SECTION 15: VISION

Visual difficulties are common in MS. The most common problems are decreased or blurred vision (optic neuritis), double vision (diplopia) and what is termed, "involuntary movements of the eyes" (nystagmus). All are the result of MS lesions in areas of the brain that control and coordinate vision.

Optic neuritis is an inflammation of the optic nerve, which - unlike the nerves that innervate most of the body, which are part of the peripheral nervous system - is actually a part of the central nervous system and is myelinated in the same way as axons in the brain and spinal cord. Many individuals experience optic neuritis as their first symptom of MS.

Double vision and involuntary eye movements are the result of lesions in the brain stem, a part of the nervous system between the brain and cervical spinal cord.

Because these conditions are all the result of MS inflammation and myelin damage, treatment is generally the same for all three.

NON-PHARMACOLOGIC MANAGEMENT

Like other MS exacerbations, it is often sufficient to take a "wait and see" attitude; these problems often resolve on their own, after the attack or relapse has subsided. With certain visual problems, prisms in eye glasses may help some patients.

PHARMACOLOGIC MANAGEMENT

Very High-Dose Steroids

The same steroid treatment used to treat other types of MS relapses is often effective in shortening the duration of visual problems. These are usually given via IV for a few days, but steroids may also be given orally. An example of a "very" high dose of steroids would be 1,000 mg of Solu-Medrol®(IV methylprednisolone).

MS Disease-Modifying Therapies

Mentioned earlier, six disease-modifying therapies favorably reorganize the immune system and are currently approved for treating the relapsing forms of MS. Several studies have shown that these can reduce the number and severity of attacks, which in turn reduces the development of visual difficulties.

Low-Vision Management

If visual problems persist, an ophthalmologist who specializes in low vision can help provide low-vision devices that include magnification and computer modifications. He or she can also design a variety of helpful strategies for managing daily activities.