Living With Optic Neuritis and MS

Scary, But Not Often Permanent

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You may have been told that you have a good chance of developing multiple sclerosis (MS) in the future if you've experienced a bout of optic neuritis. One study found that about half of people who developed optic neuritis developed MS within 15 years, although it was less likely if they had no lesions on a baseline brain MRI.

By some estimates, up to 80 percent of people with MS will have vision-related symptoms, the most common being optic neuritis.

About 20 percent of people with MS experience optic neuritis as their first symptom. 

Causes

This condition simply translates to “swelling of the optic nerve.” The optic nerve connects the eye to the brain, and MS can damage this connecting structure, leading to vision disruptions. Optic neuritis in MS is caused by inflammatory demyelination of the optic nerve. In other words, the optic nerve becomes inflamed because of damage to its myelin sheath

Signs and Symptoms

  • Most people with optic neuritis (about 90 percent) experience pain when moving their eyes. This pain usually subsides after a couple of days, even if vision is still affected.
  • Blurred vision, reduced light, flickering, or flashes of light when the eyes are moved (called photopsia), loss of color vision (dyschromatopsia), a “blank spot” in the middle of the eye, called a scotoma.
  • Rapid onset (usually), with peak vision loss occurring within one to two weeks. 
  • More commonly affects one eye at a time. In about 10 percent of cases, symptoms occur in both eyes, either simultaneously or in rapid succession.
  • After a bout of optic neuritis, it is common to experience something called Uthoff’s Phenomenon, which is vision loss that comes on when your body temperature goes up, such as with a fever or in a hot climate. In fact, this experience can be an indication that a person had optic neuritis in the past that they may have been unaware of.
  • After experiencing optic neuritis, people may notice that their vision is better on some days than it is on others, or that they can see more clearly in the morning than they do in the evening.

Diagnosis

An ophthalmologic examination is a critical feature of diagnosing optic neuritis, and a gadolinium-enhanced MRI of the brain and optic nerve may also be used. If you've already been diagnosed with MS, your doctor may skip right to treating you after your examination, if optic neuritis is found.

Treatment

High-dose corticosteroids, namely intravenous Solu-Medrol, has been shown to be effective in reducing the duration of optic neuritis, but probably has no effect on long-term vision. Over 90 percent of people begin to recover on their own within a month without steroid treatment. Oral steroids seem to have little benefit or even have adverse effects and should be avoided.

It seems as if optic neuritis will recur in 33 percent of people, either coming back in the other eye or affecting the same eye again.

Living With Optic Neuritis

During a bout of optic neuritis, vision loss in the affected eye(s) can be quite substantial—even complete blindness is not uncommon. Thankfully, most people recover quite well and regain their vision, but it may take several months for a full recovery.

However, some permanent residual loss of clarity or reduced color perception in the affected eye can happen.

It is important to know that optic neuritis can have different causes (and approaches to treatment), so even if you have MS and are fairly confident that is why you're experiencing visual problems, you must see your doctor. He or she will refer you to an ophthalmologist or neuro-ophthalmologist for evaluation. As with many of the other symptoms in MS, visual problems may come and go throughout the course of the disease.

Sources:

Optic Neuritis. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/optic-neuritis/home/ovc-20263583.

The Optic Neuritis Study Group. Multiple Sclerosis Risk after Optic Neuritis: Final Optic Neuritis Treatment Trial Follow-Up. Archives of Neurology. 2008;65(6):727-732. doi:10.1001/archneur.65.6.727.

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