Managing vision problems.

Many people with MS will have MS-related vision problems at some point in their life. In fact, vision problems are often the first sign that MS has struck. These problems are vastly different from ordinary woes, such as near- or far-sightedness, and they are usually treated with intravenous steroids.

The good news is that most MS-related vision problems are temporary and respond well to this treatment. In many cases, the problem will eventually go away even without treatment. But this does not mean that doing nothing is the best response.

Over time, some recurring visual problems may no longer resolve, especially if the optic nerves become damaged. Avoiding permanent eye damage is another reason why treatment with a disease-modifying drug (Copaxone, Avonex, Rebif, or Betaseron) is recommended soon after MS has been diagnosed.

The most common problems

Optic neuritis involves inflammation or loss of myelin insulation of the optic nerves. It causes pain, blurring, dimming of vision, or blind spots in the visual field.

Diplopia, or double vision, results from MS damage and makes it impossible for both eyes to point simultaneously and in synchrony at the object being viewed.

Nystagmus occurs when the eye involuntarily jerks around, causing the person to feel that the world is "wiggling."

If a person has any of these symptoms, my first goal is to determine the cause. Getting to the root of serious vision problems may involve MRI scans, a spinal tap, and other tests to definitely diagnose MS and rule out other, rarer possibilities.

How are MS vision problems dealt with?

If MS is the culprit, the single most important thing a person can do is to begin treatment with a disease-modifying drug. I also typically recommend steroids to address the immediate vision problem.

Some people who have diabetes or bipolar disease may not be able to tolerate steroids. Some neurologists recommend intravenous immunoglobulin (IVIG) for these people, although a study of this treatment at the Mayo Clinic had inconclusive results. Some people report relief from vision problems after taking vitamin B-12 shots. (Adequate vitamin B-12 is one of the important components of healthy optic nerve function.) Occasionally a physician will resort to using chemotherapy or powerful immunesuppressing medications to slow down inflammation of the optic nerves.

There are also a number of things a person can do to manage these problems.

Some relief from optic neuritis pain may be provided by cold compresses applied to the eye. If brightness or sensitivity to light is an issue, I usually suggest sunglasses.

Diplopia can sometimes be helped with prism glasses. They have lenses that redirect light into the eye.

Many people find that covering one eye--it doesn't matter which one--can also reduce the sensation of seeing double or multiple images. Patching is not harmful.

Nystagmus is the most difficult MS-related vision problem to relieve. In some cases, it can be controlled with Botox. (A shot directly into the eye socket sounds awful, but with anesthetic it is more difficult psychologically than actually painful.) Neurontin (gabapentin), a drug used for seizures, may also be helpful for nystagmus.

If you're having trouble seeing: see someone

While most MS-related vision problems resolve over time, it is important to have them checked out, diagnosed, and treated to forestall permanent problems. If you are experiencing double vision, eye pain, black spots in your vision, or jerking eye movements, ask your doctor for a referral to an ophthalmologist or neurologist.

Living with low vision

Should MS damage vision permanently despite good care, there are a number of aids to help people adapt. Solutions range from magnifying devices and closed circuit television, to bright tape for marking doorways and higher wattage light bulbs. Strategies are discussed in "Living with Low Vision," from the Winter 2001 issue of InsideMS. Download a copy from our Web site at nationalmssociety.org/livingwithlowvision, or call your chapter at 1-800-FIGHT-MS and request a copy to be sent to you.

Learn more

The National MS Society offers a number of online and in-print guides for visual problems and coping strategies. Go to nationalmssociety.org/vision or call your chapter at 1-800-FIGHT-MS to get copies of this literature.

Dr. Misha Pless is associate professor of neurology at Harvard Medical School, Massachusetts General Hospital. He has specialized in neuro-ophthalmology for 10 years.