Vision issues; should I see opthamologist?

[Fluffysmom]

I saw my regular optomotrist last month, and got a stronger pair of glasses with progressive lenses and some other changes in the rx that I don't quite get.  I shared my brain MRI with him, and he said he didnt' see any signs of ON, and the spots in my right eye were just "floaters" that most people get as they get older.  

After I got my new glasses, things were pretty good for a while, then I had my LP and spinal headache, and laid in bed with spots and squiggles in both eyes, and some blurriness.  The spots and squiggles are still there.  Should I see and opthamologist (my insurance will cover it for medical reasons) or wait until after I see my neurologist on April 21.  Oh, my eyes seem to start hurting when I read or look up, down or to the sides, too.

Waiting is hard.  I want to get checked out while the symptoms are bothering me, but I wonder if my neurologist shouldn't be the one that decides if I should get my eyes checked out, since it has to be medically neceassay for my insurance to pay for it.  

What do you think?

Kathy

[Med Help]

Hi,

So your post while working on a Health Page here. We have a great Opthamologist here from the AAO that takes questions for free in both an Ask-a-Doctor forum and in the general community. Figured I'd let you know about the resources, and good luck. Here are the links:

Ask-a-Doctor: http://www.medhelp.org/forums/show/90 (the AAO answers 10 free questions a day, so if it's full today, try tomorrow)
Community: http://www.medhelp.org/forums/show/43

MedHelp - Harry

[Fluffysmom]

Wow, you seem to be using your little brain quite well!  I also spend a lot of time learning about how my body works because I know darn well the doctor's won't explain it.  I have been asked many times "Do you work in medicine?" or "Are you an nurse" because I usually go in loaded for bear.

I don't think my symptoms are bad enough to have been ON, but the info does say that it could be mild blurriness.  My vision worsened quite noticeably over the last 4 or 5 months, and when I had the acute onset tremors in Feb., I had a central defect in the vision of my right eye for about a day and a half, and now I have a lot of floaters in that eye.  After my LP and spinal headace, I developed lighter floaters in my left eye, more like cobwebs.  During the months that my vision worsened, my eyes hurt and felt swollen and hot, which may have been from sinusitis, who knows?

I'm feeling very who knows right now, having seen my neurologist today, most likely for the last time.  Sigh.

[santana8]

Did you have symptoms of ON?  Would you mind telling me what kind of symptoms you had with  your vision.  My optic nerves were normal with fundiscopic exam two years ago when this all started, and they have been checked every six months since then and have remained normal. I have no proof that I had Retoubular Neuritis as far as test except for the abnormal VEP which showed slowing in my left eye, same side as the visual field defect showed up. The field defect that I have is a left  inferior ( bottom) harmonious( in both eyes) quadranopsia( 1/4 of the visual field) defect( blind area or scatoma). That means that in both eyes tested separately by visual field showed a blind area in the bottom left corner of my field of vision. Here's the wierd part: Eventhough the field defect showed up as being on the left lower quadrant of both eyes, the actual field defect presents to me on the lower right quadrant of both eyes. Why? Because the lesion or lesions that have caused this defect  are further back in the optic track (radiations) after the nerve fibers cross. This means that the left side of the brain controls the right field of vision and the right side of the brain controls the left field of vision. Confusing, isn't it? Would you believe that I learned this by myself studing the visual pathways. When I asked my neuro if this is why I see the defect on the opposite side than where the defect showed up on the test, He said yes and wanted to know where I learned about that? Point is if you wait for the doctors to explain things like this you may never understand it! After I studied this and what the parts of the brain that I have lesions on control then the picture became clearer to me as to why I was having all of these wierd symptoms. Just like the right/ left confusion and disorientation, is caused from the lesions in the corpus collosum and the parietal lobe. The corpus collosum holds a bundle of nerves that control communication between the right and left hemisfieres. And the parietal lobe is controls direction, orientation.  I learned all of this because of the fear of not understanding what was happening to me, and the doctors were not worried about explaining it to me. I guess they thought I was too stupid to understand it. But I took what little brain I had left and used it, lol! The way that it helped me to understand this was that it made me personally know that I was not crazy or loosing my mind. All of this wierd stuff was really happening to me and now I know why! This makes me feel better to know and that is really what matters!

Santana

[Fluffysmom]

Hi,

I came back from my Ophthamologist's appointment pleased with the  "you have very healthy optic nerves" then read Santana's experience with the retrobulbar neuritis, which I had read about but forgot to mention.  I did ask if there was any evidence of past ON, and he paused, thought, said it's possible, scheduled me for a visual field test, and then said he doubted it because my nerves looked so healthy.

He did say that the new floaters were probably from the change in CSF pressure from the LP and leak, and that they were nothing to worry about.

Then I went to a soccer match wearing sunglasses and still got a rotten headache because my eyes were so dialated.  We left early, which is just as well, since the home team lost 7 - 1, but that's OK since it was against the under 23 Women's National team, and they should be better than a small but mighty college.

I'm waiting for my appointment with my neurologist, to see what test results show from my LP and blood draw.  I'm in an emotional knot; will I learn something definitive, or will  it be an "everythings normal"?  Will I have possible MS, Lyme Disease, some thing I know nothing about?  Sigh. I'll start a new thread when I get home after my appointment.

Take care,

Kathy

[CtResident]

Santana:

I know, it's so confusing, isn't it?

When I had my VEP, the tech had me look at a little laminated card with letters on it, and read them with my glasses on (bifocals) and I could hear him murmuring what my vision was. But this info was not in my report.

I was astonished to hear him say 20/70 for one part and 20/100 for another part (sorry, don't recall which eye, or which part of my lenses). So I figured "yeehaw, my VEP will be abnormal, we're getting somewhere."

I mean, really, he was showing me stuff WITH the glasses on, and I could not see it. Of course, he was holding it, not me, I would have adjusted the distance...???

It 'twas not to be..........it came back as normal.

Fluffysmom:

About the IC: I was dx'd with it by a female urogyn..............and then it went away!! I didn't even complete the recommended 8 weekly instillation treatments.

So, is that a point in the MS column?

And another thing: I had floaters in my eyes when I was a teenager! So I don't know that it's necessarily an age thing. But, hmm, was it a symptom that should have been looked into? I will never know.

Suzanne

[santana8]

This is what is puzzeling me! You said that you have had blurred vision off and on over the past couple nonths, and that it was only one eye that was bothering you with light sensitivity and that sometimes the text on the computer screen gets distorted. does this mean that all of these symptoms come and go?  Mine came in like a hurricane and has slowly improved  over the past two years, but once improvement was there it never went backwards only forward toward the good. You are not the only one on here who has discribed it as coming and going, and I am just wondering why that I am not showing this pattern if On is what I had.  I really wonder what the difference is with me on this? I think maybe if I did have it that it was bilateral as it was obviously in both eyes at the same  time.

Santana

[CtResident]

In reference to having an abnormal VEP, then told the eye exam is normal, no ON:

My VEP was normal, my eye exam by the neuro was normal.

But I've had blurry vision off & on for a few months now. It sometimes gets so bad I have to go take a nap, can't push through it. Sometimes the text on the computer gets distorted, with lines under it.  

Lately I've been having left eye hypersensitivity to light (sunglasses in the house??) Last night at sunset everything seemed so acutely painful, thankfully my dh was driving, because I had to keep shutting my eyes. It was mostly my left eye that was bothering me.

Is it possible that yes indeed, my VEP was normal in January, but things have stirred up since then? I guess I need to see an opthamologist now??

Suzanne    

[santana8]

I did not show signs of ON on my fundiscopic exam and was told that the optic nerve was normal, but later much later learned about Retoubular Neuritis which is what I am pretty sure that I had. Like Quix said it is further back on the optic nerve and cannot be observed through a fundiscopic exam. My VEP was abnormal showing slowing and my visual field test showed a defect in one quadrant of the visual field. Besides this evidence I also had every single symptom of ON so I have never doubted that that was what was going on. My problem is ON can be in ADEM or MS, although in MS it is usually only in one eye. I had symptoms in both eyes, but the testing only showed abnormal findings in one eye. Now this confuses me as to whether this was unilateral or bilateral ON. Another thing that I am can't figure out is that most of the people on here who have had ON seem to have relapes, but mine has just been one episode with no relapse. It seems impossible to figure out which one I had/have ADEM or MS when they both have almost identical symptoms. I am lost with this trying to figure it out, I suppose my neurologist may be doing the right thing by doing repeat scans every six months and just watching me for new signs. I seems that the longer I go without  any change the more he leans toward ADEM!

Santana

[Fluffysmom]

Thanks for all the info.  I will check for a Urogynecologist, or a female urologist, or a young male urologist in that order.  I'll make the call in the morning to see the ophthalmologist, as soon as they can fit me in.

When I had my LP on April 11, they drew a lot of blood as well as several vials of CSF.  My neuro said she was going to rule out MS mimicking diseases as well as rule out MS, so I assume they will do the Western Blot test?  I think she mentioned Lyme Disease.

Thanks again, I'm tired and must hit the hay.

Kathy

[Quixotic1]

First - IMO, Optometrists are NOT "real" doctors.   They are not MD's, PhD's, or DO's.  They go to a School of Optometry.  You can get an Optometry degree ONLINE, for pete's sake! Until recently, last decade or so, all they did was a refraction and fit glasses.  They have stepped up their training, though.  They do refractory exams, having increasing good CME in eye diseases and do lots of fancy testing.  They complete a 4 year program (like MD and dentists), usually after getting an undergraduate degree, so it sounds like they know a lot, but this has sadly not been my experience!

If you have more going on with your eyes than just needed a new prescription, then Yes, you should see an Ophthalmologist!!!!!!!!!!!    breath   !!!!!!!!!!!!!  These are MDs or DOs, with a subspecialty in diseases and surgery of the eye, usually another three or four years after Med School.

As far as the spinal headache causing the symptoms you had, I actually doubt it.  Your symptoms were pretty classic for Optic Neuritis and I think you should be tested for it.

AND - for all of you that have had signs of ON, but been told that you DON"T have it because the eye exam is normal, remember that the eye exam is normal in up to 50% of ON becasue the demyelinating damage is too far back on the optic nerve to show signs within the eye.  Any doctor that tells you that ON is "ruled out" by a normal physical exam of the eye doesn't know what they're talking about.  The test for ON when the symptoms are there (or were there), but the exam is normal, is either an MRI (including the orbits) and/or a VEP.  And a visual field/sector exam is not a bad idea either.  The VEP may be abnormal years after the last bout with ON.

I forget the numbers, but a large number of people with MS, WHO NEVER HAD VISUAL SYMPTOMS OF ON, have an abnormal VEP, indicating they had a sub-clinical case.

Shaking of the eyes is a different problem.  If the eyes themselves are shaking (as seen by an observer) then the problem is either nystagmus or spasms of the muscles that casue the eyes to move.  Nystagmus is a brainstem or cerebellar problem not a problem in the eyes.  The major exception is in the case of "Macular agenesis" where the macula doesn't develop (like in albinos) and the eye constantly searched back and forth for a clear image.  The macula is the point in the retina where the visual image is focused.  All else is peripheral vision.  In macular degeneration you lose the center of your visual field.

If the eyeball shakes erratically it can be from spasm of one of the eyeball muscles, which involve Cranial Nerves III, IV, and VI.  

If any of you have nystagmus that the doctor has never seen, have someone catch a video of it (like with a camera phone) when it occurs, to show the doctor.

If the visual image that you are looking at is what is shaking then you likely have a problem called "oscillopsia." (hey that would be a good name for the Hypo Gamma Chondria yacht, too!  The "SS Oscillopsia"!)  pronounced Oss-eh-lop'-see-yah.  This, I think is a problem with the central processing of the visual image.

Bladder symptoms:

If your are female with bladder problems and you have any possiblility to going to a Urogynecologist, then try to do so.  This is a relatively new specialty of Gynecologist and Urology combined.  Ther are two associated with my MS Center.  They are amazing.

There are also female Urologists, though there are precious few of them.   But, you might also look for one of them.  Lastly, look for a younger male Urologist.  I saw one who was not fazed by my Girlie Goodies at all and knew what to do and ask if the patient didn't have a Johnson.  (Now I guess it could be that my GG's are unremarkable - one can never tell, but the guy was quite knowledgeable and professional).

Kathy - have you had a Western Blot test for Lyme?  IC and ON are both described with frequency in LD.  If you have answered this before, I apologize.

Quix

[Fluffysmom]

Santana, I've seen a few of your posts, but haven't read much background on you; nice to meet you.  You're right; my optomotrist is a nice guy, but he did seem a little concerned when I saw him last, and told me to call if I had any more problems or questions.  I'll just see the opthamologist who works with him.  My eyes are very important to me; I want to take the best care of them that I can.

I will call the Eye Health office tomorrow and see if they can get me in.  I see my neurologist Monday, so I can share anything I learn with her then.  

Deb, I wish they could figure out what's causing your symptoms and find a way to fix it.  Do the opthamologists do the VEPs, or is that something the neurologist orders or does?  I'm learning so much lately, that I never thought I'd want to know. :o)

I always thought I should have gone into medicine; I guess I'm learning a lot of it on my own behalf, and for my friends that I've been meeting here.

Thanks for being here!

Kathy

[Deb61]

I agree . . . I don't think I agree that these squiggly lines are auras either.  I don't see a connection with them and my migraines.  Interestingly enough, my sister has the same problem, and was told that they were auras, too.  

Every time I've gotten new glasses in the last three years, it never had corrected the blurry vision.

I've been given lots of reasons by different eye doctors as to what's causing my blurry vision, but I haven't been diagnosed with ON (optic nerves looked fine and I passed the color test).  My vision is still screwy and has never improved much.  Besides blurred vision, my eyes cross, I've got double vision, they shake (when they're tired), and lights will be streaked.  

If you can get into the opthamologist, maybe YOUR visit will be helpful (hopefully much more than mine was).

Deb  

[santana8]

Hi, I don't think we have met, but if you have read some of my post you might know about my vision disturbances. I am not DX yet, as I am stuck between two different dx's, ADEM and MS. I started with an optomitrist because to be honest I didn't know the difference in  an optomitrist and an opthalmologist. He said my eye exam was normal and my vision was 20/20, and he was right about that! He said the light sensitivity that was sevier was due to the fact that I have hyperopia( farsightedness).  He perscribed me glasses that I later found out that I didn't need when I went to an opthalmologist who tested me to see how much hyperopia I had. He said I did have it but not enough to require glasses for it at this time. He also found my visual field defect with visual field testing. This was the turning point in getting me to a neurologist who done the MRI and found the ten lesions in the white matter. Optomitrist are basically eye doctors who do general eye exams and prescribe eye glasses. Once I went to an opthalmologist I found out that there is a very important difference in the two. Opthalmologist are specialist in eye conditions and diseases. The problems you described in my opinion should be evaluated by a opthalmologist. They just plain know more and are trained to look for eye conditions and related problems. I wasted too much time with the optomitrist and delayed getting the proper care that I so desperately needed.

Santana8

[Fluffysmom]

Hi, Deb,
It's great to be back!

I've had migraines before, and the auras only lasted a limited time.  These squiggly lines remind me of fine hairs or capillaries or something.  I'll probably call the opthamologist tomorrow, since the spots and squiggles keep hanging around and my vision isn't as good as it should be with brand new glasses. I haven't driven since the spinal tap; I'll see how I feel and see tomorrow.  A friend of mine had an eye issue and got in to the this opthamologist the same day, and he's in the same office as my optometrist so I'm an established patient.

Take care, see ya' soon,

Kathy

[Deb61]

Kathy, I'm glad you're in the land of the living!  I've had a bad experience with my spinal tap, too.  I should have gotten the blood patch.

It would be a good idea to see the opthamologist, to at least explain things to you and rule other problems out.  I have many issues with my eyes.  I don't see as good as I used to--especially at night.  

I have migraine headaches.  The squiggly line thing was described by my opthamologist as an aura.  I had a hard time linking these squiggly things with it, but that is what he said.  I also see double and my vision is blurry, but the optic nerve appeared normal to him.

Heather, I have a permament black spot in my right eye, which I notice when I look at white backgrounds.  The black spot is not very big.  Would this be a floater or spot caused from past ON?

Deb

[Fluffysmom]

Thanks,

I actually was very surprised at how quickly I got used to the new glasses, what with the Progressive lenses and all.  All was fine until the LP; I had adjusted to the floaters in the right eye.  It was laying there for days with the spinal headache, trying to read, and having spots interfering with my vision, and it would become blurry at times and I would give up reading.  I put on some soft Native American flute music and would listen and breathe, looking at the white ceiling, and all the new floaters and squiggly lines in my left eye, as well as my right.  Oh, and when I look to shave my right underarm, I get sharp pains and flashing lights in my right eye.

I know it could just be some after affect of the LP, and that it could just clear up on it's own in another week or so.  Of course, being in Limbo Land, it crosses my mind that if it was a mild bout of O.N., it would be another step down the road towards border that crosses into DX Land!  I had a viral outbreak when I was in Palm Springs the first week of the month, and came back with new urinary symptoms.  My PCP suggested I see my old urologist, who, excuse me, is more used to dealing with old penises.  I need to find some energy and find a new urologist!

When I went in to get a lumbar blood patch which thank heavens took care of the spinal headache, the anesthesiologist that I talked to said that I should see an opthamologist, as optomotrists aren't really trained to see the disease changes that the opthamologists are.  She also told me that the bladder spasms (sharp pains) and even more frequency(I have interstitial cystitis) with a clear urinalyisis and urine culture could be changes from MS, if I do indeed have it.  

Sigh, as you know, waiting is hard, and I feel that the small odd parathesias and hypersensitivities and dizziness and loss of balance that I have been experiencing over the years may be what led to the many lesions on my brain MRI, and I want to really KNOW, so I can get on a DMD and slow the progression, or accept that it was all migraines or whatever.

Thank you for listening, and caring enough to be here day after day to help all of us feel at least a little better.

Kathy

[Heather3418]

It takes time to get used to a new eye glass prescription.  Don't panic yet, hon.

Optic Neuritis is usually in one eye with MS.  You have pain upon movement of the eye, are sensitive to light and usually have some visual impairment.

If you feel that you are having ANY unusual problems, I always advise members to err on the side of caution and get in touch with your doctor.

Your eye doctor was right about floaters.  I am in my 50's now and I have floaters in both eyes and one black spot in my line of vision from a past bout with Optic Neuritis.  So the floaters are a normal part of aging.  They are especially noticeable when you are looking at a light background.  When I had O.N. even looking at a light colored piece of paper hurt my right eye.  It was like someone stabbing me in the eyeball with a knife.  This is also what I felt when I moved my eye in any direction.  It wasn't an ache, it was a sharp pain with blurred vision and sensitivity to light.

Heather