Optic neuritis - extended episode

[DeesBee]

A friend of mine has been diagnosed with optic neuritis.  It was brought on by exercise over the summer.  It started in August, and he still has not had any significant improvement in his vision.  It is effecting one eye.  He was diagnosed by a neuro-opthalmologist.  He had a minor episode last year, had an MRI, and it was normal.  Is it normal for an episode of optic neuritis to last this long (going on 4 months)?  Is there anything that can be done (other than steroids) to stimulate improvement?  Or are there other things we should be checking for?  Any info would be appreciated.  Thank you.

[DeesBee]

Bob,
Thank you for the information!  We've been seeing a neuro-opth and will be going back to her in a month or so.  He's had a VEP and there is indication of some damage.  He's prepared for not getting back to 100%, but will appreciate any improvement to the current situation.  Thank you again -

[DeesBee]

Thank you for the information - we will wait and see and be encouraged by others.  Thanks again -

[COBOB]

The Optic Neuritis is the inflammation of the Optic Nerve.  The typical cause for the inflammation is demyelination of the nerve.  The after effect can last for months or be permanent.   While we say "Optic Nerve,"  that actually refers to potions of the Optic Nerves (2,) Optic Chasm (1) and Optic Tracts (2) that end in the Optic Cortex of the brain.

A VEP measures the Timing form the stimulus through the eye to the Optic Cortex.  Anywhere along the path damage can occur.  The inflammation typically goes away quickly.  Sometimes IV Steroids speed that up.  If the nerve demyelinates, the body may repair it.  That can take months.  From what I have seen, most people that have ON with VEP changes never get back to 100% of what they had before ON.  The VEP can detect damage and latency years later.  Sometimes neural plasticity comes into play and the brain learns to compensate for signal delays.  

Now the part that throws folks is that glasses and contacts help with refractive errors of vision, but corrective lenses do not help for problems with nervous system vision problems.
Once you have had optic neuritis, you need to see an Ophthalmologist or Neuro-Ophthalmologist.  They have to be able to separate the the refractive errors from the nervous system issues when trying to correct your vision.  Certain issues with depth perception and monocular double vision may not be correctable.  

Bob
  

[huff1711]

When I had my first optic neuritis in my left eye, it lasted for over 7 months. To this day it's still about half of what it was, and I was told it probably will never get better.... but there is a chance it will, it's just a wait and see kind of thing.

[COBOB]

In the acute phase of optic neuritis (ON), IVSM can provide some benefit. The problem is that the nerve is demyelinating.  I doubt that this was really brought on by exercise, but it is possible that exercise made an existing demyelination event worse.  IVSM tries to stop the demyelination.  Once the damage is done, there is nothing for IVSM to stop.  Sometimes the body will try to remyelinate the nerve.  Sometimes it doesn't.  Most ON patient regain some of their vision in 6-9 months post attack.  Some patients have multiple attacks of the same nerve.  This is really territory for a Neuro-Ophthalmologist. MRIs can images the Optic Nerves and Optic Chasms but are limited to looking at the width and size of the nerves.  To test the conduction of the nerve and evaluate the level of damage, VEP is pretty much the standard.

Bob