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Old 10-05-2010, 02:29 PM
devsmomma's Avatar
devsmomma devsmomma is offline
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Question on Eye sight

Hi everyone,
Have a quick question on eye site. I'm under a possible MS diagnosis until my neuro appt in Dec. I've been having issues with holding my focus on something when looking at it. My eyes tend to go blurry and sometimes the item will double up and i see two of what I'm looking at.

I went to my optometrist today. He put me through a bunch of different tests and he can't find anything wrong with my eyes other than once again needing a small prescription for reading, driving, etc... My optic nerve looks good as far as his test showed and a scan he did on my eyes after dilating them.

He was surprised to find nothing wrong given the problems I've been having especially with the suspicion of MS by my pcp. He gave the strong impression that he didn't believe that I could be looking at MS where I don't seem to have any problems with my eyes that he can find.

I just wondered what everyone else experience is??? I'm more confused now than before..
"possible MS" waiting on Neuro appt 12/13/10
Old 10-05-2010, 04:00 PM
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mjan mjan is online now
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Join Date: Nov 2004
Location: Milwaukee WI
Posts: 2,420
YESS I am and still am having "ghosting" or shadowing which looks like dbl vision. And yes my eye exams over the years resulted in slight RX but it never corrected this kind of dbl vision.

Had the VER test which was normal too.

All some of the docs can think of is the focus problem is due to muscle fatigue. It only gets worse and worse..then it may relent a little for awhile. I notice its worse if I am on the computer long times or TV or in the evening. So it may just be fatigue.

Don't worry cuz they cannot find a test that tells them that. Oh wait, this year, they used the standard eye test on the wall and up close and I could not see LARGE letters/numbers. I was guessing or just could not tell. THAT's how bad it got. They noted it in my chart as I just received my MS dx this year after years of symptoms.

So hang in there.. do a "search" on this site and you'll see lots of posts on this topic.

Good luck with your MS finding journey.

I believe in miracles~!
2004 Benign MS 2008 NOT MS
Finally DX: RR MS 02.24.10
Old 10-05-2010, 05:17 PM
newme newme is offline
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Join Date: Dec 2006
Location: Pennsylvania
Posts: 284
I actually had an eye doc tell me that my optic nerve was thin but the focus problem was not MS. Then my neurologist said she thought he was wrong. Thin optic nerve means damage.

I don't think you have to wait until the damage is visible to have it. Your problem sounds so similar to many others (including mine) that it very well could be the MS causing it.

Like most MS related things, I am torn between hoping it is the MS and hoping it is something that is "treatable". I mean wouldn't it be great if all our symptoms were caused by things like pulled muscles, or need for stronger glasses, or need for a certain vitamin. But nooooo, we are "blessed" with this lovely thing that (as of now) can't be cured. Oh well, hope your vision improves soon!
Old 10-05-2010, 07:50 PM
Redwings Redwings is offline

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Location: California, USA
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Hi devsmomma:
Intermittent problems of any kind are hard to pin down. Have you ever had problems with your car, but when you took it to the mechanic it wasnít doing the funny thing so it couldnít be found? Some eye problems are the same way.

Your simple questions really have some complicated answers. That could be why some of your questions didnít get answered as a result of your eye exam. To give you some perspective about how eye and vision problems are evaluated, it might be helpful to read something I wrote for another poster recently: [url][/url]

First, ďregularĒ eye exams cover many different things, but they donít cover every possible thing that can occur with the eyes or vision. It doesnít matter whether the exam is done by an ophthalmologist or an optometrist Ė there are some things that are ďspecialtyĒ tests and just arenít included. If the preliminary/screening tests come out normal, a decision has to be made about whether or not more extensive testing is necessary. That decision is based on the severity of the symptoms, what the implications of the symptoms are, what kinds of further test might be done and what the benefit of further testing might be.

It sounds like your preliminary focusing and eye movement tests were normal. That indicates that there isnít a pressing need for specialty tests because 1) youíre already being worked up for MS (which includes ruling out other neurological causes) and 2) verifying the occurrence of the problems isnít part of the diagnostic criteria for MS and wonít be used in making a diagnosis.

There are tests that can be done to check how fatigue is affecting your blur and the doubling of vision, but they arenít part of a regular eye exam and usually arenít covered by vision or medical insurance. Theyíre part of what is often called a visual efficiency exam. Optometrists do efficiency exams but ophthalmologists usually donít. Iíve been to many, many ophthalmology practices over the years and have never seen one that does. Ophthalmologists usually forget about visual efficiency as soon as they get out of residency. The exception is neuro-ophthalmologists, who sometimes do similar tests as part of a neurological workup. But again, thatís not a regular eye exam.

Your neurologist might refer you to a neuro-ophth as part of an MS workup. The testing might or might not uncover the effects of fatigue and might or might not lead to recommendations for some kind of management, depending on whatís found. If youíd like to be tested specifically for the effects of visual fatigue, and an evaluation of whether vision therapy might be helpful, your optometrist can do that but youíll have to schedule (and pay for) for that kind of exam. If you do, bear in mind that it will be specifically for the doubling/focus/fatigue problem and not play any part in a diagnosis of MS.

Second, an eye exam can check only for the status of the eyes/vision at the time of the exam. Anything that occurs intermittently then returns to normal canít possibly be found during an exam if the eyes are in their normal state at the time. A prime example of this is an intermittently dry eye that occurs under specific circumstances that arenít present at the time of the exam. Dry eye (intermittent or permanent) is the #1 cause of transient blurriness and affects every human on the planet at one time or another.

When weíre concentrating on something -- reading and computer work are the most common times -- we forget to blink. When we donít blink, the tear film on the front of the eye isnít refreshed and the optics degrade, leading to blurry vision. When the eyes blink properly, the tear film is refreshed and vision clears back up. In an eye that isnít prone to dryness, the front of the eye will look normal at the time of an eye exam. This temporary kind of dryness is the primary suspect for people who notice blur mostly (or only) when theyíre doing something that takes concentration, like reading or working on the computer. Itís very common in Computer Vision Syndrome.

Itís entirely possible that at least some of your blur is coming from this type of intermittent dryness. If your tear film and front of the eye appeared normal at the time of the exam, there would be no way to detect intermittent dryness and no way to confirm that itís causing intermittent blur. That being said, itís also possible that you have borderline dryness that the optometrist overlooked. One way to help pin this down is to see what happens to your blur when you blink. Next time you get blurry after looking at something, try blinking five or six times. It things clear up after a couple of quick cycles of blinking, it indicates that at least some of the blur was caused by a faulty tear film.

There are some perceptual things that could be leading to some of your blur and doubling, but those generally arenít tested for outside of clinical research. Unless they showed up during the eye exam, there isnít any way for them to be detected.

A third factor that leads to confusion about whatís causing vision problems is a combination of in misunderstanding anatomy and physiology, incorrectly attributing a cause to parts of the visual system that arenít involved, and not connecting symptoms to the parts of the visual system that are.

For example, your optic nerves look normal (which is great!). But the optic nerve isnít involved in double vision -- it has no motor function and doesnít contribute to the optics of the eye. Judging double vision by the appearance of the optic nerves is like judging how well the brakes on your car work by looking at the headlights. They arenít related.

Optic nerves may or may not be involved in transient blurry vision. Theyíre not involved in the kind of blurry vision you described, which is the kind that comes with looking at something with concentration. And again, because theyíre not involved (thereís too much detail to expand on here), what they look like is irrelevant, even if they look normal.

The optic nerves and brain are involved in other types of blur, but 1) those arenít the type you described and 2) these types canít be determined from optic nerves that appear normal. That means that those types of blur canít be determined from a regular eye exam. Thatís how your eyes can look normal during an exam but youíre having those symptoms Ė itís because some parts of the visual system that are involved in the problem arenít evaluated as part of a regular eye exam. The cause of those kinds of blur are evaluated with test like MRIs and VEPs.

Another example of this Ė and itís the most common misunderstanding about vision Ė is confusing optical problems that come from refractive error (the need for glasses) with optical problems that come from physical problems affecting the optical components of the eyes, and from neurological problems that interfere with nerve signal transmission or processing. Glasses canít correct blur/ghosting/doubling that comes from cataracts and tear film/corneal problems (such as those that frequently accompany dry eye). Glasses also canít restore vision lost as a result of optic neuritis or demyelination in the visual pathways of the brain. Thatís how you can have intermittent blur/doubling that glasses donít correct Ė the problem isnít coming from refractive error.

A corollary to the ďmisattributionĒ situation is one in which only preliminary or limited testing is done, and it becomes a big mystery about what the cause is. This situation is identified by a doctorís inability to pin down a problem after only a couple of tests or when a person canít describe their problem in more that just vague terms. The source of the majority of visual problems can be determined if the appropriate tests are done and interpreted correctly.

So I hope that sheds some light for you Ė and anyone else whoíd like to better understand about how vision relates to symptoms and diagnosis Ė about why eye exams do and donít supply certain types of information and why they can leave some questions unanswered.
Old 10-05-2010, 08:09 PM
Redwings Redwings is offline

Join Date: Mar 2009
Location: California, USA
Posts: 2,438
Some neurologists should stay behind the optic nerves...

Originally Posted by newme View Post
I actually had an eye doc tell me that my optic nerve was thin but the focus problem was not MS. Then my neurologist said she thought he was wrong. Thin optic nerve means damage.
Hi newme:
Your neurologist was correct that thin optic nerve tissue indicates damage. But she was incorrect to second-guess the eye doctor and attribute your nerve damage to MS, because that isn't how MS works on optic nerves. MS causes [I]pallor[/I] of the optic nerve long before it causes visible thinness. If you do more research you'll find that [I]visible[/I] nerve thinness without pallor isn't a trait of MS. (This is should not be confused with the microscopic thinning of the retinal nerve fiber layer found in people with MS.) Your eye doc was correct in suspecting other causes first, your neurologist was wrong.

I've been to several neurologists over the years and have been both amused and horrified by what they didn't know about eyes and vision. One after another of them looked at my seriously atrophied (cupped) optic nerves (due to NMO) and told me my eyes looked just fine.

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