Visions Issues

[daisy.girl]

I had a mild case of ON in Feb 2010.....at least by the time I got to the ophthalmologists office. I had a mild afferent pupil defect and mild color loss and mild visual field loss in my right eye. However, my optic nerve looked normal. I went secondary to blurry vision, double vision and dimness of vision. This was my right eye.

I have dealt with blurry vision almost continually and occasional double vision since Feb 2010. Recently, I have noticed pain in my Left eye, blurry and double vision.

I went back to the same Ophthalmologist, and he tested everything. Both eyes showed mild color vision loss and mild to moderate visual field loss, but no afferent pupil defect this time. He said both of my optic nerves looked normal.

He told me I did not have ON because both eyes were affected....he said more likely is a brain lesion effecting my vision.

Questions:
Can you have ON and the optic nerve look normal?

In my situation, could the 'both eyes this time' just mean that my right eye still has effects from the ON last year, and that my left eye is being affected now?

I ask him about the OCT (Optical Coherence Tomography) he said that the visual field test showed him the same thing??

Does anyone else suffer with almost constant blurry vision and decreased acuity?

[jazzgirl]

Hi daisy.girl,

I'm not an expert, so take this for what it is....my story.

My second episode of optic neuritis had me presenting with something called a Marcus-Gunn defect. The ophthalmologist was all excited because he apparently didn't see something like this too often. My vision was also slowly decreasing in my left eye due to a central scotoma. In other words, LOTS of problems!

I was told then, however, that they can't visualize the optic nerve itself by an exam alone. I took the color test, and my color vision was decreased. What I had was a known problem associated with optic nerve damage, but the only way he could see it was via the MRI, with concentration on my eyes. The lesions were there (2 of them). The eye exam itself cemented that I did have the Marcus-Gunn afferent pupillary defect. I learned a lot of new words that day back in 1993.

My vision was pretty severely impaired at that time, but believe it or not it came back for me! I can still see fine CLOSE UP, but forget about distances! The pupillary defect never returned after that one time, although I have had diagnosed optic neuritis on three other occasions.

May I ask you a question? Are you presently taking steroids? They ALWAYS messed with my vision!!!

[daisy.girl]

thanks for your reply...

no, I am not taking steroids.

Marcus Gunn defect is the same thing as Relative Afferent Pupillary defect. That is what I had in the right eye back in Feb 2010. He did not see it this time though.

He dilated my eyes, and was able to look at the optic nerves....that is when he told me they looked normal.

[jazzgirl]

Sorry I couldn't be of any help to you (and I did know they were the same thing). BTW, my eyes were always dilated during an exam. I think that's SOP.

I believe, FROM WHAT I'VE BEEN TOLD, that your optic nerve will show damage if you're having an episode of optic neuritis. Perhaps a re-activation of old damage?

Hope you start to recover soon...

[salamandertom]

Questions:
Can you have ON and the optic nerve look normal?

In my situation, could the 'both eyes this time' just mean that my right eye still has effects from the ON last year, and that my left eye is being affected now?

I ask him about the OCT (Optical Coherence Tomography) he said that the visual field test showed him the same thing??

Does anyone else suffer with almost constant blurry vision and decreased acuity?

No - "both eyes this time" could not mean that your left eye is being affected this time. What he was saying is that your lesions in your *brain* are causing the vision issues you are having right now. There are optic nerves that run to your eyes - two of them. One to your right and one to your left. These cross and then go to the opposite sides of the brain. Now you are correct - you do NOT have to *see* a lesion for there to be a lesion. They never saw a lesion for my ON on my right eye - but I certainly had one. I have permanent damage in my right eye from that ON incident in November '10. Before MRIs that is how they *knew* of lesions in different areas - stuff like that that points to a particular area. ON in right eye = lesion on right optic nerve

So you have a lesion somewhere in your brain that is affecting your vision and I should know which and I am sure someone will tell you which area.

I hope that helps.

[Just a small town girl]

I don't have an answer for you. What I would say is that if you have a neuro-opthamologist in your area, it might be time to pay one a visit. Additionally, has your opthamologist ordered an MRI? It definitely sounds like one is in order.

[salamandertom]

I forgot to say that - they can "see" ON on the optic nerve sometimes when they do their exam and sometimes they cannot. They call the cases they cannot retrobulbar - that is what I had too. This just means that it is too far back on the optic nerve to see. On an MRI sometimes they can see the lesions - sometimes they cannot. My local neuro tried to tell me that it was not optic neuritis b/c she couldn't see anything on the MRI on the optic nerve - LOL. Funniest part about that is that ON is a clinical diagnosis really. My VEP confirmed ON - as did the neuro-opth, later. That neuro is not my neuro anymore.

[Redwings]

Can you have ON and the optic nerve look normal?

Yes, in fact, 2/3 of cases of ON affect only the portion of the optic nerve behind the eye -- called retrobulbar ON -- so the small portion of the optic nerve that can be seen inside the eye -- called the optic disc or optic nerve head -- can look completely normal during an episode of ON. After mild episodes, the optic nerve head may continue to look normal. It's only sometime after an episode that the nerve head can become pale, indicating optic atrophy. ON can be seen inside the eye only 1/3 of the time.

It's also possible for ON to not show up on an MRI, either. But an MRI isn't even necessary for a diagnosis of ON.

In my situation, could the 'both eyes this time' just mean that my right eye still has effects from the ON last year, and that my left eye is being affected now?

Yes, and unless you have an indication that the right eye has also flared up again, that is a more likely scenario than being due to a brain lesion.

He told me I did not have ON because both eyes were affected....he said more likely is a brain lesion effecting my vision.

A brain lesion might be a contributing factor, but the complexities of MS and the "wiring" of the visual system mean that that is NOT the more likely scenario. As you suspect, it's more likely that your right eye has residual damage and the left is being affected now.

I ask him about the OCT (Optical Coherence Tomography) he said that the visual field test showed him the same thing??

No, the OCT and visual field are completely different tests and don't show the same thing. And because they don't, the OCT isn't the most appropriate test for looking for ON. That's an acceptable reason for not doing an OCT, not because the two tests show the same thing.

daisy.girl, it looks like it's time for you to be evaluated by a neuro-ophthalmologist because your situation is beyond your ophthalmologist's ability to properly evaluate and manage you. It would be a good idea to ask your neurologist to refer you to one. In your position, I wouldn't trust the ophthalmologist to do it because 1) his judgment is already suspect and 2) he should already have referred you when your second eye was affected. You can try to find a neuro-ophth yourself, but most of them accept patients by referral only.

I've had dozens of episodes of ON over the years and I've been stunned by how little some general ophthalmologists know or understand about ON. Now that both of your eyes have been affected, it's time to leave the general eye stuff to the general ophthalmologist and take your neuro-ophth issues to a qualified specialist.

[salamandertom]

I have to agree with Redwings - time to see a neuro-opth. I am actually shocked that your NEURO hasn't referred you to one. My neuro is who sent me to one. Have you had a VEP before? If so and the left eye was fine and the right eye was not you could have another and compare - of course a neuro opth is going to be able to tell regardless of the VEP.

[lightkeeper]

Hi daisy girl. I've been going through a bout of ON's for over a month now. Mine started with blurred vision,colors faded in both eyes. Then the right eye got bad about 3 weeks later the left eye showed a clouded spot.
With me I'm also legally blind with my right eye worse off. So any inflammation of the optic nerves will cause problems for me. I believe that sometime people think that they have ON's in both eyes at the same time because of the acute blurry vision . Just blurred vision can happen with MS and it may not be because of ON's .
On's is more of a acute clouded or grayed area in the vision with or without colors fading,increased sensitivity to the light and pupil movement .
I just did a set of IV steroids and it didn't help much for me . I might have to do them again .
I also have a condition called Amblyopia. Its where the brain and the eyes don't process objects correctly. It more of a eye muscle condition. I've had this since birth . SO any vision changes is a huge thing for me.
Thats about all I know on ON's .
I hope your vision clears up soon . I know that this is a pretty scare thing but I've been told in most cases your vision returns back to normal in 6 or less months.

Hugs
Dawn

[daisy.girl]

thanks so much for all the wonderful information. I thought that the ophthalmologist was not correct on a few things. I will ask my neuro for a referral to a neuro-ophtha.

I do have one more question:

I am having pain in my left eye. It is more of a quick stabbing pain....not eye pain with movement. It happens many times through-out the day. However, I do have pain if I move my eye very quickly too. Can this still be ON?

[lightkeeper]

There are other things that can cause pain behind the eyes beside ON's but ON's does cause eye pain. Also sinusitis and migraines can cause pain behind the eyes.

My first flare up of ON's none of my doctors believed it was anything serious. It wasn't until 2007 that I finally saw an opthamologist and it just happened to be during a flare up of ON's . During that visit they did a vision field test of which went bad. He check to see if I could distinguish colors and that didn't go so well. I was dx'd with ON's at that time . But even with that my doctors (who weren't neurologist) didn't think that it was anything to worry about. Heck my PD last week told me that most people fully recover from this with no damage.
I know that he meant well but when your eyesight is almost gone to began with its a little discouraging. But he is right that most people fully recover.

If your eye get any worse don't wait to see a doctor or go straight to an ER . In the meantime try and get into see another ophthalmologist . A neuro ophthalmologist would be best. I've had to see them all my life and they're not all the same.
I've told my doctor that I can be alright if it comes to losing the use of my legs BUT I draw the line when it my arms or my eyes.
Fight to find the answers if you have to . Push to see the best doctors. If you don't agree with one doctor get a second opinion. =)

Dawn