cerebellum., vision and eye doctor questions

[RedTalon]

Alright I had some questions about this part of the brain, I know it affects balance and the like. But been doing some reading and talking, and saw that it can play a part in vision problems has well, now is this true and in what way can it?

I been noticing some visions problems since the end of my last flare had some before it ended also. I do have a visiit to an eye doctor this month, but haven't been to any eye doctor since I was a teenager, so not sure how these visits work anymore, the person who set up the visit said because I have ms they are going to refereal to a neuro eye doctor to cver bases after the visit, so what can I expect from both types of eye doctors and what information should I give?

The main thing is with the vision problem depending on the day my vision is either worse or bad, and depending on what I have been doing, the problem gets worse. Like I wake up the problem is basically not there its there a little depending on how restful a night I have had, now lets say I go down a long hallway using my walker and the hallway has bright lights, by the end of the walk I am tired, and my vision is blurry, you know like a tv with alot of static on it, can see just not the fine details. I am not sure if eye problems can be related to ms fatigue or not, and wondering if anyone has the same problems.

Sorry for any typos and errors.

[Redwings]

Hi Warren:
Vision is extremely complex, which makes your questions both easy and difficult to answer. One of my bachelor’s degrees is in Visual Science, so I’ll take a stab at them.

Vision is a process that involves:

• the physical tissues (anatomy and physiology) of the eye itself
• geometric and physiological optics
• the anatomy and physiology of the brain
• the neurological processes that transmit light from the eye to the brain, turn the signals into a visual picture, give psychological meaning to the pictures and plug those signals and meanings into other parts of the perceptual system
• the relationship of these physical parts to the other systems in the body(such as circulatory and immune systems and effects of other diseases and medications).

Part of figuring out a problem in vision is to isolate the problem to a particular part of the process. That’s how answers are either simple or complicated, and why the term “vision problems” is too vague to address on its own.

Here’s an example of why some questions are both easy and difficult to answer. You asked specifically about the cerebellum and also mentioned that your vision gets blurry and full of static. They way you’re describing the blur, the answer is no, the cerebellum is not involved in that part of vision. However, it can be involved in some other types of blur based on how the “balance” part of perception transmits signals to and from other parts of the perceptual system.

The blur you’re describing is common in people with MS, but that blur comes from other parts of the visual process and different parts of the eye and brain.

The general eye exam you’ve been referred for will look at the physical health of your eyes themselves. If performed by an ophthalmologist, the exam usually, but not always, includes a refraction to check the optics (refractive error) of the eyes. (Comprehensive exams by an optometrist always check refractive error, plus some other “visual performance” aspects ophthalmologists often don’t check.) They physical exam evaluates the eyes themselves from the eyelids back to the optic nerves. The refraction accounts for any part of the blurriness that’s due to regular optical blur and isolates optical blur from blur caused by a physical problem in the visual system.

The general eye exam does not continue into a more extensive evaluation of the “brain processing” part of vision. That’s what the neuro-ophthalmologist does, and why you’ve been referred to one. The neuro-ophth is a kind of super specialist who is concerned primarily with the parts of vision controlled neurologically and will usually not check the general eye health or optics if that’s already been done during a general eye exam.

As far as what to tell the doctors, you will, of course, supply a medical history, which includes any health problems – including MS – and all of the medications you’re taking. On top of that, describe anything you’re experiencing with your vision, describing what happens and when.

It’s also important to bear in mind what your expectations of these visits are. Some visual problems can be fixed, some can’t. Some can be compensated for, some can’t. The blur and fading of vision from MS damage and fatigue can’t be fixed, so the neuro part of the exams that cover that will be more for documentation.

Some of the tests you’ll be asked to do might be difficult. That’s OK – just do the best you can. There isn’t anything you’ll be asked to do that’s worth getting anxious about.

At the end of the exams, your eye doctors should summarize for you what they found, what it means, if any treatment or management is recommended, and when they want to see you again. Pay close attention to this part and ask questions about any of those areas that weren't covered or weren't covered in enough detail. It would be nice if you could have specific questions prepared in advance, but that's not often possible because specific questions have to be based on what the doctor tells you at the end of the exam.

Research has shown that most people forget about half of what was said to them during a medical visit. When it comes to eye exams, that seems to be particularly true. (Even on this forum, people have posted things that they believe their doctors told them that are anatomically impossible and/or just don't make medical sense.) So, if you can, it would be a good idea to have someone go with you to the exams who can take notes and ask questions, too.

[RedTalon]

Thanks, Redwings.

Thank you, Redwings.

I was getting super nervous but you helped answered some of my questions, and explained somethings nicely I was getting confused by.

The ON Queen Gets on Her High Horse

Urgh. I really need to know if all the people who get ON just get blurry vision. I sure would like to know what the _____ I have cause nobody seems to have my symptoms which were way beyond "blurry vision". I keep searching everywhere to find somebody who went through what I went through. Shall I try one more time to summarize?: Palm Springs 1999-start seeing flashes and fireworks in vision -- doc says episcleritis and vitreous detachment (both were wrong says big doc at UC Davis). After moving somewhere even hotter (desert Sierras) and walking strait up mountains all day in heat -- 3 nights of hideous headaches and I wake up with knowledge that I can't see out of left eye. It gets worse and I start to not be able to stand light or heat extremely much.

I discover I can't see light is the basic problem in left eye. right eye gets small patch. In other words: if i look right at the sun I do not see it. also severe afferent pupillary and numbness in eyeball; eye closes in light; bell's palsy in left side?; episodes of it severely changing and cavorting my whole vision around; memory loss; trigeminal neuraligia; totally numb and burnign left thigh, etc. Lost depth perception; visual memory; can't get feet off ground or barely walk; have to cut clothes off; can't see inside of anything like purse or box; especially can't see the floor right. Am working on something and can't see some small part of it although I know it is on table cause I just had it. electric tears and urine. flunked all opthalneurology tests including fly. (fly test...anybody know that).

SUPREMELY IGNORED BY NEXT DOCTORS AND ALL AROUND ME EVEN WHEN I SHOUT "HELP I'M BLIND". Okay so I wasn't totally blind was effectively blind darnit. Quit splitting hairs about my symptoms please. And this has gone on since 2001 but in a state of constant slow improvement. urgh. sorry. But is anybody else's case as long and sick as this. Please let me know I am tired of being alone.

**Post broken into paragraphs by Moderator for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print.**