Case series of retinal vein occlusions showing early recovery using oral l-methylfolate

Steven Baker; Dylan Baker; Robert Baker; Craig J Brown

doi:10.1177/25158414241240687

Case series of retinal vein occlusions showing early recovery using oral l-methylfolate

Ther Adv Ophthalmol. 2024 Apr 15:16:25158414241240687. doi: 10.1177/25158414241240687. eCollection 2024 Jan-Dec.

Authors

Steven Baker¹, Dylan Baker², Robert Baker¹, Craig J Brown³

Affiliations

¹ Northwest Arkansas NeuroVision, Fayetteville, AR, USA.
² Becker Friedman Institute for Economics, University of Chicago, Chicago, IL, USA.
³ Department of Ophthalmology, College of Medicine, University of Arkansas for Medical Sciences, 1923 East Joyce Blvd, Fayetteville, AR 72703, USA.

Abstract

This case series describes the aggregate rate of recovery in five consecutive subjects (six eyes) with retinal vein occlusion (RVO) who received l-methylfolate and other vitamins via Ocufolin^®, a medical food. Subjects were followed for 10-33 months by a single ophthalmologist. Ocufolin^® was prescribed at the time of diagnosis and subjects remained on the regimen throughout the time of observation. Examinations were performed in an un-masked fashion at 3-month intervals with recording of best corrected visual acuity (BCVA), average retinal nerve fiber layer (ARNFL) and central macular thickness (CMT), and fundus (examination of the retina, macula, optic nerve, and vessels) photography. Testing was done for vitamin deficiencies, vascular and coagulable risk factors, and methylenetetrahydrofolate reductase (MTHFR) polymorphisms. Vitamin deficiencies and vascular risk factors were found in all subjects, and all four tested subjects carried at least one MTHFR polymorphism. By the end of the study period BCVA in all subjects was 20/25 or better. Cystoid macular edema was identified and measured by optical coherence tomography (OCT). The percent change was calculated and plotted at 3-month intervals using the percent change in thickness from the time of diagnosis and percent change toward normative values for ARNFL and CMT. The total reduction in thickness of ARNFL and CMT from time of diagnosis was 44.19% and 30.27%, respectively. The comparison to normative data shows a reduction of ARNFL from 164.2% to 94% and CMT from 154.4% to 112.7% of normal thickness (100%). Plots showed the aggregate recovery was most rapid over the first 3 months and slowed over the next 3 months with most of the recovery taking place within 6 months of treatment. The rate of improvement in BCVA and resolution of retinal thickening was found to be better than predicted on historical grounds. No subjects progressed from nonischemic to ischemic RVO. Vitamin deficiencies, vascular risk factors, and genetic predisposition to oxidative stress were common in this RVO series. It appears that addressing these factors with Ocufolin^® had a salutary effect on recovery.

Keywords: MTHFR polymorphism; l-methylfolate; nutritional deficiency; retinal ischemia; retinal vein occlusion.

Publication types

Case Reports