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279234 tn?1363105249

More Evidence?

I went to the optometrist yesterday and found out some interesting things. I have to get glasses with prisms and to correct some slight nearsightedness. I would like some opinions.

My background with eye issues has always been severe nearsightedness, but that all changed when I had surgery (LASIK) back in 2004. My vision was 20/1300 so I was literally blind without the aid of glasses or contacts. I opted for the surgery when they could no longer give me an RX for contacts because my vision was so bad, and glasses were so expensive. I had to go through extensive testing (eye dilation test, pressure test, mapping of the corneas etc..) before they would ok the surgery. This all took place before my symptoms and issues were in full swing.

Since the kids are out of school, I scheduled appointments for everybody. My 2 sons went Monday. My daughter and I went yesterday. Everything went fine, with the exception of my visit..of course. I went through my health issues, my history, family history, eye symptoms etc...When she did the eye exam, which this happen for the first time for me in front of an examiner, the eye began to swing in and the lettering was doubled. She noticed. I told her that I was also diagnosed with eye muscle weakness by an ophthalmologist and that on occasions the upper eyelid will droop. These issues come and go as they please.

She looked at my optic nerve and did some more test.  First, my vision in the left eye has declined. For years after having LASIK, the left eye was 20/30. Now the left eye is 20/40 and can not see the fine details. Even when she adjusted to try to get me to 20/20, it was like my eyes wouldn't go and still couldn't see as good as the right eye.

She showed me several pictures of optic nerves. She pointed at 2 pics and said that the color of my optic nerve disc was somewhere in between the 2 of these, pale. Now, I did have one ophthalmologist who did say that my disc was somewhat pale, but he could only see this when my eyes were in a dilated state and he took pics of the optic nerve. She wanted to do an eye dilation test, but said it wouldn't be a good idea since I drove myself and said it would be best anyways to be evaluated by an ophthalmologist. My pressures were fine.

I asked her the cause..She said that it could be something I was born with (which I wouldn't think so since I've had extensive testing on my eyes and no-one has really pointed out that I had a really pale looking optic nerve disc), could be glaucoma (I wouldn't think this either because my pressures were fine, although my mother does have Ocular Hypertension). I asked if a neurological disorder could cause this and she said ..yes if atrophy of the optic nerve was involved...meaning in one scenario, I could have had ON several times and not even known it, thus causing the atrophy.

So, She wants me to go see an ophthalmologist and have a visual fields test and an eye dilation test to have the optic nerve evaluated. I know my old ophthalmologist said that my optic nerve was somewhat pale..but the pics that she was showing me was pretty obvious. Do you think this is more evidence to add to the list? I have also had a visual fields test before that showed nonspecific vision loss...it was all over the eye not peripheral. Would this be of some importance?
11 Responses
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279234 tn?1363105249
Bob,

Yeah, I read about all the causes of a pale optic disk...I'm just a limbolander of 4 years that is just now showing some evidence of something going on that the docs might pay attention to and lead to a DX. I have 5 nonspecific lesions in my brain and an abnormal SSEP so far, but the docs don't care about the brain lesions. I need to grab any evidence I can.  A  VEP isn't being ordered, so far, nor is an MRI. They are looking at glaucoma for the pale optic disc rather than a neurological disease because my mother has ocular hypertension.

That's the problem with my case..nobody looks at the whole picture and they expect the typical evidence. I'm seeing my neuro at the end of the month, and I'm going to the ophthalmologist in July so I will go over this new finding with him and see what happens. To me, if you look at the whole pic, this finding could be of some significance, especially if the cause is ON...it could lead to my DX.
Helpful - 0
1453990 tn?1329231426
There are several things that can cause "pale optic disks."  It is not a reliable diagnostic  sign, but more of a "finding."  If you have a "pale optic disk" that should lead to a VEP or an MRI with special empahsis on the optic nerves/chiasm and tracts.  My fundus photographs of boringly normal.  My VEP and MRI show damage to the right optic nerve and left optic tract.
About 40% of ON cases present with visual orbital signs (pale optic disk).  60% do not.  

If you have a pale disk, it can be optic neuritis, nonarteritic anterior ischemic optic neuropathy (NAION), Graves' orbitopathy, or an arterial infarct supplying blood to the optic nerve.  More tests are required to determine the cause of a pale optic disk.

Bob
Helpful - 0
279234 tn?1363105249
Thanks for all the info everybody!

It just seems odd to me that my eyes have been stable since the LASIK procedure (2004) and all of the sudden the left eye (which has the pale optic disc) now has a change in RX.  My L eye will turn in, or  up & out, and has been know to do the hokey pokey LOL. The droopy eyelid symptom has been absent for about a year...but I did manage to get a pic of it when it did occur really bad, since it usually resolves by the time I make it to the doctors. My old neuro actually saw it when it was happening and pointed it out.

So far, the last VEP I took (which was last year) was normal. I beginning to wonder if this would still be the same result since my SSEP is now positive.

I am also wondering if this worsening of the optic disc has anything to do with the nasty "episode" I just came out of. I had double vision pretty bad and my L eye was pretty achy. My L eye does get achy sometimes, but the pain is tolerable. Then my arm started to have spasticity and weakness. From there, my hip flexors were severely effected, along with the leg. It ended with bladder incontinence. All these symptoms effected my left side, with the exception of my right arm.

My R arm has been left with residual weakness since the episode. My L hip flexors are also having some issues as well. Evidently my eye muscles must have been effected because they couldn't stay straight for the exam..the L eye kept wanting to go outward. She called it a form of Exophoria.

Maybe my body is finally giving up some evidence that the docs will look at? I see my neuro the 30th. Wish me luck!



Helpful - 0
1045086 tn?1332126422
I'd like to come back here and read more carefully.  (Sure hope I remember.)

For the moment I wanted to share an explanation of a droopy lid from a post by Quix.  Interestingly, I happened across it just recently and it stuck in my mind because I have noticed I also have one eye that sometimes appears smaller than the other.

She wrote, "There is a muscle that encircles the entire eye called the 'obicularis'.  When it contracts, it winks the eye tightly closed (as opposed to just allowing the lid to drop.)  Think of it as the squint muscle.  It acts as a sphincter.  So when it is weak, the eye is often more open."

Now that I copied it here I am wondering if a weak muscle could be opening one eye more OR if a muscle spasm could be partially closing one.  Wonder which is my normal?

DEFINITELY see an ophthalmologist, perhaps a neuro ophthalmologist.  I believe astigmatism is common in myopic individuals but you seem to have a suggestive combo going on.  A specialist needs to figure out all the components.

I so wish there was a way to get to diagnosis without waiting for damage to become evident.  Hopefully, this can work FOR you in some way.

Please keep us updated.
Mary

Helpful - 0
987762 tn?1671273328
COMMUNITY LEADER
When i got my eyes tested late last year, for the first time 'ever' something was actually found to be wrong lol

notibly the right optic nerve was found to be slightly pale, pressure was normal and weirdly all my eye veins are crinkly (toutchorous sp). The pale part had been picked up in earlier tests but no one said anything to me, apparently because my sight was at the time 20/20 and the pressure was normal, it wasn't necessarily a problem, yet.

This later testing again picked up the pale disk, but i'd added those other things and I had double vision (diplopia) and a rappid horizontal jerk (nystagmus) and i'd lost significant sight acruity myopia (nearsighted), funny it all being in the right eye too. HELLO is it a problem yet?

I only saw an optomitrist (long stupid story lol) her thinking was that its probably just early glaucoma, why she's thinking that i think has more to do with my age and her expectations, she was very suprised i didn't have hypertension or diabetes. I did find this all confusing, because my dr thought it all very important and yes more supportive evidence that it was neurological. Adult acquired is usually neurological apparently.

Get the tests regardless of the out come, its all something you need to know :-)

Cheers........JJ

PS my left eye is just slightly off too but its farsighted which help explains my lack of depth perception lol
Helpful - 0
667078 tn?1316000935
I tried the stick on prisms for a month first. I just could not get used to them. They made me seasick. I was glad I did this first before paying for lenses.

Alex
Helpful - 0
1475492 tn?1332884167
Yes, I agree with Jens too. :)
Helpful - 0
Avatar universal
I second Jens statement. I have optic nerve damage. I was dx'd with ischemic optic neuropathy in 2007, and the pictures taken of my optic nerve showed pale optic disc. I also have double vision, and I wear a prism in my glasses.
My VEP test was abnormal and findings were consistent with demyelinating process, but this particular neuro did not even mention it when he called me. So at this point, the docs are having a difficult time, (I am assuming) that they are not sure if this is caused by optic neuritis due to ms, or optic neuropathy due to Graves Eye Disease.

I definatey think that this could be more evidence for you. My VEP  being abnormal, is proving something to my endocrinologist, he is taking me serious now. (not my neuro)

The prism takes time to get used to. At first it didn't work at all for me, and I had to wear a pirate patch or electric black tape over my glasses.
Good luck to you!
Pam
Helpful - 0
338416 tn?1420045702
Pale optic disc is something that comes up with optic nerve damage.  I would say that along with the droop of the eye and the odd eye motion, you have a very interesting case for a neuro-opthamologist.
Helpful - 0
279234 tn?1363105249
TY for your input. I've been check for MG, and probably every mimic known to mankind LOL.

I think I've been checked, and rechecked for most of the well known mimics, plus some out of the ordinary ones as well. I do have muscle weakness, but I also have muscle spasticity..severe. Those 2 symptoms I live with on a daily bases.

It does sux to have something mess with your vision along with the rest of my body, especially when it's not identified, but after 4 years in limbo, it's sad to say, but I'm use to it.

Thanks again☺
Helpful - 0
1658667 tn?1310091382
SB- I am not sure about the answer to your question but one thing that stuck out to me was your eyelid droop and double vision.

When I first went to the ophthalmologist he was concerned that my double vision was due to Myesthenia Gravis (sp?). One question he asked was if I get muscle fatigue or had an eyelid droop.

It is a simple blood test to check for this so that might be a possibility. Just food for thought :D
It really really sux to have your vision compromised. I am sorry you are going through this.
Helpful - 0
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