be uncommon.?
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=224269&Ausgabe=226340&ArtikelNr=27487
?Short term use of steroids normally does not cause eye problems,
but long term chronic use may lead to two possible complications. One
complication is glaucoma. Certain predisposed individuals exhibit a
rise in eye pressure with the use of steroids, usually after 3 to 4
weeks. This includes oral and IV steroids as well as eyedrop steroids.
The glaucoma is treatable using medication or rarely surgery, and the
pressure usually returns to normal if steroids can be stopped.
Cataract is another complication. The typical steroid induced cataract
develops on the back surface of the lens in the eye, and is called a
"posterior subcapsular cataract". This can be a rapidly forming and
very visually significant type of cataract, often causing much glare
disability. Once cataract forms, it cannot be reversed, although
surgery can remove the cataract and restore the vision.?
http://www.perret-optic.ch/optometrie/pathologie_oculaire/patho_drogues/patho_drug1_gb.htm
Prednisone increased visual acuity in Melanoma Related Retinopathy
?The patient was treated with oral prednisone 40 mg a day for 1 week
and then 20 mg a day for 2 weeks. The prednisone treatment resulted in
remarkable improvement of the visual acuity and visual fields. In May
2001, the patient was referred to the Ophthalmology Clinic at M. D.
Anderson Cancer Center for further evaluation and treatment.?
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijovs/vol1n2/mar.xml
Prednisone also aided, short term, in vision problems in MS
patients with optic neuropathy.
?The Optic Neuritis Treatment Trial (ONTT) initiated in 1988 found
that steroid treatment with high dose intravenous methylprednisolone
for three days followed by oral prednisone for two weeks accelerated
visual recovery. This treatment reduced the likelihood of clinically
definite MS for two years but did not improve the final visual
outcome. Treatment with oral prednisone alone for two weeks was
associated with an increased recurrence rate of optic neuritis and
was, therefore, detrimental.?
http://www.msfacts.org/publications/pub_articles_opticneur.html
?While complicated surgery accounts for most cases of CME, this
condition also occasionally occurs after straightforward surgery. If
ocular surgery is not the cause, a long list of events may be to
blame: retinal vein occlusion, diabetic macular leakage, idiopathic
central serous chorioretinopathy, anterior or posterior uveitis, pars
planitis, retinitis pigmentosa, radiation retinopathy, posterior
vitreous detachment, epiretinal membrane formation, idiopathic
juxtafoveal retinal telangiectasia, Nd:YAG capsulotomy or iridotomy.
Some patients may have a history of use of topical epinephrine or
prostaglandin analogs for glaucoma.
Visual acuity may or may not be reduced. If reduced, vision ranges
from 20/25 to 20/400 depending on the severity of the edema. Patients
may also experience metamorphopsia.?
?Medications for CME include the oral nonsteroidal Indocin
(indomethacin, Merck), and possibly the corticosteroid prednisone.
Topical nonsteroidal medications such as Acular (ketorolac, Allergan)
and Voltaren (diclofenac, Novartis Ophthalmics) can be quite
successful in many cases, as can topical corticosteroid drops such as
Pred Forte (prednisolone acetate, Allergan) and Lotemax (loteprednol,
Bausch & Lomb). Common dosing ranges from qid to q2h. Often a loading
dose of q2h is indicated, and then rapidly dropped to qid after
several days. Therapy may last several days to weeks. Standard therapy
calls for both Voltaren and Pred Forte (both qid).
The effort to move fluid from the retina through the choroid requires
transport of fluid ions by the retinal pigment epithelium. Studies
have shown that Diamox (acetazolamide, Lederle) use results in small
but statistically significant decreases in CME, but does not improve
vision.?
http://www.revoptom.com/HANDBOOK/oct02_sec5_1.htm
?All injections were accurately targeted to the subretinal space as
assessed ophthalmoscopically. The retinas all had flattened by 24 hr
after injection, and media was clear through 48 hr after injection. An
inflammatory response developed at 3 days postinjection in
virus-injected eyes only. Cultures of the injection solutions were all
negative for microbial (anaerobic and aerobic bacteria) contaminants.
Inflammation resolved over a period of ?2 weeks after subconjunctival
application of corticosteroids. However, there were residual vitreous
opacities visible through the remainder of the experiments in the left
eye of 94B-051 and a macular hole in one eye (left eye of 94B-102;
Table 1).?
http://www.pubmedcentral.gov/articlerender.fcgi?artid=22311
You may find these articles interesting as well:
http://vision.about.com/od/retinitispigmentosa/a/retinalimplant.htm
http://www.jsei.org/About/PDF/EYEFall2005.pdf
?A better understanding of rods and cones may help researchers treat
retinitis pigmentosa (RP) and macular degeneration, two major eye
diseases that involve loss of photoreceptors, resulting in slow but
progressive vision loss.
Swaroop explains that photoreceptors are post-mitotic cells; meaning
that when they degenerate, they cannot be replaced and a person's
vision suffers. Cone photoreceptors enable color vision and visual
acuity in bright light. Rods, which dominate the retina, are
responsible for night vision.
To date, most research has centered on rods, in part because they make
up almost 95% of the photoreceptors in human retina. Much less is
known about cones, including the important but puzzling question as to
why they do not generally survive without rods in diseases like RP.?
http://www.sciencedaily.com/releases/2001/11/011107072756.htm
?Other studies implicate Mer defects in the development of retinal
degeneration typical of retinitis pigmentosa, an eye disorder
associated with atrophy of the retina?s inner layer. In animal
studies, a failure of retinal pigment epithelial cells to clear outer
segments of cells that had been shed resulted in the death of
photoreceptors. "Indeed, preliminary studies indicate our mice
carrying the defective Mer show retinal degeneration," Matsushima
said.
Moreover, "some human patients with retinitis pigmentosa have been
shown to contain mutations in the Mer gene," the Nature authors
stated.?
http://www.unc.edu/news/archives/may01/mer051101.htm
Breakthroughs
http://www.medicalnewstoday.com/medicalnews.php?newsid=23888
http://www.blindness.org/disease/treatments.asp?type=3
?For fourteen years, I went through diagnosis after diagnosis and a
year of Prednisone treatment and all of its side effects, only to have
them disproved and finding myself back at square one with no physical
reason for the progressive loss of my central vision. For a decade I
raised babies. Luckily, I have wonderful relatives and friends who
have helped out throughout the years lessening my worry and heartache
of not being able to do for my own children.
However, throughout the years of the financial and emotional burdens
of seeing doctors, persevering through multiple visual fields, MRIs,
spinal taps, etc., my husband has never complained and our families
have been very supportive emotionally and financially. I am truly
blessed by having such generous relatives and friends. I am also
blessed with a caring and earnest ophthalmologist, Dr. J. Curtis
Creed, who has followed me for the past fourteen years and referred me
to multiple specialists across the nation looking for a diagnosis.
Just two months ago, my condition finally showed its true colors and
he was able to declare that I have a rod-cone dystrophy variant of
Retinitis Pigmentosa, as color photos of my retinas now show lots of
pigmentation.
A few years ago when my youngest child went to school full-time, I
decided to come out of my partially self-inflicted ?hibernation? and
called LRS. Over the past few years, my wonderful rehab counselor,
Stacy Marbs, has informed and advised me, and obtained assistive
equipment, orientation and mobility training, and Braille education at
the Louisiana Career Development Center (LCDC) in downtown Baton Rouge
for me. It?s not as easy as before, but equally rewarding as I
acknowledge the obstacles that I, with the help of my counselor,
friends, teachers, and family, am learning to overcome.?
http://www.latan.org/newsletter/12_04newsletter.html
?Mutations in the X-chromosomal RPGR gene account for up to 20% of all
cases of retinitis pigmentosa.?
http://www.iovs.org/cgi/content/abstract/44/4/1458
There is an interesting photo of a retina with RP (near the bottom of the page)
http://webvision.med.utah.edu/sretina.html
I hope this has helped you out! Please request an Answer
Clarification, if any part of my answer is unclear, before you close
the question by rating.
Regards, Crabcakes
Search Terms
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antibodies + retinitis pigmentosa + corticosteroids
treating retinitis pigmentosa + corticosteroids
prednisone effect + ocular blood vessels |
