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Optic Neuritis questions
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Optic Neuritis questions

A few years ago, during my first go-around with docs, I had an VEP done which said there was a problem with the right eye.  I was experiencing sharp pains in that eye and had times when the eye was blurry(lasting a few hours at a time).  The docs I was seeing at the time really wouldn't address it.  The opthomologist told me there was nothing wrong with the optic nerve.  Three years later, this March, I saw the opthomologist again and asked her about the optic nerve.  I was still experiencing sharp pains in that eye.  The pain only lasts for probably under a minute.  She said, again, that there was nothing wrong with the optic nerve and that I probably had some sort of 'eye neuralgia'.  
When I saw my new neuro, this April, his report says, "Subtle right optic nerve head pallor on funduscopy" I still have occasional sharp eye pain and one blurry vision event in the right eye lasting 6 hrs.  
I've been told that if it was ON, (by another person with MS, not a doc) that I would have pain all the time.  
I was surprised by my new neuro's report as I'd been to the opthomologist only a month before and she said 'no problem'. I don't know if there is a ON problem...I'm confused as well as being depressed by all of this.  Please comment. Thanks
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147426_tn?1317269232
Hi, I can answer this pretty quickly.  The ophthalmologist you saw intially who said there was no problem because the optic nerve look good was uneducated.  In optic neuritis (which is caused by a demyelinated area on the optic nerve), the optic disc looks normal on the exam in about 60% of cases.  So, when the ophtho looks in your eye and says it looks good, that just means that any lesion is farther back.  It does NOT mean that there is not optic neuritis.  She should have known this.  It is not a hidden fact.

The VEP was abnormal because you had a lesion.  You had symptoms suggestive of optic neuritis.  And now the optic nerve looks pale.  This is indicative of some atrophy (thinning out) of the nerve - probably because you have had several bouts of optic neuritis.

The person who told you that people with optic neuritis have pain all the time is wrong.  For people who have symptoms with their ON, the pain may only be with attacks.   Others can have ON with any pain at all (subclinical) and others fall in between.

From your history I suspect that you have had optic neuritis shown by the VEP and that the neuro is correct.  My recommendation would be to dump the ophthalmologist and find a new one, preferably a neuro ophthalmologist.  A repeat VEP would not be a bad idea, as would visual field testing.  Also, OCT might show if there is true optic nerve atrophy.

Does this make sense?

Quix, MD
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505094_tn?1240321031
Thank you so much for responding.  Everything you said is what my gut has been saying, but I've been an emotional mess lately and so I haven't been trusting myself very much.  I will talk to my new neuro about a repeat VEP and the OCT...and definitely get a new opthomologist.  I'm also going to look into antidepressants. I definitely think it's time to stop pretending I'm not depressed about all of this.  Thanks so much again, Charley.
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751951_tn?1406636463
So, does ON ALWAYS produce an abnormal VEP?  I've had repeated bouts of nasty pain in each eye (though mostly the right) and the several funduscope exams have shown nothing unusual, and my only VEP was normal.  If it's not ON, what else would/could produce symptoms of this type?
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If Quix doesn't get back on this one, try posting on the Eye Care Forum. I mean the regular one, not necessarily the Expert one. They seem to have lots of knowledgeable doctors responding, and fast.

ess
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751951_tn?1406636463
Thanks, ess.
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620877_tn?1282767697
If you get an answer to your question - can you let us know what they say?  I am curious!

I had a VEP which was normal - but about a month later had my first bout of blurry vision - neuro #2 saw "pallor of the left optic disc" which is I think why he ordered the VEP.  I hadn't had any blurry vision prior to the VEP though, just some eye pain.  So I have always been curious about this.

Thanks,
Chrisy
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I know that you can have abnormal VEP and then they can become normal.. so I guess if you have your VEP way after symptoms have subsided etc. you could get a normal result.  

I have two VEP that was abnormal and then the latter ones have been normal but they still reckon I had Optic neuritis, but a long time ago so perhaps new nerve pathways have been found?  I don't think VEP are totally full proof for ON either but don't quote me on that.

Udkas.
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