Loss of vision is among one of the more frightening symptoms of multiple sclerosis. The facts will help reassure you.
It 's nice to know when the world around you is dimming, doubling or dancing erratically that the frightening condition is very likely to be temporary. Or at least will improve considerably before stabilizing Although nearly half of those who develop multiple sclerosis can expect to experience vision problems sometime during their lives, improvements in visual impairment - either spontaneous or with treatment - are very common with many MS-related eye symptoms, according to Dr. Robert M. Herndon, director, Center for Brain Research, University of Rochester (N.Y.) Medical Center. "In a number of cases, vision returns to near normal," the neurologist stresses.
Vision specialist Robyn Fillman, of Children's Hospital in Columbus, Ohio, points out that "even total blindness almost always improves." "The nervous system can do much to repair itself, and the individual can help improve visual function with practice."
The three most common eye disorders are optic neuritis, or inflammation of the optic nerve; diplopia, or double vision; and nystagmus, an involuntary jerky movement of the eyes.
Optic neuritis is a frequent first symptom of multiple sclerosis, says Dr. Herndon. "It usually begins with a loss of vision in one eye. The problem begins near the center of the visual field and spreads toward the edges.
"Although total blindness occasionally results, considerable recovery usually can be accomplished with treatment." By treatment, Dr. Herndon is referring to ACTH and oral steroids, which are anti-inflammatory agents.
He adds that optic neuritis also can produce blind spots in the field of vision (scotomata), blurriness, color blindness or difficulty in seeing objects either with poor contrast, or those in very bright light.
Diplopia, or double vision, is another very common symptom of MS. It occurs when the two eyes do not move together in a coordinated fashion. The eyes are not seeing the same thing at the same time. In double vision, the nerve fibers disrupts the mechanism that coordinates the movement of both eyes. "Almost invariably, double vision improves after a few days or a few weeks," Dr. Herndon says. "Usually the eye movements improve, but if they don't, the brain compensates by suppressing the visual image in one eye. If the problem persists, the individual can accomplish the same thing by covering one eye with a patch."
A third MS eye disorder, nystagmus, causes jerky eye movements and makes it difficult to focus on a particular object or point. Dr. Herndon says nystagmus can cause a "sensation of movement or blurring, and when it develops rapidly, it can be accompanied by dizziness. Improvement usually occurs within a few weeks."
He points out that while multiple sclerosis vision problems can present themselves clearly and sometimes dramatically, in other cases they can be mild and subtle. In cases where a positive diagnosis of MS has not yet been made, identifying optic neuritis and either double vision or nystagmus, can be a strong indicator of MS. "Any new vision problem is good cause to see your neurologist or ophthalmolo gist," Dr. Herndon says. "There are a number of painless tests that can help explain a visual symptom."
Once the problem has been identified, is there anything you yourself can do to hasten recovery or minimize eye damage? "There used to be 'sight-saving' schools for the blind," Robyn Fillman, who volunteers her services to the Mid-Ohio Chapter, says, "because doctors thought sight was something for the visually impaired to conserve. Now we understand that, in general, the more you use your eyes, the better you can see. We recommend that people with MS-related eye problems go to low-vision clinics, which are usually located in university optometry schools or in state rehabilitation agencies. There they learn to use what sight they have more effectively."
Low vision clinics demonstrate the effectiveness of outlining doorways, steps and other edges with high contrast markings for those whose contrast or oversight is reduced. Wearing yellow-tinted sunglasses also improves contrast. The colorblind are taught to notice patterns instead of colors. Traffic lights, for example, are arranged from top to bottom: red, yellow, green. Seeing the color itself is not necessary.
For those who have an impairment of either central or peripheral vision, low vision clinics give instruction in how to see better through the part of the field of vision that is still clear.
Besides eliminating double vision with an eye patch, Robyn Filiman suggests wearing an inexpensive Fresnel prism, which bends the light of vision. The prisms can be replaced if the eyes change.
Robyn doesn't recommend taking the trouble to learn braille. She says people with MS rarely have such poor vision that they cannot make use of one or more of the many optical aids available today. Braille, she explains, is not only difficult to learn, but difficult to buy and hard to find. In addition, people with MS often have a reduced sense of touch, which is essential in reading braille. Materials in large print and recorded books are available from the American Printing House for the Blind and the Library of Congress. There are also many different types of magnifiers on the market. Tape recorders as well as talking calculators and computers, which are constantly being improved, bypass the sight process entirely.
Many of these aids can be expensive. You may, however, qualify for disability income. Partial vision is defined as the range between 20/70 and 20/200 in the better eye, with correction. legal blindness begins when vision is less than 20/200 in the better eye with correction, or when your visual field is 20 degrees or less. Even if you do not qualify for disability payments, many state rehabilitation agencies will assist you in getting visual aids and training in their use if you can prove that you have some visual impairment. "It would be tremendously helpful, though if the diagnosing physicians themselves could become an additional resource," Robyn says.
On a final note, Robyn cautions, "You will see better on some days than others, because vision is affected by heat, lighting, illness, fatigue, training and your emotional state. But," she urges, "use your remaining vision and feel confident that you will not lose all of your sight. Most people don't."
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