Multiple sclerosis (MS) is a disease that can impact vision in a number of ways. In the opening paragraphs, we’ll provide quick answers to common questions about how MS affects eyesight.
Can MS cause vision problems?
Yes, vision problems are common with MS. Over 50% of people with MS experience issues with their vision at some point.
What kinds of vision problems can happen with MS?
There are several vision-related symptoms that can occur with MS:
- Optic neuritis – inflammation of the optic nerve that leads to eye pain and vision loss
- Double vision (diplopia) – seeing two overlapping images instead of a single normal image
- Blurry vision
- Impaired color vision
- Eye movement problems – trouble moving the eyes or having rapid, uncontrollable eye movements (nystagmus)
Why does MS affect vision?
Vision problems with MS are caused by damage to the pathways that carry signals from the eyes to the brain. This damage is caused by inflammation and demyelination (loss of the protective myelin coating around nerve fibers).
Is optic neuritis common with MS?
Yes, optic neuritis is one of the most common visual symptoms of MS, occurring in up to 70% of people with the disease at some point.
What are the symptoms of optic neuritis?
Typical symptoms of optic neuritis include:
- Eye pain, especially with eye movement
- Diminished color vision
- Blurry vision
- Partial or complete vision loss in one eye
Is optic neuritis permanent?
No, optic neuritis is usually temporary. Most people regain all or most of their vision within 10 weeks, even without treatment. However, recurrent episodes of optic neuritis can lead to permanent damage.
How is optic neuritis treated?
Treatment for optic neuritis usually involves high-dose intravenous corticosteroids such as methylprednisolone to reduce inflammation and speed vision recovery. Plasma exchange may also be used.
Can MS cause permanent vision loss?
Permanent vision loss is possible in MS if there is significant damage to the optic nerve or areas of the brain related to vision. However, most vision symptoms, even optic neuritis, are temporary.
Does MS cause blindness?
Only around 5% of people with MS end up with severe vision loss or legal blindness. However, some degree of vision impairment is common.
Can MS cause eye twitching or pain?
Yes, eye twitching (myokymia) and eye pain can both occur with MS. Inflammation of the nerves controlling eye muscles can lead to twitching, spasms, and pain.
Is dry eye syndrome associated with MS?
Dry eyes are very common with MS, affecting up to 20% of people. Brain lesions in MS can disrupt signaling from the brain to the lacrimal (tear) glands, reducing tear production.
Can MS cause vertigo or dizziness?
Dizziness and vertigo are possible with MS due to damage to balance centers in the brain and brainstem that work closely with visual input and eye movements. Nystagmus can also contribute to vertigo.
Can vision changes be an early symptom of MS?
Yes, optic neuritis or other vision changes can be one of the first symptoms of MS. Vision problems occur early in the disease for about 20% of patients.
Should vision changes prompt an evaluation for MS?
Yes, any unexplained vision changes, especially optic neuritis, should prompt a full neurological workup to evaluate for possible MS or other underlying conditions.
Can MS relapses affect vision?
Yes, new or worsening vision symptoms like blurry vision, double vision, or optic neuritis can occur during MS relapses when disease activity increases. Vision problems may be the primary symptom of a relapse.
Conclusion
Vision symptoms like optic neuritis, eye movement problems, and eye pain are very common in MS given the effects of the disease on the optic nerves and nerve pathways. While permanent vision loss is relatively rare, transient vision changes are often an early sign of MS. Any unexplained visual symptoms should prompt a full evaluation for MS and other possible neurological conditions. With proper treatment and monitoring, most vision issues related to MS can be managed.
Vision Problems Related to MS
Multiple sclerosis (MS) can affect various aspects of vision and eye function. Some of the most common visual symptoms that can occur with MS include:
Optic Neuritis
Optic neuritis causes inflammation of the optic nerve, which carries signals from the eye to the brain. This results in pain, loss of color vision, and blurred vision or blindness in one eye. It occurs in up to 70% of people with MS and is often one of the early presenting symptoms.
Diplopia (Double Vision)
Double vision occurs when the eyes are temporarily misaligned due to dysfunction of the nerves controlling eye muscle movements. This results in seeing two overlapping images instead of a single image.
Nystagmus
Nystagmus causes involuntary, rapid shaking movements of the eyes from side to side, up and down, or in a circular pattern. This occurs from MS lesions in areas of the brain that coordinate eye movements.
Impaired Color Perception
Some people with MS experience a muted or washed out perception of colors or difficulty distinguishing between colors like red and green. This can result from optic neuritis or lesions in the visual pathways.
Other Symptoms
Additional visual symptoms that may arise in MS include:
- Blurred vision
- Partial vision loss
- Diminished contrast sensitivity
- Photophobia (sensitivity to light)
- Dry eyes
- Eye twitching or pain
Causes
MS is believed to damage vision through:
- Demyelination of optic nerves and neurons carrying visual signals
- Inflammation damaging optic nerves and visual pathways
- Lesions in areas of the brain involved in processing vision
- Disruption of nerve signals controlling eye muscles and coordination
This interference with flow of visual signals leads to the various vision-related symptoms.
Diagnosis
A neuro-opthalmologist can help diagnose optic neuritis and other vision problems related to MS through:
- Visual acuity tests
- Eye movement exams
- Color vision tests
- Vision field analysis
- Ophthalmoscopy of the retina
- MRI scans to identify optic nerve and brain lesions
Treatment
Treatments that may help manage MS-related vision symptoms include:
- Corticosteroids to reduce optic neuritis inflammation
- Disease-modifying therapies to slow MS progression
- Prism lenses for diplopia
- Eye movement therapy
- Lubricating eye drops for dry eyes
Vision symptoms may resolve on their own after an MS relapse. Proper treatment can reduce vision impairments and improve quality of life.
Vision Rehabilitation in MS
Since visual disturbances are so common in multiple sclerosis (MS), various rehabilitation approaches can help maximize vision function. Vision rehab may employ strategies like:
Prisms and Patching
Prism lenses bend light to align images and treat double vision. Occluding patches can also be used to block vision in one eye at a time.
Eye Movement Therapy
Exercises can help strengthen extraocular muscles and improve control. This reduces nystagmus and improves coordination of eye movements.
Compensatory Scanning Training
Scanning exercises help develop head and eye movements to expand the useful field of vision and avoid blind spots.
Light Filters
Tinted lenses or filters can treat photophobia and visual perceptual problems by controlling the amount and spectrum of light entering the eyes.
Vision Aids
Optical devices like magnifiers and closed circuit televisions can improve reading, writing, and detail work by enlarging images and text.
Computer Adaptations
Modifying computer settings, screen contrast, font sizes, and using screen reading software can optimize computer use for those with visual deficits.
Environmental Modifications
Improving lighting, glare control, contrast marking of edges, removing clutter and trip hazards can support safe mobility and functioning.
Reading Rehabilitation
Training in eccentic viewing, saccades, and fixing optimal reading distances based on visual acuity supports easier reading.
Vision rehabilitation can significantly improve visual function and quality of life for MS patients by targeting specific deficits. Rehab programs are customized for each individual’s visual needs.
Effects of MS Medications on Vision
Disease-modifying therapies used to treat MS can have beneficial or adverse effects on vision-related symptoms:
Corticosteroids
Steroids like intravenous methylprednisolone speed recovery from acute optic neuritis but offer no long-term visual benefits.
Interferons
Interferons may reduce severity and frequency of optic neuritis attacks.
Glatiramer Acetate
Glatiramer acetate has not been found to significantly impact vision outcomes.
Natalizumab
Natalizumab lowers risk of acute visual loss from MS but does not reduce long-term visual decline.
Fingolimod
Fingolimod may mildly improve visual acuity and quality of life but has a small risk of macular edema.
Ocrelizumab
Ocrelizumab is highly effective at lowering rates of clinical MS relapses that impair vision.
Cladribine
Evidence is limited but cladribine appears to reduce optic neuritis attacks.
Overall, disease-modifying therapies can reduce severity and frequency of acute visual symptoms but have limited effects on gradual vision loss. The benefits of slowing MS progression outweigh the minor risks of vision-related side effects.
The Future of Vision Care in MS
Research into new approaches for managing visual dysfunction in MS focuses on areas like:
Neuroprotection and Regeneration
Developing therapies to protect neurons and stimulate regeneration of optic nerves could reverse damage from MS.
Remyelination
Promoting repair of myelin sheaths around optic nerve fibers may restore transmission of visual signals.
Inflammation Suppression
Better understanding of mechanisms driving optic neuritis could lead to treatments to permanently prevent inflammation and attacks.
Disease-Modifying Therapies
More effective MS drugs to slow overall disease progression can limit damage to visual pathways.
Gene Therapy
Introducing normal genes into MS-damaged neurons may protect cells and stimulate regeneration.
Stem Cell Therapy
Stem cells offer possibilities for repairing demyelinated neurons and replacing optic nerve tissues.
Neuroprostheses
Devices like retinal implants could artificially stimulate visual signals in the optic nerve to restore vision.
While currently available treatments have limitations, the future holds promise for restoring visual function by reversing the underlying pathological processes in MS.
Coping with Visual Changes in MS
Coping with MS-related vision changes often involves:
Education
Learning about your specific visual deficits helps you know what to expect and how to adapt.
Rehabilitation
Vision rehab trains compensatory strategies and skills to optimize functioning.
Adaptive Devices
Items like prisms, magnifiers, and walking canes help you adjust and maintain independence.
Support Networks
Connecting with peers provides validation and ideas for managing vision challenges.
Lifestyle Changes
Modifying activities, pacing tasks, arranging your environment, and finding alternative pursuits aids coping.
Professional Help
Counseling provides support in adjusting to vision loss and maintaining emotional wellbeing.
Treatment Adherence
Using prescribed medications and following treatment plans prevents worsening symptoms.
Staying flexible, patient, and positive can help you successfully adapt to MS vision changes. Though challenging, most people find ways to lead full, active lives.
MS and Higher Risk of Eye Disorders
In addition to direct effects of MS on vision, studies show an increased risk of other eye conditions among people with MS.
Uveitis
Uveitis is inflammation inside the eye, especially the iris, ciliary body, and choroid. Research indicates a 2-3x higher prevalence in MS patients.
Cataracts
Cataracts involve clouding of the eye’s lens. Data show both younger age at cataract diagnosis and faster progression in MS patients.
Retinal Disorders
Detachment, tears, edema, and thinning of the retina occur up to 3x more often in MS populations.
Glaucoma
Increased pressure inside the eye damages the optic nerve in glaucoma. MS patients have around double the risk.
Dry Eye Disease
Tear film deficiencies in dry eyes are very common in MS, though the exact prevalence is uncertain.
| Disorder | Risk Increase in MS |
|---|---|
| Uveitis | 2-3x higher |
| Cataracts | Earlier and faster progression |
| Retinal disorders | Up to 3x higher |
| Glaucoma | Up to 2x higher |
| Dry eyes | Much more common |
The reasons for increased extraocular conditions in MS are not fully understood. Some combination of inflammation, vascular changes, medications, genetics, and lifestyle factors may play a role.
Conclusion
Vision symptoms like blurred or double vision, eye pain, and optic neuritis are experienced by a majority of multiple sclerosis patients at some point. While permanent vision loss is relatively uncommon, temporary visual disturbances can significantly impact quality of life. However, thanks to understanding of the mechanisms of vision loss in MS, newer treatments, rehabilitation approaches, and adaptive technologies, most patients are able to find effective ways to cope and manage visual dysfunction.
With further research into neuroprotection, remyelination, inflammation suppression, and regenerative therapies, the future looks increasingly hopeful for restoring visual abilities in MS. Until those new treatment options are available, optimizing currently available disease-modifying drugs, vision rehab, and supportive care allows most people with MS to adapt and maintain productive, enjoyable lives despite the challenges of visual symptoms.
Staying informed about how MS affects vision, working closely with one’s medical team, and using all available resources permits people with MS-related visual deficits to maximize their functioning and quality of life.