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Optic Neuritis question
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by lydia231, Oct 16, 2010
Last year I had a feeling of pressure behind my right eye.  Sometimes it was so severe there was pain and it felt like my eye was being pushed outwards.  My eyesight was very blurry in that eye. The symptoms lasted for several weeks.  I was seen by an Opthamologist, but after he looked into the back of my eye said he didn't see anything.  He said my vision was weak in that eye and suggested eyeglasses.

The symptoms went away after several weeks. I decided not to get glasses because I felt that was not the problem.  Whenever I have severe fatigue and depression my vision becomes severly blurry.  Does this sound like I may have had Optic Neuritis?
Thanks
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Member Comments (24)
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by LATW, Oct 16, 2010
Do you have a diagnosis?  Do you have other MS symptoms?
If not, you do need to get glasses and start there.  When I first had Optic Neuritis my eye doctor saw nothing in my eye that suggested ON.

He told me my eye problem was due to aging.  I already had glasses at that point. He told me to go home and wait to see what happened.  

I waited about 7 days and just knew something was not right so I went back to my eye doctor and he sent me to a Neuro opthamologist.  That eye doctor sent me in for an MRI because he couldn't even see the ON.

The MRI showed ON.

So, my point with saying all of this is Jump The Hoops.  If the doctor feels you need glasses, you need to get them.  

If your vision is still a problem go back to the eye doctor and ask him to send you to a neuro op.  

LA dx'd feb 2008


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by COBOB, Oct 16, 2010
The biggest joke in ophthalmology is: "Patient walk in and says I don't see anything from my left eye.  Dr looks in left eye and says I don't see anything either.  Must be Optic Neuritis."

If you have retrobulbar ON, the Ophthalmologist  should see indictions in the optic disk.  If it is back in the depths of the cranial nerve, the only way to detect it is a VEP or an MRI of the optic nerves (and the MRI is a big maybe.)  There is a lot of optic nerve that can be effected and most of it is inside your brain.

In my case, my exam was normal, but my VEP had decreased conduction velocity and amplitude with a well maintained waveform consistent with Optic Neuritis.

Bob

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by Quixotic1Blank, Oct 16, 2010
Everyone on the forum remember that 64% of people with Optic Neuritis have a normal eye exam.  However, it seems few of the Ophthalmologists seem to know this.  We have even heard Neuro-Ophtho's state that a normal fundoscopic exam means no optic neuritis.

Bob - you got it slightly backwards or it was a misprint.  If the ON is bulbar, that is involving the part of the optic nerve that has already reached the eye, there is usually (but not always) some sign on exam.  In Retrobulbar Optic Neuritis the lesion is back behind the eye on the optic nerve, and typically NO change in the optic disc will be seen in the acute inflammation.

He is right.  If the symptoms suggest optic neuritis, and the exam is normal the next step would involve Visual Evoked Potentials (VEP), visual fields testing, color saturation testing, and/or an MRI which focuses down on the optic nerve.  Remember that a common symptom of optic neuritis is loss of color vividness in that eye.  Colors may seem washed out.

Eventually, if the damage to the optic nerve is severe enough, the optic nerve will atrophy and this can usually be seen on exam or with OCT.

Quix

In my case, I never had symptoms of ON, but on testing with OCT (Optical Coherence Tomography) I have measurable atrophy of the optic nerve on the left and borderline on the right.  Both of these are too slight to be seen on exam, however it is proof that I have had some optic neuritis in the past - apparently without symptoms.

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by kelly97, Oct 16, 2010
Do you usually need to ask for an VEP test or should the neurologist or opthamologist offer it to you? I've never had one.  

They didn't see my ON on my brain MRI. But since it takes so long to get into the neuro here (4-7 months), my brain MRI wasn't until 4 months after my ON presented.  

Lydia, the symptoms that you are having sound very strongly like ON to me.  Like LA, I was also wondering if you had any other MS type symptoms.

When I switched to a new neuro, he saw the moderate/severe APD (afferent pupillary defect) in both of my eyes and the pale optic discs. Plus, a visual fields test showed a handful of central scotomas in both of my eyes.

Good Luck,
Kelly
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by Quixotic1Blank, Oct 16, 2010
In Kelly's post, the key phrase was "When I switched to a new neuro..."

Yes, Lydia, those symptoms are characteristic of optic neuritis.  Does your eyesight also become bad when you get overheated?

Quix
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by COBOB, Oct 16, 2010
The big issue with ON it that the typical Ophthalmologist can only se retrobulbar inflammation. A Neurologist or Neuro-Ophthalmologist will typically order a VEP if there is a suspicion of ON.  When I had ON (Neuro Attack #1) the Neuro-Ophthalmologist ordered the MRI and VEP at the same time.  He also did a pretty complete Neurologic Exam so he could start a diagnostic timeline.

Even though a regular Ophthalmologist can order the VEP they lack the neurodiagnostic training to evaluate it.

Bob
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by COBOB, Oct 16, 2010
Yes I meant disk changes in bulbar.  My brain and finger don't alway connect to well.  I get the joy of going back and rereading posts that should have had better editing.  I had retrobulbar ON.  

One of the key things Quix said was an MRI focusing on the optic nerves.  That is not the same MRI of the Brain done with the MS protocol.  There are special sequences called Long Echo Time Short Tau Inversion Recovery that are typically used for imaging the optic nerves.  

This is a study I would not want done in an imaging center.  If it was me, I'd head to a teaching hospital with a 3 Tesla magnet and a large neurosurgical/neuro-oncology program.  They do a fair share of this type of imaging  
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by risnerrose, Oct 17, 2010
As far as "needing glasses" . . . I had a similar incident, but I did get the glasses.  When they came in two weeks later, I couldn't see a thing with them . . . my vision had improved by that point.  Fortunately, I am able to rely on over the counter reading glasses.
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by COBOB, Oct 17, 2010
My Neurp-Ophthalmologist says wait 6-9 months after ON before having a new refraction done.   In most people, the vision will improve of that period of time as the nerve remyelinates and repairs itself.  Also, glasses will only correct vision issues with the eye itself.  If you have visual field defect or monocular double vision due to nerve damage, glasses will not correct this.

Bob