He raruraru kei te rere o te toto ki ngā kanohi? Me ako tātou mō te (Ischemic Optic Neuropathy) i roto i tētahi huarahi māmā!

Kua pōuri kē koe i te tirohanga? Tērā pea i ara ake koe i te ata, ā, kāore i kitea mārama te kanohi kotahi? I pōuri kē rānei koe i te tirohanga, me te mea he pōuri kei mua i ō kanohi? Mēnā kua pāngia koe e tēnei āhuatanga, kaua e wareware noa iho, āe? I tēnei rā ka kōrero tātou mō tētahi āhuatanga ka puta ai ēnei tohu, ā, me tūpato koe, engari ki te mōhio koe ki tēnei āhuatanga i mua i te wā, ka taea e ia te āwhina i a koe ki te whakahaere. Ko te ingoa o tēnei ko te `(Ischemic Optic Neuropathy)` , e mōhiotia ana ko te `(ION)` .

E mōhio ana koe he aha te `(Ischemic Optic Neuropathy - ION)`?

Ki te kī ngāwari, ko te `(Ischemic Optic Neuropathy)` he āhuatanga e kore ai e nui te toto e whiwhi ana i te io matua e kawe mai ana i te tirohanga ki tō kanohi, te `(Optic Nerve),`, ā, ka ngaro te tirohanga. Whakaarohia, he aha te mea ka tupu mēnā kāore e nui te wai e whiwhihia ana e te tipu putiputi i roto i tā tātou māra? Ka mate haere, tika? Koinei te āhua o tēnei. Ina mutu te rere o te toto ki ētahi wāhanga o tō `(Optic Nerve)`, ka mutu te mahi tika o aua wāhanga, ā, ka tīmata te mate. Mēnā ka nui rawa te aukati i te rere o te toto, ka roa rānei te wā, ka taea te pakaru tonu te `(Optic Nerve)`.

Ko te tikanga ka puta tēnei āhuatanga i te rohe porowhita i muri o tō kanohi e kiia nei ko te "Kōpae Tirohanga." Ko te "Kōpae Tirohanga" te wāhi e hono ai ngā oko toto me te "Nerve Tirohanga" ki te kanohi. Ko tēnei āhuatanga, e kiia nei ko te "ION", ehara i te mea tino noa, ā, ko te nuinga ka pā ki te hunga neke atu i te 50 tau te pakeke.

He momo matua o `(ION)`?

Āe, e rua ngā momo matua o te `(Ischemic Optic Neuropathy)`. Kia tirohia tātou he aha ēnei:

1. Te Neuropathy Whatu o Mua o te Ischemic (AION) : Koinei te momo ION tino noa. Ka pā ki te io whatu i raro i te kōpae whatu, ki te kōpae whatu rānei.

2. `(Posterior Ischemic Optic Neuropathy - PION)` : I tēnei momo, ka puta te pānga ki tētahi wāhanga o te `(Optic Nerve)` kei muri paku atu.

Nā, kia kōrero tātou mō ia momo me ētahi atu taipitopito.

Ngā Huringa i roto i te `(AION)`

E rua anō ngā momo momo o te `(AION)`:

• Te Neuropathy Ischemic Anterior Arteritic (AAION) : He mumura tēnei o ngā uaua toto (Arteritis) . Ka puta pinepine tēnei āhuatanga me ngā āhuatanga pēnei i te Vasculitis, arā, he mumura o ngā oko toto.
• `(Nonarteritic Anterior Ischemic Neuropathy - NAION)` : I roto i tēnei, kāore he mumura o ngā uaua e ai ki te kōrero i mua ake nei. He maha ngā wā ka puta tēnei nā te mea kua herea te rere o te toto ki te `(Optic Nerve)`.

Kia ako tātou mō `(PION)`

Pērā i te AION, e rua ngā momo PION, ko te Arteritic me te Nonarteritic. Arā, ko te PION ka puta mai i te arteritis, ā, ko te PION ka puta mai i te whakararuraru i te rere o te toto me te kore arteritis.

He aha ngā tohu o tēnei? Kei a koe anō ēnei?

Ko te tohu matua o te `(ION)` ko te ngaronga o te tirohanga. Heoi, ka rerekē te āhua o tōna putanga mai i runga i te momo `(ION)`. Waihoki, ka rerekē anō hoki ētahi atu tohu i runga i te momo.

Ngā tohu o te `(NAION)`

Ko te ngaronga o te tirohanga nā te NAION he mea ohorere, kāore hoki he mamae. He maha ngā wā ka kitea he pōuri te tirohanga, he ngaronga rānei o te tirohanga i tētahi wāhanga o te tirohanga, inā koa te haurua o raro . I ētahi wā , ka puta pea te ngaronga o te tirohanga tae (dyschromatopsia) .

He tokomaha te hunga ka kite tuatahi i tēnei ngaronga o te tirohanga ina ara ake rātou i te ata. Tērā pea i muri i te moe roa, i te moe poto rānei.

I ētahi wā, ka heke haere te tirohanga i roto i te rua wiki pea. Ko te NAION te momo ION tino noa, ā, ka pā ki te kanohi kotahi i ia wā. Heoi, tata ki te 15% o te hunga he NAION kei ​​roto i te kanohi kotahi ka pāngia pea e te mate i te kanohi kē atu i muri mai.

Ngā tohu o te `(AAION)`

I roto i te `(AAION)` , ka ngaro ohorere te tirohanga. Arā, ka pōuri te tirohanga, ka memeha, ka iti haere, ka ngaro rawa rānei. I roto i te `(AAION)`, ka haere tahi pea me ngā tohu e pā ana ki te `(Arteritis)` i whakahuatia i mua ake nei. Ko ēnei:

• Te ānini o te upoko: Ina koa i ngā taha e rua o te rae.
• Te pupuhi o ngā uaua toto i ngā taha e rua o te rae: Kāore e taea te rongo i te pā o te manawa ina pāngia ēnei.
• Te mamae o ngā uaua o te kauae i te wā e ngaungau ana i te kai.
• Te matekai me/ te ngaronga taumaha kāore i te mārama.

I roto i te tokoiti o te tangata, ka puta pea he momo "ngaro" o te Arteritic ION. Ko te tikanga ka ngaro te tirohanga, engari kāore tetahi o ngā tohu kē atu o te Arteritis e kitea ana.

Ngā tohu o te `(PION)`

Ka puta te ngaronga tirohanga ohorere, kore mamae i te PION Arteritic me te PION Nonarteritic. Heoi, ka taea e te PION te whanake haere i ngā wāhanga tōmua. Ko te tikanga ka kino haere ngā tohu i te roanga o te wā.

He aha i puta ai tēnei `(Ischemic Optic Neuropathy)`? He aha ngā take?

Ka rerekē pea ngā take o te `(ION)` i runga i te momo. Kia kite tātou me pēhea te mahi.

Ngā Take o `(NAION)`

Kāore anō kia tino mārama ngā tohunga he aha te take e whanake ai a NAION. Engari ki tā rātou he huinga o ngā āhuatanga.E whakaarohia ana ko te take o tēnei he aukati i te rere o te toto ki te io whatu. Ko ēnei āhuatanga ka pā ki te huarahi e whakahaere ai tō pūnaha tohanga toto i te rere o te toto mā roto i te io whatu. Mena kei te mahi tika taua whakahaere-ā-roto, e kore koe e pāngia e te NAION. Heoi, ka taea e ētahi huihuinga, raruraru rānei te whakararu i taua whakahaere-ā-roto. Kei roto i ēnei ko:

• Ngā panonitanga hanganga o te `(Kōpae Whatu)` i roto i te kanohi: Ko te tikanga ka iti haere, ka kikī ake rānei te `(Kōpae Whatu)`. Ka kiia hoki tēnei he "kōpae kei te mōrearea".
• Te toto toto tiketike (hypertension).
• `(Te Mate Huka Momo 2)` (Te Mate Huka Momo 2).
• Atherosclerosis (ngā putunga ngako i roto i ngā uaua).
• Te mate moe (apnea moe).
• Te hekenga o te toto i te wā e moe ana ('Nocturnal Hypotension').
• Te kore toto toto (te hekenga o ngā toto whero, te hemoglobin rānei i roto i te toto).
• Te momi hikareti (tae atu ki te vaping).
• Ngā migraines.
• Ētahi rongoā: Ka taea e ngā aukati phosphodiesterase (hei tauira, ngā rongoā e whakamahia ana hei rongoā i te ngoikore o te ure) te whai wāhi ki te ION. Heoi, kāore ngā tohunga e whakapono ana ko ēnei rongoā anake te take o te ION.

Ngā Take o te `(Arteritic ION)` (AAION me te APION)

He rite tonu te take matua o te `(AAION)` me te `(APION)`: `(Arteritis)` (arteritis). Ka puta tēnei āhuatanga ina he mumura puta noa i te pūnaha tohanga toto. Ko ngā tino take o tēnei ko:

• `(Te Mate Pūtau Nui - GCA)`
• Ētahi atu momo `(Vasculitis)` (ngā mate mumura o ngā oko toto).

Ngā Take o te `(PION Kore-Arteritic - NPION)`

He maha ngā take motuhake e pā ana ki te `(NPION)`. Koia ēnei:

• Ngā āhuatanga e pā ana ki te rere o te toto i roto i te kanohi: He rite tonu te nuinga o ēnei ki ngā mea e puta ai te NAION. Hei tauira, te Mate Huka Momo 2, te Toto Toto tiketike, te Atherosclerosis.
• Te toto: Ka ārai pea te rere o te toto ki muri o te kanohi i te hekenga ohorere o te toto, ka puta ai te NPION.
• Pokanga: Ka heke pea te toto toto i te wā o te pokanga mō ngā take maha. Ka arahi pea tēnei ki te PION.

Ko wai kei te nui ake te mōrearea ki te whakawhanake i tēnei?

He nui ake te tūponotanga o ētahi tāngata ki te pāngia e tēnei mate (Ischemic Optic Neuropathy). Kia kite tātou ko wai rātou:

• Te hunga whai take mōrearea toto: Ko te tikanga tēnei he nui ake te mōrearea o te hunga whai mate pēnei i te toto toto tiketike, te mate huka, te cholesterol tiketike, te momi hikareti, me te moe pōrearea.
• Ngā tāngata whai mate mumura: Hei tauira, ko te hunga whai mate pēnei i te `(Giant Cell Arteritis - GCA)` he nui ake te mōrearea ki te whakawhanake i te `(ION)`.
• Ngā tāngata neke atu i te 50 tau te pakeke.
• Mō ngā tāneKa taea e rātou te tipu ake i te nui ake i ngā wāhine.

Me pēhea te mōhio o te tākuta ki tēnei?

Ka taea e tō tohunga tiaki kanohi te tātaritanga i te ION mā te whakamahi i te huinga o ngā tikanga maha. Ko te tikanga ka tīmata te tukanga tātaritanga mā te pātai atu ki a koe mō ō tohumate, ngā huihuinga o nāianei, me tō hītori hauora. Mā ō whakautu rātou e āwhina ki te whakawhāiti i te rārangi o ngā take pea mā te whakakore i ētahi atu āhuatanga e rite ana ki te ION. Kātahi ka whakahaerehia e rātou he whakamātautau kanohi , me te aro nui ki ngā wāhanga o te kanohi e titiro ana ki te kōpae whatu, kei muri o te kanohi.

• ION o Mua (AION): Ka puta ngā panonitanga kitea i roto i tō kōpae whatu i te tīmatanga o te AION Arteritic me te AION Nonarteritic. Mā ēnei panonitanga ka taea e tō tākuta kanohi te tātaritanga i te mate. I te tātaritanga o te AAION, ka tirohia hoki e rātou mēnā kei a koe ētahi o ngā tohu e pā ana ki te Arteritis.
• `(Posterior ION - PION)`: He uaua te tautuhi i ēnei momo. Nā te mea i ngā wāhanga tōmua, kāore he huringa e kitea ana i roto i te `(Optic Disc)`.

He aha ngā whakamātautau e mahia ana mō tēnei?

He maha ngā whakamātautau hei āwhina i te tautuhi i te mate (ION) me ngā āhuatanga katoa e puta ai. Ko ētahi o ēnei he māmā noa iho, ā, kāore e nui te kaha tinana e hiahiatia ana. Hei tauira:

• Whakamātautau tirohanga: Tirohia mēnā he hapa o te tirohanga (ngā ira matapo).
• Te ine i te toto toto.
• Ngā whakamātautau toto: Tirohia mēnā he mate pēnei i te mate huka momo 2, te cholesterol tiketike, me te korenga o ngā huaora.
• Te ine i te pēhanga o roto o te kanohi.
• Angiography Fluorescein: Ka whakamahia he tae motuhake hei tango pikitia o ngā oko toto i roto i te kanohi.
• Tomography Whārite Ātaahua (OCT): Ka taea e tēnei te whakaputa whakaahua whakawhiti-wāhanga taipitopito o te io whatu me te retina.

Ko ētahi whakamātautau ka mahia motuhake hei tātaritanga, hei whakakore rānei i ngā āhuatanga pēnei i te "Arteritis" (e hiahia ana kia rongoatia wawe tonu). Kei roto i ēnei whakamātautau ko:

• Ngā whakamātautau whakaahua: He whakaahua oro-ā-oro, he whakaahua aukume rānei (MRI) o ngā oko toto i raro i te kiri i ngā taha e rua o te rae.
• Kohikohi i te uaua o te roro: Ka tangohia he wahi iti o te kiko mai i te uaua i ia taha o te rae, ka whakamatautauria mō ngā āhuatanga pēnei i te GCA.
• Ngā whakamātautau toto mō ngā huringa e pā ana ki te mumura: pērā i ngā whakamātautau `(Erythrocyte Sedimentation Rate - ESR)` me te `(C-reactive Protein - CRP)`.

Tērā pea ka tūtohu tō tākuta i ētahi atu whakamātautau i runga i ō tohu me tō hītori hauora. Ka taea e rātou te kōrero atu ki a koe mō ngā whakamātautau me te take e hiahiatia ai aua whakamātautau.

He aha ngā rongoā mō tēnei? Ka taea te whakaora?

He rerekē te maimoatanga mō te ION i runga i te take. I ētahi wā, ka taea e te tākuta te rongoā tika i te ION. I ētahi wā, ko te mea anake e hiahiatia ana ko te whakahaere i ngā āhuatanga mōrearea o ngā toto me te rongoā i ngā tohu.

Te rongoā mō te `(Arteritic Ischemic Optic Neuropathy)`

Me rongoā wawe tonu te `(Anterior)` me te `(Posterior Arteritic ION)` mā te whakamahi i ngā rongoā `(Corticosteroid)` ārai-mumura (hei tauira `(Prednisone)`) me ngā rongoā ārai-mate pērā i te `(Tocilizumab - Actemra®)`. Ko te `(Corticosteroid)` ka hoatuhia hei pire, engari i ētahi wā ka hoatuhia hoki mā roto i te uaua (IV). Ka hoatu tuatahitia te horopeta o tēnei `(Corticosteroid)` i roto i ngā horopeta teitei, kātahi ka whakaitihia haeretia mō ētahi rā, wiki rānei. Tērā pea me tango e ētahi tāngata tēnei rongoā i te horopeta iti mō te wā roa hei ārai i ngā raruraru tirohanga tuturu mai i te `(ION)`.

Te rongoā mō te `(Neuropathy Optic Ischemic Nonarteritic)`

Engari, kāore anō kia kitea he rongoā whai hua mō te `(Nonarteritic ION)`. Ki te kore koe e pāngia e tētahi mate pēnei i te `(Arteritis)`, kāore i te tūtohutia ngā rongoā `(Corticosteroid)`.

I tēnei wā, ko te maimoatanga matua mō te `(Nonarteritic ION)` ko te whakahaere i ngā tohu me te rongoā, te whakaiti rānei i ngā take me ngā āhuatanga whai wāhi. He mea nui tēnei nā te mea ko te `(Nonarteritic ION)` ka pā ki te kanohi kotahi i te wā kotahi. Nō reira, ka taea e tēnei huarahi te whakaiti i te mōrearea o te ngaronga o te tirohanga i ngā kanohi e rua nā te `(ION)`.

Mena kua ngaro tō tirohanga nā te ION, ka tūtohu pea tō tākuta kia whakamahia ngā taputapu āwhina pēnei i ngā whakanui, te whakamahi rānei i ngā tautuhinga whakanui, i ngā whakahau reo/urupare rānei i runga i ō taputapu. Ka taea e ēnei te āwhina i a koe ki te whakatika, ki te whakatika rānei i ngā raruraru tirohanga.

He aha tā tātou e tumanako ai mēnā ka puta tēnei āhuatanga?

Ko te tikanga, ka ngaro ohorere te tirohanga i te ION. Ko te tikanga o te "Ohorere" he meneti, he hāora rānei, engari i ētahi wā ka roa pea ngā rā. Ko ngā momo ION tino noa ka pōuri, ka ngoikore rānei te tirohanga. Ko ētahi momo ka ngaro katoa te tirohanga. I ētahi wā, ka puta he wā poto o te pōuri i mua i te ngaro katoa o te tirohanga i te ION.

Ka pai ake anō rānei taku tirohanga i tēnei?

Ehara te `(ION)` i te mea mōrearea ki te ora, engari ka taea e ia te whakararuraru i tō tirohanga, ā, ka whakararuraru i tō oranga.

I ētahi wā, ka taea te whakakore i te ION, engari i te nuinga o te wā ka puta he ngaronga tirohanga tuturu.Heoi, ka ako hoki te hunga kua ngaro te tirohanga ki te 'urutau' ki tēnei āhuatanga. Kātahi ka tīmata rātou ki te whakamahi i ētahi atu wāhanga o tā rātou tirohanga mō ngā mahi motuhake, pērā i te pānui. Ina tupu tēnei, tera pea te āhua kua pai ake tā rātou tirohanga, engari ko te mea e tupu ana ko te pai haere o tā rātou mahi ki te karo i te ngaronga o te tirohanga.

Ka taea te ārai i te Ischemic Optic Neuropathy?

Kāore e taea te ārai katoa i te (ION). Engari ka taea e koe te whakaiti i tō tupono ki te pāngia e te mate. Ko te huarahi matua ki te mahi i tēnei ko te karo, te whakahaere rānei i ngā āhuatanga ka puta, ka whai wāhi rānei ki te (ION). Ka tūtohu pea tō tākuta kia hurihia tō rongoā toto toto tiketike hei ārai i te toto toto iti i te wā e moe ana, kia tīmata ai te rongoā whakaheke cholesterol, kia whakarerekētia ai tō rongoā mate huka, kia mutu ai te whakamahi tupeka (tae atu ki te vaping), me ētahi atu mahi ārai hei whakaiti i tō tupono ki te pāngia e te (ION).

Waihoki, ki te hiahia koe ki te pokanga, ka mahi ngā tohunga hauora i ngā mahi hei ārai i te `(ION)`. Mena kua pāngia koe e te `(ION)` i mua, ki te mōhio rānei koe he mate kei a koe ka pā mai (pēnei i te `GCA`, i te `vasculitis` rānei), kōrero atu ki tō taote pokanga me/ranei ki tō kaiwhakamamae i mua i tō pokanga. Kātahi ka taea e rātou te whakamahere i runga i te tikanga me te mahi i ngā huringa e tika ana.

Me pēhea koe e tiaki ai i a koe anō mēnā kei a koe tēnei āhuatanga?

Mena kua pāngia koe e te "ION Kore-Arteritic" i te kanohi kotahi i mua, me tino tupato koe ki ngā huringa, ki te ngaronga rānei o te tirohanga i tō kanohi kē. Nā te mea ina pā ki te kanohi kotahi, ka nui ake te tūponotanga ka pā ki te kanohi kē i muri mai.

Mena kei a koe te Arteritic ION, ka tukuna koe e tō tākuta kanohi ki tētahi tohunga, pērā i te Rheumatologist. Ka taea e te Rheumatologist te āwhina i te tātaritanga me te rongoā i ngā āhuatanga ārai mate, mumura rānei e pā ana ki tō Arteritis. He mea nui kia whai i ngā tohutohu a tō tākuta kanohi me ētahi atu tākuta hei whakahaere i tō āhuatanga. Ma tēnei ka āwhina i a koe ki te karo i ngā putanga mai o ngā mate me te ngaronga o te tirohanga, ngā raruraru rānei ā muri ake nei.

Āhea koe me toro atu ki tō tohunga kanohi?

Ka whakaritea e tō tākuta kanohi he haerenga tirotiro auau hei aroturuki i tō tirohanga, i ō kanohi rānei, mō ngā huringa. Me pupuri e koe ēnei wā whakarite kia rite ki tā rātou e tohutohu ana. Waihoki, ki te kite koe i ētahi huringa o tō tirohanga, me whakapā atu koe ki a rātou i te wā e taea ai. Ka taea e rātou te kī atu ki a koe mēnā me kōrero koe ki a rātou, me rapu awhina hauora ohorere, me ētahi atu huringa motuhake rānei.

Āhea koe me haere ki te Wāhanga Maimoatanga Ohotata (ETU) ?

Ko te ngaronga ohorere o te tirohanga he tohu ohorere e hiahia ana kia awhina hauora tonu.Nā te mea, i ētahi wā he tohu pea tēnei o tētahi mate e morearea ana ki te ora pērā i te `(Stroke)` (he mate pērā i te pararutiki), he mate whawhati tata rānei ki te kanohi pērā i te `(Retinal Detachment)` (he motumotu o te retina - ka taea te whakaora mēnā ka tere te rongoā).

Ko te tohunga hauora whakangungu me ngā whakamātautau motuhake anake ka taea te kī mēnā he āhuatanga ohorere te ngaronga o te tirohanga ohorere. I roto i tēnei āhuatanga , ka nui te rerekētanga o ngā meneti. Koia te take he pai ake kia kaua e warewarehia mēnā kāore anō koe kia pāngia e te ngaronga o te tirohanga ohorere i mua. Mēnā he āhuatanga tōu e tūpono ai koe ki te ngaronga o te tirohanga ohorere, mēnā rānei kua pāngia koe i mua, kōrero ki tō tākuta. Ka taea e rātou te whakamārama i te wā e hiahiatia ana he maimoatanga ohorere mō tēnei tohu, me te wā e tika ana kia tumanakohia i runga i tō āhuatanga.

Ngā pātai hei pātai atu ki tō tākuta

Anei ētahi pātai ka hiahia pea koe ki te pātai:

• He aha te momo Ischemic Optic Neuropathy kei a au?
• He aha pea te take, te take rānei o tēnei?
• He aha ngā kōwhiringa maimoatanga e taunaki ana koe?
• Ka pumau tonu rānei te ngaronga o taku tirohanga, kāore rānei he tūponotanga ka pai ake?

He `(Stroke)` te `(Ischemic Optic Neuropathy)`?

Kāo, engari he āhua ōrite ētahi.

Ko te `(Ischemia)` ko te wā kāore e ranea te rere o te toto ki ngā pūtau, ā, ka tīmata te mate. Ko te `(Ischemic Stroke)` ko te wā ka puta i roto i tō roro. Ko te `(ION)` ka puta i roto i tō `(Optic Nerve)`. Koia te take he rite tonu engari kāore i te ōrite.

Ko tētahi atu take e rite ai ēnei, ko te mea he maha ngā wā ka pāngia te hunga whai `(ION)` e ngā tohumate. Mēnā ka puta tēnei, ko te tikanga he nui ake tō tūponotanga ki te whakawhanake i te `(Optic Nerve Ischemia)` me te ngaronga o te tirohanga i roto i ngā rā torutoru e whai ake nei. Nō reira, kaua e warewarehia te ngaronga ohorere o te tirohanga. Mēnā ka puta tēnei, me rapu tonu koe i te awhina hauora ohorere.

Hei whakamutunga, ngā mea hei maumahara

Ko te ngaronga ohorere o te tirohanga me te Ischemic Optic Neuropathy ko te tikanga kāore e nui te toto e whiwhihia ana e tō Io Optic. I roto i te wā, ka arahi pea tēnei ki te kino tuturu me te ngaronga o te tirohanga. Nō reira, kaua rawa te ngaronga ohorere o te tirohanga e waiho hei mea hei wareware, hei tatari rānei.

Mena kei a koe tētahi āhuatanga ka arahi pea ki te ngaronga ohorere o te tirohanga, te "ION" rānei, he mea pai kia kōrero koe ki tō tohunga kanohi. Ka taea e rātou te tohutohu i a koe he aha ngā mea hei tirotiro māu, me te aha hoki hei mahi mēnā ka kite koe i ngā huringa o tō tirohanga. Mā te mahi tere ka nui te rerekētanga, ā, ka āwhina i a koe ki te tiaki i a koe mai i ngā raruraru tirohanga kino me te kore whakamarie. Nō reira, tiakina ō kanohi!

` Neuropathy Whatu Ischemic, ION, AION, PION, Ngaronga Tirohanga, Mate Kanohi, Io Whatu, Ngaronga Tirohanga Ohorere