Aa
ON question
Do all cases of ON leave a lesion on the optic nerve?
LA
LA
I am not driving at night at the moment as I nearly went off the road with my 6yr old daughter in the car after passing a car coming in the the other direction and I was momentarily disorientated. There was no white lines or cats eyes on the road (a rural one), do you think that this will be a permanent thing? It was like my bad eye took a second or two to catch up with the other.
Living in the far north of scotland in the winter we can have as little as 6 hours of daylight in the winter, though in summer it does not get completely dark so I think I'll be okay then.
Alixjo
Living in the far north of scotland in the winter we can have as little as 6 hours of daylight in the winter, though in summer it does not get completely dark so I think I'll be okay then.
Alixjo
I have to leave soon, but have a few random comments.
ON is ALWAYS from a lesion on the optic nerve - WHETHER OR NOT it can be seen with MRI.
Once that lesion is healed, it will most always still convey an imperfect (slowed) signal. Remyelination is never quite as good as the original thing.
The visual blurring that we get with ON is not correctable with glasses as it is not a refreactive error. This means the blurring is not due to imperfect "focusing" of the image on the macula. When they fit us with glasses they measure our refractive error. How much of difference in lens is needed to focus correctly? Refractive error is caused by an eyeball that this not a perfect shape - like having a eyeball that is too long front to back (farsightedness) or too short front to back (nearsightedness) or is out-of-round (astigmatism).
But, in ON the problem isn't that our eyeball shape is the problem, it is that the signal being carried to the brain is messed up due to a demyelinating lesion on the optic nerve. That is why the doctor may say our acuity is normal, and we think he is an idiot, because we aren't perceiving correctly, and things are still "blurry".
The other major cause of disc thinning or abnormal OCT is glaucoma. OCT has been used routinely in the care of glaucoma (high pressure in the eye) for decades. Its use is new in MS.
That is a great artical on ON.
Quix
ON is ALWAYS from a lesion on the optic nerve - WHETHER OR NOT it can be seen with MRI.
Once that lesion is healed, it will most always still convey an imperfect (slowed) signal. Remyelination is never quite as good as the original thing.
The visual blurring that we get with ON is not correctable with glasses as it is not a refreactive error. This means the blurring is not due to imperfect "focusing" of the image on the macula. When they fit us with glasses they measure our refractive error. How much of difference in lens is needed to focus correctly? Refractive error is caused by an eyeball that this not a perfect shape - like having a eyeball that is too long front to back (farsightedness) or too short front to back (nearsightedness) or is out-of-round (astigmatism).
But, in ON the problem isn't that our eyeball shape is the problem, it is that the signal being carried to the brain is messed up due to a demyelinating lesion on the optic nerve. That is why the doctor may say our acuity is normal, and we think he is an idiot, because we aren't perceiving correctly, and things are still "blurry".
The other major cause of disc thinning or abnormal OCT is glaucoma. OCT has been used routinely in the care of glaucoma (high pressure in the eye) for decades. Its use is new in MS.
That is a great artical on ON.
Quix
Thanks for the article you mentioned,
The bit that struck a chord with me was -
CONTRAST SENSITIVITY:
Most patients with recovered optic neuritis and 20/20 Snellen acuity insist that vision in the affected eye(s) is imperfect. Using psychophysical tests, such as contrast sensitivity measurements, investigators have been able to detect the hidden visual loss. One important outcome of this research is that optic neuritis patients who have difficulty seeing and 20/20 vision are protected from misdiagnosis as non- organic cases of functional amblyopia. Low contrast letter wall charts provide the clinician with an easy method for measuring contrast sensitivity. Pelli-Robson low contrast letter charts discriminate normal from abnormal peak contrast function (a mid-range spatial frequency), and provide reproducible results [25]. The measurement of peak contrast sensitivity is an extremely effective indicator of subclinical optic neuritis.
However, the test is not usefui in differentiating optic neuritis from maculopathies, and because it is a subjective test, it is of no value in distinguishing organic from non-organic factitious visual loss.
I was really beginning to think I was imagining this.
Alixjo
The bit that struck a chord with me was -
CONTRAST SENSITIVITY:
Most patients with recovered optic neuritis and 20/20 Snellen acuity insist that vision in the affected eye(s) is imperfect. Using psychophysical tests, such as contrast sensitivity measurements, investigators have been able to detect the hidden visual loss. One important outcome of this research is that optic neuritis patients who have difficulty seeing and 20/20 vision are protected from misdiagnosis as non- organic cases of functional amblyopia. Low contrast letter wall charts provide the clinician with an easy method for measuring contrast sensitivity. Pelli-Robson low contrast letter charts discriminate normal from abnormal peak contrast function (a mid-range spatial frequency), and provide reproducible results [25]. The measurement of peak contrast sensitivity is an extremely effective indicator of subclinical optic neuritis.
However, the test is not usefui in differentiating optic neuritis from maculopathies, and because it is a subjective test, it is of no value in distinguishing organic from non-organic factitious visual loss.
I was really beginning to think I was imagining this.
Alixjo
Here's another interesting section from the site Mary notes:
EYE PAIN:
The incidence of ipsilateral eye pain in unilateral optic neuritis ranges from 53% to 88% [1,6]. In one study,it occurred only with eye movements. In 19 pain preceded a decrease in visual acuity. 115 optic neuritis patients (62%) complained of pain during an attack in or behind the involved eye. In 39 (21%) it occurred only with eye movements. In 19 (16%) pain preceded a decrease in visual acuity. Headache in the involved eye region was reported by 40 patients (22%) and generalized headache by 24 (13%) [6]. Typically, the pain is experienced as a dull ache or sinus pain, with or without tenderness of the globe. It reaches maximum severity within 24-36 hours and resolves spontaneously within 48-72 hours. Persistent pain for 7 days is highly atypical and should prompt a search for other causes of optic neuropathy. The cause of the eye pain is unknown. It does not correlate with the severity of visual loss, with the absence of optic disc swelling (which implies retrobulbar optic neuritis), with enlargement of the optic nerve or with localization of the demyelinating plaque in the intracanalicular region.
In the original, the sentence starting "Persistent pain" is emphasized. I've never read that before. Hmm.
ess
EYE PAIN:
The incidence of ipsilateral eye pain in unilateral optic neuritis ranges from 53% to 88% [1,6]. In one study,it occurred only with eye movements. In 19 pain preceded a decrease in visual acuity. 115 optic neuritis patients (62%) complained of pain during an attack in or behind the involved eye. In 39 (21%) it occurred only with eye movements. In 19 (16%) pain preceded a decrease in visual acuity. Headache in the involved eye region was reported by 40 patients (22%) and generalized headache by 24 (13%) [6]. Typically, the pain is experienced as a dull ache or sinus pain, with or without tenderness of the globe. It reaches maximum severity within 24-36 hours and resolves spontaneously within 48-72 hours. Persistent pain for 7 days is highly atypical and should prompt a search for other causes of optic neuropathy. The cause of the eye pain is unknown. It does not correlate with the severity of visual loss, with the absence of optic disc swelling (which implies retrobulbar optic neuritis), with enlargement of the optic nerve or with localization of the demyelinating plaque in the intracanalicular region.
In the original, the sentence starting "Persistent pain" is emphasized. I've never read that before. Hmm.
ess
Oh boy this is a very interesting topic to me!!
Up until I saw my current doctor, a neuro-opthamologist, I was told I don't have any vision issues. My only complaint was an episode of being sensitive to brightness back in November which lasted for about a month. Things like a stark white background on a webpage would seem overly bright to me or a dim room seemed overly dim.
My PCP and first neuro looked in my eyes and both said they look normal.
My current doctor does vision testing as your first new patient exam. The OCT test showed a bit of thinning, but still within normal limits. The VEP test showed normal on my right eye, and an 8 millisecond delay on my left. The doctor said this is enough to warrant further testing.
If this is MS I have, it is the first real flare up. I've had exhaustion issues a few times, but the neurological issues just started in November. I'm waiting for insurance to approve all the MRI's my doctor wants done. I hope those give some answers.
Up until I saw my current doctor, a neuro-opthamologist, I was told I don't have any vision issues. My only complaint was an episode of being sensitive to brightness back in November which lasted for about a month. Things like a stark white background on a webpage would seem overly bright to me or a dim room seemed overly dim.
My PCP and first neuro looked in my eyes and both said they look normal.
My current doctor does vision testing as your first new patient exam. The OCT test showed a bit of thinning, but still within normal limits. The VEP test showed normal on my right eye, and an 8 millisecond delay on my left. The doctor said this is enough to warrant further testing.
If this is MS I have, it is the first real flare up. I've had exhaustion issues a few times, but the neurological issues just started in November. I'm waiting for insurance to approve all the MRI's my doctor wants done. I hope those give some answers.
Mary, thank you for the web reference above. It obviously is not meant for laymen, since it's quite technical, but I think it gives a good summary of how ON is recognized and what its implications are in terms of MS.
I found this section to be quite interesting: ------------
In asymptomatic patients, mild dyschromatopsia, temporal pallor of the optic disc and slits in the nerve fiber layer detected on a routine eye examination are clear signs of the disease. Subclinical cases are also detectable electrophysiologically by delay of the P 100 potential latency on the visual evoked potential test. They are also detectable postmortem, as demyelination of the optic nerve. --------------
It is frustrating for a lot of us that general ophthalmologists seem to know little about ON, and neuro-ophthos are not exactly abundant. Years ago my standard ophtho consulted a big name Hopkins neuro-ophtho on my behalf, and the biggie said he thinks VEPs are a waste of effort and mean nothing. So there we go.
ess
I found this section to be quite interesting: ------------
In asymptomatic patients, mild dyschromatopsia, temporal pallor of the optic disc and slits in the nerve fiber layer detected on a routine eye examination are clear signs of the disease. Subclinical cases are also detectable electrophysiologically by delay of the P 100 potential latency on the visual evoked potential test. They are also detectable postmortem, as demyelination of the optic nerve. --------------
It is frustrating for a lot of us that general ophthalmologists seem to know little about ON, and neuro-ophthos are not exactly abundant. Years ago my standard ophtho consulted a big name Hopkins neuro-ophtho on my behalf, and the biggie said he thinks VEPs are a waste of effort and mean nothing. So there we go.
ess
I have had some eye issues and pain as well, but no damage to optic nerve and VEP results were normal. My neuro said "I don't know what is causing your eye problem but it isn't optic neuritis". That was about a year ago. Now it's back - MRI from last month was unchanged from previous MRI. Could be something else I suppose, but he offered no other possible causes.
This is a good question. I do have Uthoff's phenomenon since my bout with ON a couple of years ago. I wonder if this means that there's a lesion still there. If I get overheated, my vision is blurry and the reds are faded. I also think have a permament black spot in my field of vision as well. I wish this spot would go away, but it appears to be there to stay.
I found the following on the net to be very helpful.
http://www.jandoerffel.de/on.htm
Information about patients with ON converting to full blown MS is on the bottom of the page.
Mary
http://www.jandoerffel.de/on.htm
Information about patients with ON converting to full blown MS is on the bottom of the page.
Mary
Well, I can answer y'alls question based on my own experience. I've now had optic neuritis in both eyes. Optic neuritis in my left eye was my first neurological symptom. It was pretty mild--I didn't have eye pain, but I did have fuzzy vision in part of my visual field that got worse when I got hot. I also had color desaturation. However, all of the tests that I was put through, including VEP, Humphrey visual field, and I think maybe that OCT test (I had to stare into this machine and it scanned my eyeball) were normal.
In fact, my doctor was great because she said that she believed my symptoms, it was just that they were so mild, they weren't showing up on the tests. I had an MRI of the brain and eye orbits, and there was no visible lesion on the optic nerve, BUT I had a brain lesion, which prompted her to refer me to a neurologist. She was a neuro-opthalmologist.
So you can have optic neuritis (she did diagnose me with that) and have your tests show up normal. I just had a mild case. When the neuro saw me, he said the brain lesion was suspicious, so then ordered all of the rule out tests that we are familiar with. At that time I also had left leg numbness (2nd neuro symptom, more than a month apart from the first), and my cervical/thoracic MRI showed lesions, which led to my diagnosis.
Fast forward a few months later and I had symptoms of optic neuritis, but in my right eye this time. I still didn't have eye pain, but this time my entire field of vision was fuzzy. A subsequent MRI showed a nice fat lesion on my optic nerve, and when she examined me, this optic nerve was swollen. My visual field test was abnormal as well. So, I've had optic neuritis in both eyes, one eye did not show any abnormality on the eye tests, and one eye did. So it is possible!
In fact, my doctor was great because she said that she believed my symptoms, it was just that they were so mild, they weren't showing up on the tests. I had an MRI of the brain and eye orbits, and there was no visible lesion on the optic nerve, BUT I had a brain lesion, which prompted her to refer me to a neurologist. She was a neuro-opthalmologist.
So you can have optic neuritis (she did diagnose me with that) and have your tests show up normal. I just had a mild case. When the neuro saw me, he said the brain lesion was suspicious, so then ordered all of the rule out tests that we are familiar with. At that time I also had left leg numbness (2nd neuro symptom, more than a month apart from the first), and my cervical/thoracic MRI showed lesions, which led to my diagnosis.
Fast forward a few months later and I had symptoms of optic neuritis, but in my right eye this time. I still didn't have eye pain, but this time my entire field of vision was fuzzy. A subsequent MRI showed a nice fat lesion on my optic nerve, and when she examined me, this optic nerve was swollen. My visual field test was abnormal as well. So, I've had optic neuritis in both eyes, one eye did not show any abnormality on the eye tests, and one eye did. So it is possible!
Also--- Do all abnormal VEP results mean there was ON, recognized or not? I think other conditions may cause this delay, but I'm not sure.
To make things even more complicated, my neuro told me that if VEP results are abnormal, then an OCT test would be abnormal too, 100% of the time. OCT (Optical Coherence Tomography) looks at nerve fibers in the retina to look for thinning, characteristic of MS.
http://www.sciencedaily.com/releases/2007/10/071015193523.htm
Here, the OCT test is discusssed in terms of MS, but Dr. Peter Calabresi of Hopkins says that other problems can cause this nerve damage.
I find this topic very confusing and would appreciate some help.
ess
To make things even more complicated, my neuro told me that if VEP results are abnormal, then an OCT test would be abnormal too, 100% of the time. OCT (Optical Coherence Tomography) looks at nerve fibers in the retina to look for thinning, characteristic of MS.
http://www.sciencedaily.com/releases/2007/10/071015193523.htm
Here, the OCT test is discusssed in terms of MS, but Dr. Peter Calabresi of Hopkins says that other problems can cause this nerve damage.
I find this topic very confusing and would appreciate some help.
ess
I do have ON confirmed by the MRI. That was my presenting symptom almost 3 years ago, as far as I know. I have nerve damage, blind spots confirmed by a vision field test and nerve testing in my eye, and an abnormal VEP.
I was just wondering if every case of ON leaves a lesion. Sorry to be so confusing.
The last neuro I saw made a big deal out of telling me about some of his patients who have had ON as many as 5 times and have never converted to MS.
I am just really stressed about the situation I find myself in right now.
LA dx'd Feb 2008
I was just wondering if every case of ON leaves a lesion. Sorry to be so confusing.
The last neuro I saw made a big deal out of telling me about some of his patients who have had ON as many as 5 times and have never converted to MS.
I am just really stressed about the situation I find myself in right now.
LA dx'd Feb 2008
Oh, I would assume that would count! I think the cranial nerves are considered part of the CNS, so a lesion there would count. I thought your question was, "If I've had ON would there always be a lesion?" But now I think you mean, "If there's a lesion is it evidence of ON?" I think that's a yes, but Quix should probably weigh in.
I have a lesion on my optic nerve and am wondering if this is always the case or not. Also wonder if that counts in the lesion count when you have a doctor who is counting.
LA dx'd 2008
LA dx'd 2008
I don't think so, at least as far as a visible lesion on MRI, but I'm sure someone will correct me if I'm wrong.
I think like damage to any other part of the CNS the MRI may pick up the damage or it may not. This is why we don't want doctors to "map" the lesions to specific symptoms we're having, because it doesn't always work!
Stephanie
I think like damage to any other part of the CNS the MRI may pick up the damage or it may not. This is why we don't want doctors to "map" the lesions to specific symptoms we're having, because it doesn't always work!
Stephanie
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