[Natalie8]

When I was diagnosed with MS at age 39 I had mild optic neuritis in my left eye. I've always needed glasses since I was kid for near sightedness. Over the past few years my vision has declined in both eyes (even before the MS diagnosis) which sometimes happens as you get older.

When I went on Tysabri my vision seemed to get extremely sharp. The vision in my left eye now seems to be retrogressing a little (like I need new glasses). How do I know if this is from repeat O.N. or just declining eyesight because of age? Can new lenses in your glasses actually help correct O.N.? When I had the O.N. 20 months ago my eyesight seemed more like some one had smeared vaseline over my eye (hazy) rather than out of focus like when you need new glasses.

I'm just trying to figure out if I should contact the neurologist or go to my eye doctor?

[Erin524]

I dont think glasses can help correct ON, since ON is caused by a malfunctioning optic nerve.

I'd go to the eye doctor if I were you. (ophthalmologist, not an optician) They can adjust the Rx for you if you need new lenses.

I had ON in 2006, and got new glasses in 2007 and last summer. (my Rx changed 2yrs in a row) Eye doctor told me that was probably normal aging for me and probably not related to the ON.

I went to the eye doctor on friday, and he told me that my current Rx seems to be stable, so I didnt have to shell out tons of money for new lenses. (altho, I love picking out new frames...I've only been wearing glasses since 97, but I've bought new frames at least 7 or 8 times because I like getting new frames)

[lady_express_44]

If it is ON, they probably won't be able to get your eyesight to 20/20. The problem with that approach (seeing the Optho, to determine if it is ON or just aging) is that sometimes the symptoms fluctuate with ON.

I went 3 times to get a rx, and every time they came up with a different rx and couldn't get it to 20/20 the first two. When she finally did, that just happened to coincide with a day on the road to recovery . . . so ultimately the the rx was too strong when they fully recovered.

I got my rx in Dec, and had my glasses made up right away. I think the ON recovered some time in early Jan, but it took till mid-way through March before I could finally get a pair of contacts that worked.

My rx before the ON was -5.75 in both eyes. In Dec, I got a rx for -7.50 in the left, and -6.50 in the right, and that is what my glasses were made up as. Contacts are always a little lower, but after several reductions, I am now at -6.50 in the left, and -5.75 in the right.

I guess what I'm trying to say is that if it is ON, this isn't the time to spend lots of money on new lenses/glasses.

Your optometrist should be able to help determine if it might be ON, based on whether she can get it to 20/20. Mine referred me to a neuro-optho, and I had a VEP and Visual Field Test. She saw the ON damage even before that testing, but it appeared to be "old" damage to the nerve. It is worth seeing a Neuro-optho at this time, if ON is a possibility ...

BTW, apparently our eyes do get worse in our 40's, for those of us who've always had eye problems, regardless of the MS.

And one more thing, from the upcoming AAN meeting next week:

[S57.004] Clinical and Ocular Imaging Characteristics of Eyes with Visual Loss over Time in Multiple Sclerosis

Esther Bisker, Sally C. Chang, David Long, Lauren Talman, Amy Conger, Girish Hiremath, Teresa Frohman, Michael Loguidice, Steven Galetta, Clyde Markowitz, Dina Jacobs, Yang Dai, Gui-Shuang Ying, Maureen Maguire, Elliot Frohman, Peter Calabresi, Laura J. Balcer, Dallas, TX, Baltimore, MD, Philadelphia, PA

OBJECTIVE:

The purpose of this study was to determine the degree of retinal nerve fiber layer (RNFL) thinning by optical coherence tomography (OCT) that is associated with losses of low- and high-contrast acuity over time in a multiple sclerosis (MS) cohort.

BACKGROUND:

Visual dysfunction and axonal loss are common in MS. The emergence of OCT has allowed us to capture the unique structure-function correlations provided by the anterior visual pathway in MS clinical trials.

DESIGN/METHODS:

Patients with MS underwent OCT-3 imaging at baseline and at 6-month intervals during a mean follow-up period of 1.5 years (range 0.5-3.7) at three academic centers. RNFL thickness was measured for 360 around the optic disc. Visual function testing was performed using low-contrast (2.5 and 1.25% levels) and ETDRS acuity charts. Eyes with comorbid ocular conditions or acute ON within 3 months prior to testing were excluded.

RESULTS:

Among 1,148 patients (2,296 eyes, age 4411 years) who underwent baseline assessments, 365 (725 eyes) have participated in longitudinal follow-up. Worsening of low-contrast acuity was noted in 237 eyes of 123 patients (33% of MS eyes). Approximately 1/3 of eyes with visual loss had a past history of ON. Two-line (10-letter) losses of low-contrast acuity were associated, on average, with 1.6 m decrements in RNFL thickness over time at 2.5% contrast (p=0.009, GEE models, accounting for age and within-patient, inter-eye correlations), and 3.7 m reductions at 1.25% contrast (p=0.02). Patients with worsening vision were only slightly older (age 45 vs. 43 years), and had slightly greater disease duration (12 vs. 11 years).

CONCLUSIONS/RELEVANCE:

Visual loss occurs in a substantial proportion of MS eyes, and may be present even in the absence of a history of ON. Reductions in low-contrast acuity are associated with RNFL thinning over time, suggesting that axonal loss may be a significant contributor to visual dysfunction in MS.

Supported by:

National Multiple Sclerosis Society Grants PP115, RG 3208-A-1, RG 3428-A-2 (Dr. Balcer), National Multiple Sclerosis Society Translational Research Partnership TR 3760-A-3 (Dr. Balcer), and National Eye Institute / NIH K24 EY 018136 (Dr. Balcer)

Category - Neuro-Ophthalmology/Neuro-Otology - Epidemiology

Thursday, April 30, 2009 4:30 PM
(thanks Agate)

Cherie

[Koala77]

It's pointless to get new spectacles in an attempt to correct vision loss during an exacerbation of optic neuritis. Most visual disturbances correct themselves when the optic neuritis passes.

If however, the vision loss becomes permanent and is assessed some time after the exacerbation, then spectacles might assist your changed vision.

[Natalie8]

thanks for the info everyone.

Two things confuse me. First, when I got diagnosed with O.N. my vision was still 20/20...it just seemed like vaseline was smeared over my eye. Second, I had laser eye surgery in 1999 which gave me 20/20 vision. My eyes have regressed some since that surgery and I have to wear glasses now (which is a total bummer). I think I'm at -1.75 and -1.25. Anyhow, I just can't tell if this is a relapse of O.N. or just vision changing. I do have a neuro-opthamologist. He usually has a long wait list for appointments but I suppose I could call tomorrow and try to get squeezed in for an appointment if I tell them I'm having vision issues.

I've also been outside in the heat for 5-7 hours at a multi-day, all day long jazz fest for the past 2 days...and tons of stress and sleep deprivation 2 weeks before. I guess if it lasts for a longer time than I know it's a true relapse and not just from heat and stress??

Cherie, I'm still confused. Are you saying that if you have O.N. you can have your eyes corrected by lenses? Others suggest if it is O.N. than there is nothing lenses can do because damage is permanent?

[lady_express_44]

Sorry if I my post was confusing, Natalie . . . I seem to be having one of those days.

For me, Uhthoff's (worsening of vision, due to heat) is a very temporary symptom. I heat up by showering, or by working in the garden, and my vision goes wacky almost immediately upon a raise in body temp. Then when I cool off, often within 5 - 15 min, it goes back to normal. The way I know it is Uhthoff's for sure is that it only happens in one eye, and the vision change (good/bad/good) is very obvious.

That this problem seems to be affecting you most of the day, leads me to believe it wouldn't be simply Uhthoff's.

So, that brings the likely options back to ON, or just your eyes worsening (which they do in our 40's ...).

When I had ON, there were times (days/hours) that weren't as bad as other times. I don't know if everyone is like this, but there were certain times (like when I first woke up) that I could barely see at all. It was also much worse in the dark (with lights), or in the bright sunshine.

So, when I was tested the first two times, she could NOT get me to 20/20. The third time she did (testing done on different days), BUT in the end that rx wasn't right anyway. That was DURING the ON attack though.

Every day was different for me, basically, although there were some patterns; NOT heat/stress related; mostly lighting that made it worse, during my period of ON.

The damage is most often NOT permanent with ON, at least not as bad as when the ON was at it's worst. We can be completely blind, and recover eventually. Once the ON has healed, then you can see where your new "norm" is. For me, that meant an increase in lense to -6.50 (from -5.75) . . . but I have not gone back to check and see if that gives me 20/20 vision. I doubt it, but it is the best I could get to.

Whether they were able to correct somewhat for the ON "damage" with this new rx, I'm not sure. I did have ON, I did recover, my rx did increase . . . but I don't think I got back to 20/20 after that episode.

Does that make any more sense? If it doesn't, ask away . . . I might have clearer thinking in the morning.

Cherie

[Koala77]

I also wanted to say that visual damage from ON is not necessarily permanent. I have had around 8 events of ON over a 30 year period since diagnosis with MS, and so far my vision has returned each time.

I didn't suffer any long time eye damage from the ON that I suffered, but others were not as lucky as I. Like MS, ON affects each of us diffeently.

[Dejibo]

I have Uthoffs as well. during heat waves, or prolonged exposure in overly warm areas, or even over heating due to exercise can make my vision go wonky. I am one of those that goes nearly blind if I try to run.

I agree, new glass wont fix ON, but a visit to the eye guy is needed if you think you are in a flare with ON. That is the one thing I will take steriods for. I dont wanna play with my vision.

[Riverwild]

So are you saying you may need bifocals??

Seriously, make an appointment with your opthalmologist. My vision is back to pre-diagnosis levels, but I have noticed that it's getting harder to read for long periods of time. My eyes sort of stop focusing on the printed words. I asked the neuro if it was damage from ON and he told me I was getting old...

I bought a pair of reading glasses at the dollar store just to see if they helped and voila! I can read!

I went for my eye appointment and the prescription came back that I could use bifocals...at the level that the glasses I got were (+1.25)
The doc said to just keep buying the el cheapo reading glasses until the prescription changes enough to make buying the bifocals worth it.

I bought the ugliest pair I could find and wear them with a smile!

[Dejibo]

As we grow older, our lenses are not as flexable and therefore more rigid, and wont flex like we need to for reading in lower light. Find a patch of sun. the brighter the better. Your lense doesnt have to flex as much in bright light. I chose a few drug store reading glasses from the job lot places at $3 a pair. I have them tucked everywhere.