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**Redwings** · 12-13-2011, 06:54 PM

Originally posted by PattySmith View Post

Need info to decide current treatment. Should I stay on Avonex and go blind?

Hi Patricia:

Sorry to hear you're having so much trouble.

The problems you're having are common enough in the general population that of course some people with MS -- and even people on Avonex -- are likely to have them. Even without knowing what the specific eye problems were in the Avonex test groups (don't overlook that 2% on placebo also had "eye disorder"), an argument can be made that the incidence of glaucoma would be lower in the test subjects than in the general population. It's going to be difficult to prove that Avonex is the cause of problems that occur in the general population at a rate equal to or exceeding that in the test group.

One thing you didn't mention is whether you've used steroids over the years to treat your MS. Corticosteroids are well-known for causing glaucoma. You're also in the age group that increases your risk for glaucoma.

Glaucoma is such a complex subject that it can't be explained in a forum post, and certainly not in a way that applies to your specific case. But one thing to note is that some of the newer research suggests that any degenerative brain disease (which would include MS) makes optic nerves more susceptible to glaucoma. (That doesn't mean that these conditions cause glaucoma.) Research also shows that people with MS show some degeneration of nerve cells within the eye. Eye doctors who aren't familiar with this research might confuse that with glaucoma in some patients.

So there are several things that are known to be correlated with glaucoma that far outweigh any risk that might theoretically come from Avonex.

The recurrent Elschnig's pearls is a different issue and complicated in its own way. I read one source (which was generally referenced without a specific citation, so I don't have a convenient way to verify it) that says that up to 80% of people have a reformation of Elschnig's pearls after capsulotomy -- and those aren't people on Avonex.

However, interferon beta (Avonex is interferon beta-1a) is a cytokine that modulates immune response. As such (and this is pretty esoteric stuff), it can be involved in a complex inflammatory chemical cycle that stimulates the production of collagen in lens capsule cells that can lead to the formation of Elschnig's pearls. If your pearls are reforming every two months, this has to be a consideration.

The only way to see how Avonex might be contributing to the reformation of the pearls is to stop taking it and monitor what happens. (Betaseron, Extavia and Rebif are also interferons, so they're not suitable replacements if you choose to discontinue Avonex.) If the reformation stops, that's a suspicious enough association that you can report it to the FDA as an adverse event.

If you discontinue Avonex, it will give you the opportunity to evaluate your glaucoma as well. In the meantime, you can always get a second opinion about the glaucoma. There's value in getting an opinion from a neuro-ophthalmologist, who can comment about any possible contribution MS-related factors might have played in the glaucoma diagnosis. I speak here from personal experience, after a glaucoma specialist misdiagnosed my severe optic-neuritis-related optic nerve atrophy as glaucoma. My case is very different from yours, but the value of a second opinion still stands.

**PattySmith** · 12-14-2011, 09:10 AM

Redwings,

Thank you for your highly intelligent and knowledgeable response. Have printed it out and keeping for reference. My glaucoma responds very well to Lumigan and therefore the opthimologist felt it was true Glaucoma.

I will be quitting Avonex as no longer eligible for free access program.

Will keep you updated on things.

I'm sorry to hear about your misdiagnosis. Thats terrible new. Keep me updated as well.

Happy holidays

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