Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, including the brain, spinal cord and optic nerves. Vision problems are common for people with MS and can significantly impact quality of life. There are several different types of vision issues that can occur with MS, including:
Optic Neuritis
Optic neuritis is inflammation of the optic nerve, which connects the eye to the brain. It is one of the most common vision problems in MS and occurs in about 1 in 5 people at some point during the course of their disease. Optic neuritis causes eye pain, blurry vision, dimmed color vision and vision loss. Symptoms are usually in one eye and develop over hours to days. Most people recover within 6 months, but some permanent vision loss can occur.
Diplopia (Double Vision)
Diplopia or double vision happens when the eyes are misaligned and they send two different images to the brain. MS can cause double vision due to inflammation damaging the nerve pathways that control eye movement and coordination. Double vision tends to come on suddenly and may last for weeks or months in MS. It can happen in just one eye or both.
Nystagmus
Nystagmus causes involuntary and repetitive eye movements, often described as the eyes wiggling or flickering side to side, up and down or in a circular motion. It is a common symptom of MS, occurring in about 1 in 4 people with the disease. Nystagmus can reduce visual acuity and cause dizziness or vertigo.
Visual Field Loss
Inflammation of the optic nerve or lesions in the brain can lead to blind spots or scotomas in the field of vision. People may miss objects on one side of their vision or have blurry or blacked out patches in their visual field. Visual field testing by an ophthalmologist is needed to detect these blind spots.
What Causes Vision Problems with MS?
The vision symptoms associated with multiple sclerosis stem from damage to the optic nerves or impaired signaling between the eyes and brain:
– Inflammation – Swelling and damage to the optic nerve from autoimmune attacks is thought to cause acute vision loss in optic neuritis.
– Demyelination – Breakdown of the myelin coating around nerve fibers interferes with vision signaling.
– Transection – MS plaques can transect or destroy axons of retinal ganglion cells causing vision loss.
– Neurodegeneration – Over time, loss of neurons and neural connections leads to cumulative visual deficits.
– Imbalance of neurotransmitters – Dysregulation of chemicals that facilitate vision signaling likely contributes to visual symptoms.
Diagnosing Vision Problems in MS
A neuro-ophthalmologist can perform a series of tests to diagnose vision problems associated with MS:
– Visual acuity test – Measures sharpness of vision using a Snellen chart.
– Eye movement exam – Checks eye alignment and coordination.
– Pupillary light response – Evaluates optic nerve response to light.
– Color vision test – Identifies color blindness or desaturation.
– Visual field testing – Maps field of vision and detects blind spots.
– Ophthalmoscopy – Examines the optic nerve for signs of atrophy or inflammation.
– OCT scan – Measures thickness of retinal nerve fiber layer.
– Visual evoked potentials – Records brain response to visual stimuli.
Are Vision Problems an Early Sign of MS?
For many patients, optic neuritis is one of the earliest presenting signs of multiple sclerosis. Vision loss or eye pain prompts them to seek medical evaluation, eventually leading to an MS diagnosis.
In 20-30% of people with MS, optic neuritis is the first definitive symptom. In up to 50% of patients, it occurs at some point within 5 years before or after the initial MS diagnosis.
Sudden onset vision changes like blurry vision, eye pain or loss of vision in one eye should be evaluated promptly for possible MS. Prompt treatment can limit nerve damage.
How are MS-Related Vision Problems Treated?
Treatment approaches for vision issues with MS may include:
– **Corticosteroids** – High dose IV steroids are used short-term to control inflammation and speed vision recovery from optic neuritis attacks. They do not affect MS progression long-term.
– **Plasma exchange** – Filters the blood to remove antibodies and immune factors to calm inflammation. Helpful when steroids fail for acute optic neuritis.
– **Disease modifying therapy** – MS drugs like interferon, Aubagio, Tysabri and Ocrevus can reduce future relapses including optic neuritis attacks. They may prevent cumulative vision loss over time.
– **Rehabilitation** – Vision therapy helps strengthen eye muscles, improves control and coordination of eye movements and promotes visual retraining.
– **Prism lenses** – Prisms bend light to reposition images and can be used to correct double vision. Occlusion therapy may patch one eye to relieve diplopia.
– **Low vision aids** – Devices like video magnification systems and talking software can assist with reading and seeing.
MS Vision Problems – Prognosis and Outlook
The visual prognosis depends on the specific type of vision issue:
– **Optic neuritis** – Most people regain good vision within 1-6 months after an attack, but some permanent vision loss in that eye may remain. Recurrent episodes confer a worse prognosis.
– **Ocular misalignment** – Double vision from MS lesions often resolves within several weeks, but nystagmus is likely to persist.
– **Visual field defects** – Blind spots tend to be permanent, but the brain can be retrained over time to compensate.
– **Worsening visual function** – Unfortunately, MS-related vision loss is often progressive over time as the disease advances and causes nerve damage.
Regular ophthalmologic exams are important to monitor changes and update optic corrections as needed. Proper treatment of relapses and halting disease activity can help maintain visual function. Low vision rehabilitation can maximize independence.
Coping with Vision Loss from MS
Significant vision changes can understandably cause fear, anxiety and loss of independence. Some tips for coping include:
– Learn about all available vision-assisting tools and services. Don’t delay getting low vision aids.
– Modify your environment by minimizing clutter, adding more lighting, adjusting contrast and using magnifiers.
– Practice self-care through meditation, therapy and joining a support community.
– Establish consistency in your living space so you can navigate safely.
– Ask for help from loved ones when needed. Maintain social connections.
– Stay positive and focused on what you can do and how far treatments have come.
– Your quality of life and self-worth are not defined by vision. Stay engaged in hobbies you enjoy.
Key Takeaways
– Optic neuritis, eye movement abnormalities, visual field loss and progressive impairment are among the vision symptoms of MS.
– Inflammation, demyelination, nerve damage and neurotransmitter imbalance contribute to visual deficits.
– Eye exams and tests help diagnose specific vision issues related to MS.
– Steroids treat acute attacks and MS therapies may prevent cumulative damage. Rehabilitation and visual aids can maximize function.
– Vision prognosis varies depending on the type and severity of ocular symptoms. Treatment and adaptation can improve the outlook.
– Stay positive, utilize assistive tools, modify your environment and embrace support to cope with vision changes.
Conclusion
Vision problems are very common in multiple sclerosis given how the disease damages the optic nerves and disrupts visual pathways in the brain. Symptoms like blurred or double vision, eye pain, vision loss and involuntary eye movements can significantly impact quality of life. However, understanding the causes of MS visual deficits and pursuing proper diagnosis allows patients to implement beneficial treatments and rehabilitation strategies. Coping with permanent vision changes is challenging but focusing on adaptation and maintaining positivity can help overcome the challenges. With a combination of therapies that control MS disease activity and low vision aids, many people can still maintain satisfying vision and sustain independence.