For many people with MS, one of the early symptoms is a problem with vision. This may be in the form of temporary loss or blurring of vision, or double vision.
Most people with MS who experience visual symptoms recover well. A small number of people may develop a persistent problem.
A problem with vision could be caused by a number of factors; it is important not to assume that all difficulties are due to MS. If you develop problems with your vision, ask your GP for a referral to an ophthalmologist (eye specialist) or neurologist. Seek advice on what might be causing it and what might be done. The visual deficit may worsen over a period of approximately 7 days, then typically remains stable (at that level) for 3 to 8 weeks, followed by gradual visual improvement. The great majority of patients with optic neuritis will recover much of their vision within 6 months of the onset of optic neuritis.
When a patient with reduced vision presents to the ophthalmologist, vision, eye pressure, and pupillary function is evaluated and the eyes are dilated such that the optic nerves and retina can be examined. There is always an abnormal pupil in optic neuritis, known as an afferent pupillary defect (paradoxically dilates when light is shone in the eye). The optic nerve in this disorder may appear normal or swollen. A visual field (peripheral vision) test may then be completed, and the patient is usually scheduled to have a MRI of the brain. The MRI (in this case) is a brain-imaging study, which will assist in the determination as to whether any central nervous system lesions are present.
There is a risk of developing multiple sclerosis (MS) in patients with optic neuritis. Fifteen years after the onset of optic neuritis, approximately 75% of women will have developed MS, and about 34% of men will have developed MS. For those patients with an abnormal MRI of the brain (white matter lesions), the risk of developing another sign or symptom of MS is 36% in 2 years. However, only 3% of patients with a normal MRI of the brain had another sign or symptom of MS within 2 years. MS is characterized by exacerbations and remissions of motor and sensory function, and may produce mild or severe disabilities over a period of years.
1. What is it Optic Neuritis?
• Optic Neuritis is inflammation with accompanying demyelination of the Optic Nerve which serves the retina of the eye. It is a variable condition which presents with various abnormalities of vision. Vision can be severely or moderately affected. It can either affect one only or both eyes concurrently or at different times and is usually reversible, with in some cases spontaneous recovery occurring. The patient may notice blurred or distorted vision, reduced color vision, or a blind spot. There is also frequently a history of pain with eye movement, and this may precede the visual loss.
2. What are the symptoms of Optic Neuritis?
• Blurring of vision occurs in around 58% ofoptic neuritis cases. This can range from mild blurriness in 34% of cases, through moderate (12%), to severe or total loss of light perception (complete blindness) in 54% of cases.
• Eye pain occurs in 53% to 88% of optic neuritis presentations. Sometimes pain is only noticeable with eye movement, sometimes pain preceded an episode of blurred vision, or a general eye ache, sometimes a headache gripping the affected eye, or a generalised dull headache.
• Reduced colour vision occurs in 100% of optic neuritis cases. Typically this is reported as a reduction in colour vividness, particularly reds.
• Visual flashing sensations brought about by side-to-side eye movement or sound often occur with optic neuritis. They are most obvious in a dimly lit room. Obscuration of the visual field in bright light is another common symptom of optic neuritis and many people with ON, particularly those with a chronic condition, report that they see better in dimly lit rooms. It is likely that both of these symptoms are caused by fluctuating interference of the nerve transmissions along the visual pathways.
• Uhthoff's symptom, the worsening of symptoms with heat or exhaustion, is present in about 58% of cases of Optic Neuritis.
3. What tests and treatments are available for Optic Neuritis?
a)Tests:-
• Mostly, doctors will diagnose optic neuritis by asking about a person’s history and observing typical signs.
• A blood test may be carried out to help identify the cause.
• Electrical testing of how the optic nerves are working, called ‘visual evoked potentials’ or scans of the optic nerves can sometimes help as well.
b) Treatments:-
• IV (Intravenous) Steroids -Corticosteroids have been the mainstay of treatment for the management of acute relapses for many years. They have immunomodulatory and anti-inflammatory effects that restore the integrity of the blood-brain barrier and possibly facilitate remyelination and improve axonal conduction. Corticosteroid therapy has been shown to shorten the duration and severity of the relapse and accelerate recovery, but there is no convincing evidence that the overall degree of recovery is improved or that the long-term course of the disease is altered.
Brief courses of high-dose intravenous (IV) methylprednisolone (IVMP, 500-1000 mg/day for 3-5 days) are generally given on a day- patient basis in hospitals, some doctors opting for a tailing-off dose of oral prednisilone tablets.
• Copaxone (Glatiramer Acetate) and the Beta-Interferons (Rebif, Avonex and Betaseron) have all been shown to reduce the probability and severity of reoccurrences of ON in addition to the other symptoms of multiple sclerosis.
• Aimspro or Goat Serum - read the lastest research on Aimpsro and Optic Neuritis here
• Supplements and Alternative Remedies for Optic Neuritis:-
Blueberries, Vitamin D, Vit A. ,Devils' Claw, Bromelain, Lutein, Beta- Carotene, Zinc, Selenium and Copper
Essential Fatty Acids lower levels of Interleukin 12 and raise levels of Interleukin 10 are good These include Omegas 3 and 6, Fish Oils, Flax Seed Oil, Evening Primrose Oil, Vitamin E in high Doses
• A Homeopathic Remedy:-
Phosphorus appears to be specific for sometimes helping optic neuritis. A reasonable prescription for optic neuritis would be phosphorus 30C every day until resolution begins. Combining this with hypericum seems effective. The double vision which sometimes occurs can be helped with gelsemium.
4. Recovery in Optic Neuritis.
• Most recover well from optic neuritis. Following ON ,vision tends to recover by itself. Nearly 80 per cent of people show signs of improvement by three weeks and over 90 per cent begin to recover within five weeks. Further improvement in vision can happen up to a year after symptoms begin.
Recovery from ON is often complete and even in the worst cases patients seldom fail to recover some sight. In around 65-80% of patients, the sight recovers to 20/30 or better, although many report some enduring visual deficits.
Further improvement in vision can happen up to a year after symptoms begin.