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Optic Neuritis vs. Glaucoma??
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Optic Neuritis vs. Glaucoma??

Does anyone know if there is a way to tell if damage to the optic nerve is done by glaucoma or MS?   I saw a new optometrist a couple of days ago, and I told him I was having off-&-on blurry spells, esp. with the left eye, and having left eye pain.  I've had these spells before.  Also, I'm having numbness in my chin and periodical tingling in my face, teeth and nose.   Have been given MRI's 2 yrs. ago, for suspicion of MS (in an "open unit") and they were clear.  

When he did complete all the testing, including a "snapshot" of my optic nerve, he said that I had high intra-occular pressure (20 in left, and 22 in rt), "notching" on the optic nerve head rim, and mass tissue build-up on the back of my eye.  Someone with MS said that they too had the "notching' on their optic nerve head rim, and that her neurologist & ophthamologist told her it was from Optic Neuritis.  My optometrist said he didn't see any evidence of "optic neuritis."  Again, my question is, does anyone know how can they tell the difference??    Thanks.  ;)
~tj
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8 Comments Post a Comment
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147426_tn?1317269232
Hi, there.  I actually do not know the difference.  I would encourage you to see an actual opthalmologist to evaluate the elevated pressures in your eyes.  You need to be under the care of one anyway if there is a suspicion of glaucoma.  An Optometrist is NOT trained to treat this kind of eye problem.

We have an Eye Expert Forum and you might ask this question of the doctors there.

http://www.medhelp.org/forums/show/90

Let us know what you find out.

Quix
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763858_tn?1234815337
Thank you quix, I'll do.  ;)  
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Avatar_m_tn
If you don't know the difference; then how in the world would you know what treatment entails.  Optometrist's ARE trained to recognize the difference between glaucoma and optic neuritis.  

There are different types of optic neuritis, depending on what part of the optic nerve is inflammed.  If the anterior aspect of the nerve is inflammed, then optic disc swelling will be present; if the inflammation is retrobulbar (behind the eyeball) then the disc will not be swollen and often presents with painful eye movement.  Pallor of the disc is another sign of neuritis.

As primary care providers, optometrists often the first provider the patient will encounter; so understanding the manifestations of multiple sclerosis in the eye and appropriate referral is crucial.

More appropriately, the question should be more how to differentiate between optic atrophy secondary to MS vs. normal tension glaucoma.  Seeing as you've been tested for MS before and the results were negative, I doubt you have had any substantial neuritis to facillitate atrophy.  Your age and ethnic background can also help shed light on the diagnosis.  It is still important for you to follow up with a neurologist if you believe you are having symptoms of MS, however, particularly numbness and tingling!
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987762_tn?1331031553
Hi and welcome,

I'm not sure if you realise it or not but you have responded to a very old post (feb 2009) and although your information was informative, it actually came across as a little defensive or hostile and i'm sure you didn't intend it to be. Eyes issues in MS are common discussions and i'm sure you will have a lot of really informative things to say, so again welcome!

No offense to you and your training, but if an optomitrist even suspects ON or glaucoma wouldn't the right thing for the patient be to refer them to a more qualified professional, such as Quix suggested an Opthalmologist or go one better if ON is suspected refer them to an Neuro-opthalmologist?

A common problem for members seems to be the information they are getting from optomitrists, for example I personally have adult acquired nystagmus, diplopia, pale optic disk with normal pressure on top of the probable dx of MS and the optomitrist 'suspected' the pale optic disk was possibly early glaucoma and requires no treatment because of the normal pressure. Even I know its more likely to be ON than the rarer condition of glaucoma with normal pressure.

So please believe me when i say not all Optomitrists are trained well enough for the issues commonly seen in MS.

Cheers.......JJ
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Avatar_n_tn
"supermum_ms" please note the correct spelling of "OPTOMETRIST"!!
If you are going to make comments on Optometrists at least get the spelling right.
Plus for your information Optometrists are highly trained in detecting ocular diseases. Optometrists have to spot early signs of diseases which are often very subtle hence the need for extensive training. An Optometrist must then refer to an Ophthalmologist who deals with the treatment side.  
I hope this post does not come across to "aggressive" for you and I hoped I improved your spelling.
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1453990_tn?1329235026
Actually, Supermum_MS is in Australia and I think they use the en_UK spelling, so you may need to understand that this is an International forum, and there are variation in accepted spellings.  

Bob
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1453990_tn?1329235026
ps:  I noticed I missed the "s" on "variations."  This forum doesn't let us edit our posts, and many of us have vision, cognitive, and small motor function issues, so we are kind of used to "forgiving/accepting" errors in spelling, typing, grammar, etc.  Here, it really is the thought that counts.

Bob
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1447542_tn?1318030681
Wow. Just wow. Spelling police are not necessary, or needed, on this forum.
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