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Saw ophthalmologist today...

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    Saw ophthalmologist today...

    And had a full exam with dilated eyes and everything. The whole thing was pretty routine except I apparently couldn't pass the test on one machine where you have to stare at a black dot and press a clicker when you see lines flicker on the screen. The tech did it twice on my R eye and 4 times on my L and said it still showed errors. Finally she just decided to stop.

    Vision is still great. 20/15 both eyes. But the sudden blindness and the blurred white fuzz that shows up are still undefined.

    During the exam of the retina and optic nerve the doctor took FOREVER and kept stabbing my eyes with his light. Finally he called in another doctor to look and started talking about visual occlusions and the optic nerve and narrowed arteries and crossing and I kind of sat there freaking out.

    Came down to this:

    2nd Doctor: "If I hadn't known your history and just came in and saw a picture of your eyes and a chart I would say that it looks within normal. ...except for..."

    My Doctor: "No prescription or eye drops. And you don't need surgery. (WHAT?! Why even bring THAT up?) Your eyes look fine. ...except for..."

    The except for was apparent abnormal narrowing of the retinal arteries and arterioles. And crossing of them both. My doctor kept saying "...but she's only 27..."
    They took my BP and it's normal. And I've never had high blood pressure, not hypertensive or even pre-hypertensive.

    I asked if it was something to be concerned about and they said
    "You're working with a Primary, aren't you? They should get together with an internist."

    Good news there because the Primary I'm picking tomorrow IS an internist.

    The only info on this that I can find on the internet is about "Retinal Hypertension" or Carotid Artery Disease. Oh, and apparently it could be a sign of a stroke or TIA. Who knew.

    Any ideas? Anyone have experience with this on their own?
    Right now it's just something ELSE to take to my new primary when I finally see her.

    And WHY bring up surgery? All I can think and could think but didn't say during the appointment was, wait, why? does that mean this could mean I'll need surgery later? What am I supposed to do about it now...?


    Current Dx: Poss. MS pending MRI / LP
    *Living In Limboland*

    #2
    I will be terribly honest and say I have no clue what any of this means, but I will give you a virtual hug anyway.

    If you can, make sure to have your records from the eye-guys to take with you to your new primary. Or have them sent over. Best to have all your records in one place (especially when bouncing from doc to doc), and I've found it most useful to have my own copy of everything, including discs of my MRIs.

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      #3
      HUGS! Was this your first eye exam? I ask because you didn't mention if the vascular anomaly was a new finding. I have heard that if you have narrowing of the eye vessels it may signify small vessel disease. That's probally why they want you to see an internist. It's important to know if all your veins and arteries are narrow.
      Your internist will have the answers you seek.

      Comment


        #4
        Hi Dennah:
        You'd be surprised how often the first question a patient asks -- especially about a structural anomaly -- is, "Do I need an operation?" It's possible that your doctor has heard the question so many times that he just cut to the chase and answered it right away. So for now, you can let that one go.

        The next question is often, "Do I need any medicine?" Sounds like your doctor addressed that right away, too.

        Whether or not you have MS is a separate issue. Transient blindness is not related to MS. The primary cause of transient blindness -- particularly the kind you had -- is some kind of vascular/blood flow anomaly. So you're correct here: likely TIA at some level. And while it's true that some cases of MS involve vascular inflammation that could very, very rarely (as in, almost zero chance) affect retinal blood vessels, what you've described is not a case of that. If there had been signs of vasculitis, your doctor would have brought it up. Instead, apparently, the doctor mentioned arterio-venous crossings, which is entirely different. What's more, one of the docs said your eyes look essentially normal.

        TIA, stroke, retinal hypertension and carotid artery disease are all possibilities. So are metabolic and blood disorders. That's why your ophthalmologist wanted to be sure you're going to be evaluated by an internist.

        The transient blindness is unrelated (about 99.99%) to MS. You've already researched this and didn't find anything to even suggest otherwise. But a systemic problem that's affecting your cerebral blood flow (as evidenced by your vision and your retinas) can certainly affect you neurologically without the condition being MS. So again you're right: this is something ELSE to bring to your new primary.

        The blurred white fuzz you've seen might be MS, it might not be. The mechanisms behind the fuzz and the absolute blindness can be different. It's too soon to tell.

        Kaiser is computerized (I'm in Kaiser SoCal), so your new primary will have intranet access to your ophthalmology records. She won't know what most of the notations mean, but she'll know (or should) from the ophthalmologists' assessment that you have a systemic issue that needs to be followed up on. Some Kaiser docs are very good about consulting each other (the internal email makes it quite easy) and some aren't. I hope it all goes smoothly for you.

        And again, about the surgery comment... forget about it. Your doctor meant for it to reassure you, not worry you.

        Comment


          #5
          Originally posted by Redwings View Post
          Kaiser is computerized (I'm in Kaiser SoCal), so your new primary will have intranet access to your ophthalmology records. She won't know what most of the notations mean, but she'll know (or should) from the ophthalmologists' assessment that you have a systemic issue that needs to be followed up on. Some Kaiser docs are very good about consulting each other (the internal email makes it quite easy) and some aren't. I hope it all goes smoothly for you.
          And here I am, dragging paper print outs and CD-ROMS to all my appointments. Rural Montana is clearly in the medical records dark ages.

          Comment


            #6
            A good eye doctor is fantastic. They can find things other doctors will miss.

            Comment


              #7
              Redwings,

              Would you mind sharing where you got all the info about the statistics of vision loss and MS?

              From what I've learned from calling the doctor back, vision loss can definitely be a symptom. Retinal Hypertension, not really, but the vision loss is called an Amaurosis, and it can be caused by neurologic disorders, including demyelinating diseases.

              He directed me to look up Amaurosis Fugax, which is the technical term, and MS together and I found this, which seems to correlate his statements.

              http://ijahsp.nova.edu/articles/vol4num2/Bacigalupi.pdf


              I'm just trying to understand all of the facts.

              Thanks!

              Current Dx: Poss. MS pending MRI / LP
              *Living In Limboland*

              Comment


                #8
                Hi Dennah:
                That's an excellent article. You can get some clarity (but no hard answers) by knowing how to interpret the major points the article is making.

                The introduction points out that amaurosis fugax is a spectrum of different kinds of transient visual disturbances having different presentations and many different causes, which have been categorized based on the underlying pathophysiology. Table 1 is a list of different conditions within those categories. It's important to note that it is just a list of differential conditions and doesn't go into the actual act of making the differential diagnosis by matching up the conditions with the kinds of visual disturbances they cause.

                The remainder of the article walks through how the differential is made, matching up signs/symptoms with the conditions that have the underlying mechanisms capable of causing them. MS is on the list of differentials because it's a neurologic condition that can and does cause visual disturbances. But the critical point here is how that applies specifically to your situation. MS causes visual disturbances, but not the kind you described having.

                Because of the way MS operates (the underlying pathophysiology), it does not cause the kind of sudden temporary blindness you described. The article goes on to say, "If the disturbance lasts 2-30 minutes and resolves, this is suggestive of an ischemic attack." Sudden total or near total blindness is possible from ischemia because blood flow can change in literally a heartbeat. Remember that it takes only about 6 minutes for oxygen deprivation to cause brain death. Lack of blood flow can have very swift consequences, including shutting down vision within seconds.

                To be sure, MS can cause visual disturbances that last for that amount of time, but the disturbance isn't total blindness because the mechanism by which MS can cause temporary visual disturbances isn't capable of causing that kind of blindness without specific precipitating events that you haven't described having. The blurred white fuzz you've seen is more characteristic of MS, but not sudden, transient blindness. To appreciate why that's true will take an understanding of the underlying mechanisms of MS that you don't have yet.

                Another point that's important to note is that the article only minimally addresses demyelinating disease, including it only as a differential for some kind of visual disturbance. That can in no way be interpreted to mean that "MS can cause amaurosis fugax so because I have amaurosis fugax and some other neuro symptoms I must have MS." Visual disturbance doesn't automatically mean neurologic, and neurologic doesn't automatically mean MS. The ophthalmologists apparently didn't say anything about MS, and that's a clue about what's more or less likely to be causing your symptoms.

                Again, it's a great article. But it's a generic article about how a differential diagnosis is made. It doesn't contain any medical information you can apply to your own case to get your questions answered. You might have MS, you might not. But the visual symptoms you've had are not the visual symptoms that are characteristic of MS. That means that MS will have to be investigated separately from your visual symptoms, and your visual symptoms will be investigated on a much broader basis than just MS. Right now there isn't enough evidence to form an association between the two.

                It looks like the facts you need -- and the understanding of them -- will be uncovered during your medical workup and a lot of study of neuroanatomy and physiology.

                Comment


                  #9
                  The double doc's

                  I've had the double doc look before. The "is this" "why yes" "but what does that" and then they go on in doctorese and I sit there dumbfounded by what they are saying. I can't offer advice as to what is wrong with your eyes, but I can send happy thoughts, and sympathise!

                  Sometimes the best thing to do is scedule the followup and forget about it for a while. I have to take that advice myself often. I see a neuro opthamologist the end of this month for my vision loss. I've seen two different regular opthamologists and they give me the "oh yeah" and "that isn't normal" and then they tell me to talk to my neuro. Sooooo Here's hoping the neuro Opthamalogist knows what's going on and how we can slow it down or stop it. I WOULD like to see my kids grow up if it is at all possible. And if it makes you feel any better, I'm only 32 and I did go blind on the right side completly 2 times now, but it came back There's always hope!
                  Time is but a name we give to the passing moments of life, it is these moments that hold all the meaning.

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