Q: What is a
neuro-ophthalmologist?
neuro-ophthalmologist?
A:
People
know about ophthalmologists treating the eye and visual problems and people
know about neurologists treating issues with the brain. A neuro-ophthalmologist
is right in the middle, they treat brain issues that affect vision.
know about ophthalmologists treating the eye and visual problems and people
know about neurologists treating issues with the brain. A neuro-ophthalmologist
is right in the middle, they treat brain issues that affect vision.
There
are a lot of different disorders that affect vision. Some of the common things
are stroke, aneurysms and brain tumors. They can all present with visual
problems. There are also other disorders like thyroid eye disease, myasthenia
gravis and multiple sclerosis.
are a lot of different disorders that affect vision. Some of the common things
are stroke, aneurysms and brain tumors. They can all present with visual
problems. There are also other disorders like thyroid eye disease, myasthenia
gravis and multiple sclerosis.
Q: What is Multiple
Sclerosis?
Sclerosis?
A:
It’s an
immune system disorder. The immune system is designed to protect us from
infection, but sometimes it’s confused and can attack our bodies. In multiple
sclerosis, our systems attack our brain, spine and optic nerves. There are many
different symptoms with anything that the brain or spinal cord is responsible
for. That includes weakness, sensation such as numbness or burning pain,
trouble with walking or balance and of course, visual problems.
immune system disorder. The immune system is designed to protect us from
infection, but sometimes it’s confused and can attack our bodies. In multiple
sclerosis, our systems attack our brain, spine and optic nerves. There are many
different symptoms with anything that the brain or spinal cord is responsible
for. That includes weakness, sensation such as numbness or burning pain,
trouble with walking or balance and of course, visual problems.
Q: Is it true that MS
strikes mainly young adults and women more commonly than men?
strikes mainly young adults and women more commonly than men?
A:
That’s
exactly true. We don’t know why, but MS affects people in a younger age group.
The average age of diagnosis is between 20 and 40 years of age. In addition, it
does affect women more than men. There are a lot of men who have MS, but two to
three times as many women are affected.
exactly true. We don’t know why, but MS affects people in a younger age group.
The average age of diagnosis is between 20 and 40 years of age. In addition, it
does affect women more than men. There are a lot of men who have MS, but two to
three times as many women are affected.
Q: Are visual symptoms
prevalent in people with MS?
prevalent in people with MS?
A:
For a
significant number of patients, the first inkling that they have MS is a visual
problem. Easily a quarter up to half of MS patients might actually present for
the first time with some type of visual problem. Almost all MS patients have
some type of visual disturbance in their lifetime.
significant number of patients, the first inkling that they have MS is a visual
problem. Easily a quarter up to half of MS patients might actually present for
the first time with some type of visual problem. Almost all MS patients have
some type of visual disturbance in their lifetime.
It’s
not uncommon for patients to have double vision. The reason you’re seeing more
than one image is because the eyes aren’t working together. Patients may also
have shaking vision where patients have trouble reading or watching television
because the image is shaking due to the MS. One of the most common vision
problems people with MS present with is losing vision in one eye and that is
called optic neuritis.
not uncommon for patients to have double vision. The reason you’re seeing more
than one image is because the eyes aren’t working together. Patients may also
have shaking vision where patients have trouble reading or watching television
because the image is shaking due to the MS. One of the most common vision
problems people with MS present with is losing vision in one eye and that is
called optic neuritis.
One of
the hallmarks of multiple sclerosis, even the name multiple sclerosis itself,
is presenting with different events, multiple times, during the course of their
disease. We call that attack, relapse, and exacerbation. Any individual system
may get better within weeks to months, but the issue is that sometimes other
symptoms come as well. They can be short lived, but the issue is that you may
have many different symptoms.
the hallmarks of multiple sclerosis, even the name multiple sclerosis itself,
is presenting with different events, multiple times, during the course of their
disease. We call that attack, relapse, and exacerbation. Any individual system
may get better within weeks to months, but the issue is that sometimes other
symptoms come as well. They can be short lived, but the issue is that you may
have many different symptoms.
Q: What is optic
neuritis and how does it affect patients with MS?
neuritis and how does it affect patients with MS?
A:
Our
eyes are like cameras. The eyes are in the front, seeing the world, but they
have to transmit that information back to the brain which allows us to see
things. So if we have a camera capturing the image, the optic nerve is the
cable that connects the eye to the brain. If the optic nerve becomes inflamed
due to multiple sclerosis, we refer to that as optic neuritis.
eyes are like cameras. The eyes are in the front, seeing the world, but they
have to transmit that information back to the brain which allows us to see
things. So if we have a camera capturing the image, the optic nerve is the
cable that connects the eye to the brain. If the optic nerve becomes inflamed
due to multiple sclerosis, we refer to that as optic neuritis.
Optic
neuritis is a specific description of inflammation of the optic nerve. If it
happens, that can be one of the multiple things that characterizes multiple
sclerosis. However, it is possible to have optic neuritis by itself. You don’t
necessarily treat optic neuritis because it usually gets better on its own.
However, we frequently use steroids because they offer instant relief.
neuritis is a specific description of inflammation of the optic nerve. If it
happens, that can be one of the multiple things that characterizes multiple
sclerosis. However, it is possible to have optic neuritis by itself. You don’t
necessarily treat optic neuritis because it usually gets better on its own.
However, we frequently use steroids because they offer instant relief.
Q: How would you
determine if optic neuritis is due to MS or another cause?
determine if optic neuritis is due to MS or another cause?
A:
If you
have optic neuritis, there’s a chance you could have multiple sclerosis, but
really the hallmark of multiple sclerosis is multiple episodes over time. By
definition, if you had a single event, you can say that technically, you don’t
have multiple anything at that point. But the question is will you go on to
have other issues, that’s where the challenge is in diagnosing.
have optic neuritis, there’s a chance you could have multiple sclerosis, but
really the hallmark of multiple sclerosis is multiple episodes over time. By
definition, if you had a single event, you can say that technically, you don’t
have multiple anything at that point. But the question is will you go on to
have other issues, that’s where the challenge is in diagnosing.
We
often use MRI, which is a non-invasive way to image the brain. It seems counter
intuitive that if you come to my office with optic neuritis that we want to
take a picture of the brain, but the reason for this is that we’ve learned that
if you have optic neuritis with lesions or white spots that look like plaque,
then you’re risk of developing MS is much higher than if you had optic neuritis
and a normal MRI.
often use MRI, which is a non-invasive way to image the brain. It seems counter
intuitive that if you come to my office with optic neuritis that we want to
take a picture of the brain, but the reason for this is that we’ve learned that
if you have optic neuritis with lesions or white spots that look like plaque,
then you’re risk of developing MS is much higher than if you had optic neuritis
and a normal MRI.
Q: How effective are
medications in preventing visual symptoms for patients with MS? Is there an
oral medication in development?
medications in preventing visual symptoms for patients with MS? Is there an
oral medication in development?
A:
They’re
good and getting better. When I was in training there was no treatment for MS
at all. In the past 10 or 15 years, we’ve made tremendous strides in treating
multiple sclerosis and there are more and more treatments and they are getting
more and more effective. As far as treating the vision specifically, the MS
medications unfortunately cannot undo damage that has already been done. MS
medications are designed to prevent additional attacks.
good and getting better. When I was in training there was no treatment for MS
at all. In the past 10 or 15 years, we’ve made tremendous strides in treating
multiple sclerosis and there are more and more treatments and they are getting
more and more effective. As far as treating the vision specifically, the MS
medications unfortunately cannot undo damage that has already been done. MS
medications are designed to prevent additional attacks.
If
you’ve had an optic neuritis, you’re probably going to do pretty well. They key
is to consider MS medications to prevent you from having additional MS related
symptoms such as weakness, numbness, imbalance, or other visual symptoms.
you’ve had an optic neuritis, you’re probably going to do pretty well. They key
is to consider MS medications to prevent you from having additional MS related
symptoms such as weakness, numbness, imbalance, or other visual symptoms.
There
is actually an oral medication on the horizon. A first we had no treatment of
any kind, then we got better at treating it, but they were all injectible
therapies. It’s very exciting because we’re seeing more and more pills for MS
being developed and they may be even more effective than the first generation
treatments.
is actually an oral medication on the horizon. A first we had no treatment of
any kind, then we got better at treating it, but they were all injectible
therapies. It’s very exciting because we’re seeing more and more pills for MS
being developed and they may be even more effective than the first generation
treatments.
Q: If someone is
having a sudden onset of vision problems, is it an urgent situation requiring
treatment from a specialist?
having a sudden onset of vision problems, is it an urgent situation requiring
treatment from a specialist?
A:
Absolutely.
Most patients will see an eye doctor first, but it’s important to see a
neurologist if it looks like you have optic neuritis. Sometimes, optic neuritis
signals MS and the earlier you’re treated for MS, the better. If you are
experiencing visual symptoms that could be optic neuritis, you should see a
physician because we really want to do our best to prevent future problems.
Most patients will see an eye doctor first, but it’s important to see a
neurologist if it looks like you have optic neuritis. Sometimes, optic neuritis
signals MS and the earlier you’re treated for MS, the better. If you are
experiencing visual symptoms that could be optic neuritis, you should see a
physician because we really want to do our best to prevent future problems.
Q: How do the eyes and
brain work together to enable us to see?
brain work together to enable us to see?
A:
Humans
are visual animals. We like to explore the environment visually. We have two
eyes that work like cameras, but there’s a lot of neurologic machinery
processing the images.
are visual animals. We like to explore the environment visually. We have two
eyes that work like cameras, but there’s a lot of neurologic machinery
processing the images.
Vision
leaves the eyes and travels through the optic nerves and radiates through most
of the lobes of the brain. We start with the front, obviously with the eyes,
but the pathway travels through the entire brain all the way to the visual
center, the occipital lobe, located at the back of the head. There’s a lot
involved in vision. Imagine if you had two different cameras, you have to make
sure they’re pointing at the same thing or you see more than one image. There’s
also a lot of coordination of the eyes in terms of improvement and integration
of taking the two slightly different images and putting them together so when
we look around, we see only one image.
leaves the eyes and travels through the optic nerves and radiates through most
of the lobes of the brain. We start with the front, obviously with the eyes,
but the pathway travels through the entire brain all the way to the visual
center, the occipital lobe, located at the back of the head. There’s a lot
involved in vision. Imagine if you had two different cameras, you have to make
sure they’re pointing at the same thing or you see more than one image. There’s
also a lot of coordination of the eyes in terms of improvement and integration
of taking the two slightly different images and putting them together so when
we look around, we see only one image.
Q: Why do headaches
and migraine headaches sometimes cause visual disturbances?
and migraine headaches sometimes cause visual disturbances?
A:
A
migraine is an interesting phenomenon. I think a lot of people think of
migraines as being synonymous with headaches and that’s not exactly correct. A
migraine is really a neurologic brain phenomenon and is often associated with
visual disturbances. Some people will have an aural warning. They may notice
blurring, sparkles, flashes or zigzags in their vision and that’s a signal that
a headache is coming on. That’s a classic migraine, when you’re headache is
preceded by visual symptoms.
migraine is an interesting phenomenon. I think a lot of people think of
migraines as being synonymous with headaches and that’s not exactly correct. A
migraine is really a neurologic brain phenomenon and is often associated with
visual disturbances. Some people will have an aural warning. They may notice
blurring, sparkles, flashes or zigzags in their vision and that’s a signal that
a headache is coming on. That’s a classic migraine, when you’re headache is
preceded by visual symptoms.
Some
people can have just the visual symptoms without the pain and it’s counter
intuitive because most people think migraine means headache. Some patients come
to my office with migraine phenomenon, but no headache. They just have visual
symptoms like blurring, seeing gray dots or the sparkle of vision. We call this
an acephalgic migraine, or a migraine with no headache.
people can have just the visual symptoms without the pain and it’s counter
intuitive because most people think migraine means headache. Some patients come
to my office with migraine phenomenon, but no headache. They just have visual
symptoms like blurring, seeing gray dots or the sparkle of vision. We call this
an acephalgic migraine, or a migraine with no headache.
In
general migraines hurt and they’re uncomfortable. Thankfully, they are limited
and treatable and don’t usually leave behind any significant neurologic
symptoms.
general migraines hurt and they’re uncomfortable. Thankfully, they are limited
and treatable and don’t usually leave behind any significant neurologic
symptoms.
Q: What are some other
neurological conditions that can lead to vision changes?
neurological conditions that can lead to vision changes?
A:
The
common one would be stroke. Sometimes aneurysms or brain tumors can cause it
and even a brain infection, if it affects the right part of the brain, can
result in visual problems.
common one would be stroke. Sometimes aneurysms or brain tumors can cause it
and even a brain infection, if it affects the right part of the brain, can
result in visual problems.
In
general I would say if anyone is having a visual problem, the first stop needs
to be with an eye doctor. My focus is on visual problems due to brain issues,
but there are visual problems due to eye issues such as cataracts, glaucoma or
astigmatism. The first step is to see an eye doctor. If the eye doctor examines
the eye carefully and sees that everything in the eye itself appears to be
fine, then you should consider the possibility that the visual problem is a due
to a neurologic cause.
general I would say if anyone is having a visual problem, the first stop needs
to be with an eye doctor. My focus is on visual problems due to brain issues,
but there are visual problems due to eye issues such as cataracts, glaucoma or
astigmatism. The first step is to see an eye doctor. If the eye doctor examines
the eye carefully and sees that everything in the eye itself appears to be
fine, then you should consider the possibility that the visual problem is a due
to a neurologic cause.
Q: Are there new or
upcoming treatments for visual problems caused by neurological conditions?
upcoming treatments for visual problems caused by neurological conditions?
A:
A lot
depends on what the visual problem is. For example with optic neuritis, there
are treatments that help and treatments that prevent future attacks. On the
other hand, sometimes MS, strokes or aneurysms can cause double vision or
misalignment of the eye. In that case the treatment is geared toward getting
the images back together. That can be done by using special prisms in the
glasses to realign the images and occasionally asking a surgeon to help
straighten out the eyes.
depends on what the visual problem is. For example with optic neuritis, there
are treatments that help and treatments that prevent future attacks. On the
other hand, sometimes MS, strokes or aneurysms can cause double vision or
misalignment of the eye. In that case the treatment is geared toward getting
the images back together. That can be done by using special prisms in the
glasses to realign the images and occasionally asking a surgeon to help
straighten out the eyes.
Sometimes
we’ll use the quick trick of covering one eye because if you cover one eye, you
can’t have double vision anymore. You can take advantage of the phenomenon,
especially if someone developed blurred or double vision because there are only
two possibile causes.
we’ll use the quick trick of covering one eye because if you cover one eye, you
can’t have double vision anymore. You can take advantage of the phenomenon,
especially if someone developed blurred or double vision because there are only
two possibile causes.
One
possibility is that the images are blurred or doubled because the eyes are not
aligned well and if that’s the case, then it’s a neurologic problem. The other
possibility is that the blurring or double vision is due to a problem in the
eye like a cataract or a retinal detachment. One trick we use is to ask the
patient to cover one eye or the other to see if that helps the symptoms. If
someone’s eyes are misaligned and they have double vision, when you take away
the other eye, you only see one image. If I had a cataract in the left eye that
made things look blurry and doubled, then covered the right eye and things are
still blurry and doubled, then there’s a problem in that eye.
possibility is that the images are blurred or doubled because the eyes are not
aligned well and if that’s the case, then it’s a neurologic problem. The other
possibility is that the blurring or double vision is due to a problem in the
eye like a cataract or a retinal detachment. One trick we use is to ask the
patient to cover one eye or the other to see if that helps the symptoms. If
someone’s eyes are misaligned and they have double vision, when you take away
the other eye, you only see one image. If I had a cataract in the left eye that
made things look blurry and doubled, then covered the right eye and things are
still blurry and doubled, then there’s a problem in that eye.
There
are also some forms of vision therapy. If you have loss from a stroke and have
a field of vision problem, there are some strategies to try to help your brain
retrain and regain some of the lost visual function.
are also some forms of vision therapy. If you have loss from a stroke and have
a field of vision problem, there are some strategies to try to help your brain
retrain and regain some of the lost visual function.
Q: Many people
experience trouble with their vision as they get older, is this part of normal
aging?
experience trouble with their vision as they get older, is this part of normal
aging?
A:
It’s
called presbyopia. With a camera, I can take the lenses and move them. Our eyes
don’t have the ability for the lens to move, but what our eyes do have is a
muscle that changes the shape of the eye. The lens is made of a clear and
flexible material. When we’re younger, let’s say less than the age of 40, our
eyes are able to change the shape of the lens. Once you hit 40, the lens
doesn’t want to change shape as much. For most people, they have more and more
trouble focusing on things up close and this is the phenomenon where we hold
things far away until eventually, you can’t hold them far enough away. That’s
when people start wearing reading glasses which are really just magnifiers. If
you’re nearsighted and lived your life wearing glasses, you may discover that
you can take your glasses off and see things up close.
called presbyopia. With a camera, I can take the lenses and move them. Our eyes
don’t have the ability for the lens to move, but what our eyes do have is a
muscle that changes the shape of the eye. The lens is made of a clear and
flexible material. When we’re younger, let’s say less than the age of 40, our
eyes are able to change the shape of the lens. Once you hit 40, the lens
doesn’t want to change shape as much. For most people, they have more and more
trouble focusing on things up close and this is the phenomenon where we hold
things far away until eventually, you can’t hold them far enough away. That’s
when people start wearing reading glasses which are really just magnifiers. If
you’re nearsighted and lived your life wearing glasses, you may discover that
you can take your glasses off and see things up close.
http://umm.edu/programs/ms/health/vision-and-neurological-disorders#ixzz3C0IxbTE8
University of Maryland Medical Center
~~~~~~~~~~~~~~~~~~~~
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