The FOXO4 factor is considered to regulate various cell pathways, including insulin signaling, cell cycle progression, and other functions that regulate growth and differentiation
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Optometrists should advise their patients that although these medications are conclusively linked to an increased risk of NAION, the overall risk is still extremely low: only about 2.30 per 100,000 people are diagnosed with NAION each year
These effects are more pronounced during the first few weeks and often improve as the patient adapts to the medication
When assessing for vitamin B12 deficiency, in addition to checking a vitamin B12 level, consider ordering a methylmalonic acid level or a holotranscobalamin level and CBC (to assess for red blood cell size)
Morning is often better for managing side effects, but evening can work too