so what exactly is this Optic Neuritis I'm having....

In case you're unfamiliar, I'll give a little explanation and photo to see "what I was seeing" (mine never got quite this bad, but you get the idea!)



The main symptoms of Optic Neuritis are:

1. Loss of visual acuity (blurring of vision) which occurs in around 58% of ON cases. This can range from mild blurring of vision in 34% of cases, through moderate loss of acuity (12%), to severe or total loss of light perception (complete blindness) in 54% of cases. (I have this)

2. Eye pain occurs in 53% to 88% of ON presentations. In one study examining the pain associated with ON, 12% of cases reported no associated pain, 21% patients reported that the pain was only noticeable with eye movement, in 16% the pain preceded a loss of visual acuity, in 22% it occurred as a general eye ache, in 16% it was reported as a headache centering on the affected eye and in 13% it was reported as a generalised dull headache [Nikoskelainen, E. 1975]. (I had pain during eye movement, and a dull-achey headache)

3. Dyschromatopsia (reduced colour vision) occurs in 100% of optic neuritis cases. Typically this is reported as a reduction in colour vividness, particularly reds. An Ishihara colour chart and/or Farnsworth-Munsell hue tests are often used to evaluate the degree of dyschromatopsia. If the inflammation is not visible on the macular (back of the retina), then dyschromatopsia is the most sensitive clinical diagnostic measure of optic neuritis. (I experienced some cloudy/color loss)

4. Movement and sound phosphenes (visual flashing sensations brought about by side-to-side eye movement or sound) often occur with optic neuritis. They are most obvious in a dimly lit room. Obscuration of the visual field in bright light is another common symptom of optic neuritis and many people with ON, particularly those with a chronic condition, report that they see better in dimly lit rooms. It is likely that both of these symptoms are caused by fluctuating interference of the nerve transmissions along the visual pathways. (It was like seeing stars, but all the time!)

5. Uhthoff's symptom, the worsening of symptoms with heat or exhaustion, is present in about 58% of cases of Optic Neuritis. (heat and my MS are not BFFs...so a few days without a working AC did not help this situation!)

TESTING: Visually Evoked Potential (VEP, VER) tests, which detect the speed of nerve transmissions down the optic nerve, are used as a diagnostic test for optic neuritis. (This was done on 9/5 and the delayed vision response was noted. This prompted a visit to the ER on Sunday to start steroids for the optic neuritis. I go back today, 9/12, for a recheck.)

The rate of onset of Optic Neuritis varies from a few hours to few days and occasionally greater. Typically sight is at its worst around one week after onset of symptoms. (mine was about a week, til it got so bad I was freaking out!)

Recovery from ON is usually very good, often complete and even in the worst cases patients seldom fail to recover some sight. In around 65-80% of patients, the sight recovers to 20/30 or better, although many report some enduring visual deficits. (I'm already noticing some increased vision and no more pain!)

Reoccurrence of Optic Neuritis in one or other eye is seen in about 33% of cases. Reoccurrence is more likely in people with Uhthoff's symptom (48%). (oh, great!)

The inflammation associated with Optic Neuritis can often be observed with an opthalmoscope on the back of the eye (macular) provided that the inflammation is not further back along the optic nerve (retrobulbar optic neuritis). (not sure if this was seen, but my inflammation could be in the way back of the nerve and possibly not noticed on this test.)

Cortico-Steroids (oral prednisone and IV methylprednisolone) have been shown to significantly increase the rate of the recovery from optic neuritis. Continued use of steroids for around 3 years has been shown to delay the reoccurrence of ON and conversion to multiple sclerosis [Beck, R. W., 1995]. However, such studies have shown that after 4 years of use, they have no long term effect on either the reoccurrence of ON nor on conversion to MS. Indeed one study has shown oral prednisone treatments to actually increase the long-term probability of reoccurrence. It should also be remembered that cortico-steroids, particularly their continued use, have significant side effects. (I'm on solumedral. raging appetite, hot hot hot, flushed face and lips, can't sleep, figity....let me tell you it's so fun...but it's worth it in the end to be able to see clearly!!!)

COP-1 (Copaxone) and beta interferons have both been shown to reduce the probability and severity of reoccurrences of optic neuritis in addition to the other symptoms of multiple sclerosis. (I take a daily injection of Copaxone...and after this flair up, I'm doing it every day, no matter what! Yes, I inject myself daily with 20mg of an MS drug that without insurance costs $1800/month.)