Visual Changes
For many people, a problem with vision is the first MS symptom. Vision problems are not uncommon, affecting up to 80 percent of people with the disease. The symptoms affect either your vision or the movement of the eye itself. Keep in mind that while vision problems are common in MS, they rarely result in permanent vision loss.
Fact
Optic neuritis typically affects people aged between fifteen and fifty years of age. In this age group, studies indicate that more than 50 percent of patients will be diagnosed with multiple sclerosis within fifteen years after a first bout with optic neuritis. As with MS, women are about twice as likely as men to present with ON and the prevalence in Caucasian people is higher than in other racial groups.
Optic Neuritis (ON)
Optic neuritis (inflammation of the optic nerve caused by demyelination) is the most common visual disorder and can cause an array of symptoms including vision loss in one eye, pain behind an eye, blind spots in the visual field, faded or washed-out color vision, and other problems. The visual deficit may worsen over a period of approximately seven days, and then typically remains stable for three to eight weeks, followed by gradual visual improvement. The great majority of patients with optic neuritis will recover much of their vision within six months of the onset of ON. Your neurologist may prescribe intravenous corticosteroids, as they've been shown to significantly increase the rate of the recovery from ON. If visual loss is relatively mild and manageable, the best alternative is probably to wait for the episode to remit on its own. It is not uncommon for a person to experience recurring episodes of ON and some residual effects may remain after the episode has cleared up, such as changes in color vision.
Alert
The symptoms of ON can flare up if your body is overheated from exercise, hot weather, or fever (an occurrence called Uhthoff's phenomenon). This is an example of a pseudorelapse and the symptoms usually clear up once your body temperature goes back to normal. Fatigue may also provoke symptoms from a previous episode of ON.
Eye Movement Problems
These problems refer to the movement of the eye and prove to be a complicated area of neurology. As with other MS problems, the difficulties can be subtle or marked. People with MS can experience problems when moving their eyes rapidly from side to side, for example, or when trying to follow the path of a moving object. Others experience involuntary eye movement. The more common eye movement problems in MS are diplopia and nystagmus.
Diplopia
Diplopia occurs when complex eye movements are out of sync. In other words, each eye has a mind of its own and the result is double vision. It's caused by decreased nerve input to the eye muscles. When the images are not properly fused, the person perceives a double image. Double vision may increase with fatigue or overuse of the eyes (such as extended reading) and improve with rest. Resting the eyes periodically throughout the day can be beneficial.
Diplopia usually resolves without treatment. In some cases, it is treated with a short course of corticosteroids. Temporarily patching one eye while trying to drive or read will also stop the double image. Surgery or special prescription glasses in more severe cases are also options that should be discussed with your eye specialist.
Nystagmus
Another relatively common visual finding in MS is nystagmus, uncontrolled horizontal or vertical eye movements in one or both eyes. Nystagmus may be mild, only occurring when the person looks to the side, or it may be severe enough to impair vision. It does not always cause noticeable symptoms, and is a painless problem. Some drugs and special prisms have been reported to be successful in treating the visual deficits caused by nystagmus and another related eye movement disorder called opsoclonus, which causes “jumping vision.” Corticosteroids may also be helpful in treating nystagmus, or the problem may resolve on its own. Baclofen, Klonopin, and Neurontin may alleviate nystagmus in some people.
Essential
Low-vision specialists and behavioral optometrists are licensed doctors of optometry who are trained in the examination and management of patients with visual impairments. Their services do not offer a cure for the causes of low vision, but they do help the patient learn how to utilize his remaining vision to its fullest potential. Check out
Other problems that can occur as a result of visual disturbances are dizziness, nausea, loss of balance, and disorientation, so getting a handle on eye problems is essential. Doctors who treat eye disturbances are low-vision specialists, ophthalmologists, and optometrists.
