Vision problems are prevalent among people with multiple sclerosis (MS). Visual symptoms can be early indicators of MS and are often what motivates people to seek medical treatment. “The symptom that made me pay enough attention to go to the doctor was my vision change,” a MyMSTeam member wrote. Visual problems can also occur in people who have had MS for longer periods of time.
Just like other MS symptoms, everyone experiences vision problems a little differently. Members of MyMSTeam describe the vision problems they have experienced:
Multiple sclerosis can affect vision in several ways. Vision problems associated with MS may include optic neuritis, vision loss, diplopia (double vision), and nystagmus.
Diplopia, or double vision, can be an early symptom of MS. Diplopia in people with MS is related to damage to the nerves that control eye movement. This causes a misalignment in the eyes. Diplopia is sometimes temporary. In other cases, it is persistent.
Nystagmus is a vision problem that causes the eyes to move from side to side in a repetitive, uncontrolled manner. It is sometimes called “dancing eyes.” Nystagmus also can prevent a person from holding a steady gaze. This can cause or worsen dizziness and nausea, which can contribute to balance issues and falls. Nystagmus may be persistent or it may be recurrent.
MS can damage the nerves in the cerebellum or brain stem and cause nystagmus. The cerebellum and the brain stem are both regions of the brain responsible for muscle movement, vision, and balance. Nystagmus may also be caused by optic nerve nerve damage. Damage to the optic nerve disrupts the interpretation of visual information.
Optic neuritis is one of the common symptoms of MS. It is often a very early indicator of the condition. “People experience blurred vision in one or both eyes and often also experience pain with eye movements,” explained Dr. Jacqueline Nicholas, a neuroimmunologist and MS specialist at the OhioHealth Multiple Sclerosis Clinic in Columbus, Ohio.
Another symptom is a scotoma — a blurry, dim, or blind spot. A scotoma may occur in the center of the visual field without changing peripheral vision. Optic neuritis may also impact color vision and cause graying.
Optic neuritis is linked to neuromyelitis optica, a rare condition that can cause blindness and paralysis. Treatments to prevent future attacks of neuromyelitis optica are different from treatments used to prevent MS relapses, so accurate diagnosis of vision problems is important.
When optic neuritis occurs in a person with MS, it's often because of inflammation of the optic nerve and demyelination. “It's caused by an immune attack of someone's own white blood cells attacking the myelin coating on the optic nerve,” said Dr. Nicholas.
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Optic neuritis doesn’t only affect people with MS. Between 1 and 5 people in 100,000 are affected by optic neuritis. Much like MS, optic neuritis tends to affect more women than men, and develop between the ages of 20 and 40 years old.
In people with MS, optic neuritis can occur regardless of the type of multiple sclerosis they have. According to Dr. Nicholas, “We see optic neuritis in relapsing MS because it typically comes on in the form of a relapse.” People who have secondary progressive MS also can develop optic neuritis.
The prognosis for recovery is promising for many MS-related vision problems. “For many people with optic neuritis, it often improves with time, although improvement may not be complete,” explained Dr. Nicholas. “The good news is that there are options to help individuals with decreased vision often offered through low-vision clinics.”
Treatment options for vision problems include steroid treatment at the time of onset, plasmapheresis, and specialized lenses.
High doses of steroids, such as Solu-Medrol (Methylprednisolone), are often the go-to treatment for an episode of optic neuritis in people with MS. They are commonly delivered intravenously (by IV). Dr. Nicholas said the dosage is “usually a gram of that once a day for anywhere between three to five days.” High dose oral steroids can also be used in the treatment of optic neuritis.
Nystagmus is more complicated to address than other MS-related vision problems. Fewer treatment options exist to address the involuntary eye movements associated with nystagmus. Sometimes eyeglasses or contact lenses can help slow the uncontrolled movements of the eyes and improve a person’s vision. Drugs like Neuronton (Gabapentin) may be used to lessen the eye movement or reduce twitching.
In rare instances, surgery is employed to address nystagmus. Surgery, however, does not directly address the eye symptoms associated with nystagmus.
When double vision occurs due to an MS relapse, it often resolves itself partially or fully. Treatment with steroids can hasten this recovery. Some people wear a patch over one eye to help with diplopia.
A Fresnel prism is a special lens attached to a person’s glasses. It may adjust the way light enters a person's eyes. In some instances, a Fresnel prism can help realign the way visual information enters the eye.
Sometimes double vision persists for extended periods of time. In these cases, Botox (Botulinum toxin) or surgery may be used to help bring the eyes back into proper alignment and to adjust the affected eye muscles.
By joining MyMSTeam, the social network and online support group for those living with multiple sclerosis, you gain a support group more than 157,000 members strong. Vision problems are one of the most discussed topics.
Have you experienced vision problems related to MS? Share your experiences in the comments below or directly on MyMSTeam.