Multiple sclerosis
Multiple sclerosis or MS is an autoimmune disease that occurs when the myelin sheath that protects nerve cells is damaged. This leads to slowing of nerve impulses. Inflammation along the brain, optic nerve or spinal cord leads to nerve damage.
Those who have a family history of MS are more susceptible to this condition. The symptoms appear in episodes that relapse after days or weeks or even months. The episodes might be triggered by stress or fever.
Symptoms of Multiple sclerosis appear all over the body as they affect nerve cells. There is numbness and loss of balance, tremors in arms or legs, muscle spasms and difficulty in walking. There is an overriding feeling of fatigue. Patients suffering from MS might have eye discomfort with double vision or loss of vision. There might be painful spasms in the facial muscles and stool or urine leakage. The person might experience depressive feelings, slurred speech and difficulty in swallowing.
MS is diagnosed through brain MRI and spinal MRI. Spinal tap of cerebrospinal fluid is done to check for Multiple sclerosis. Medications to reduce the degradation caused by MS include interferon, Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan). Speech therapy and occupational therapy helps the patients to a large extent.
Optic Neuritis
Optic neuritis is a condition where the optic nerve gets inflamed. Due to the inflammation, light and visual images are not clearly transmitted to the brain. Optic neuritis can be caused by autoimmune diseases such as multiple sclerosis or viral infections such as chicken pox or measles. Optic neuritis is usually the first sign of multiple sclerosis. This condition tends to affect more women than men.
Patients suffering from optic neuritis notice reduced vision. This is more so when the body temperature is elevated. The eyes are sore and painful when moved. There is reduced color perception and diminished peripheral vision. Persons suffering from optic neuritis may have headache and fever. The vision diminishes for about a week and then gradual improvement is noticed. Typically most patients suffering from optic neuritis tend to recover most of their vision within about 6 months.
The opthalmologist will test the patient's color vision and visual field. Eye presure and pupillary function will be examined. The optic disc is viewed with indirect ophthalmoscopy. Brain MRI may be taken for testing for multiple sclerosis. Intravenous steroid medication has shown results on those suffering from initial occurence of optic neuritis.
Neuro Ophthalmologist
All vision problems need not necessarily stem from the eye. Some vision problems involve the brain. Neuro ophthalmology is the sub specialty of both neurology and ophthalmology. A neuro ophthalmologist is a phycian who specializes in the diseases affecting vision that originates from the nervous system. Conditions such as optic nerve disorders, loss of vision from central nervous system disease, double vision diplopia and involuntary movement of the eyes nystagmus are some of the disorders under the purview of a neuro ophthalmologist. An ophthalmologsit attends to patients with disease or injury in the eye ball, cornea and the lens or into the eyeball at the retina inside the eye. If any problem occurs behind the eye in the optic nerve or in some distinct visual pathways connecting the brain, it requires the special skills of a neuro ophthalmologist.
A neuro ophthalmologist could be an ophthalmologist or a neurologist with additional special training. After completing a residency program in any one of the two specialty areas, they take a fellowship in neuro ophthalmology for a year or two before starting to practice as a neuro ophthalmologist. A neuro ophthalmologist attends to a full spectrum of neuro opthalmic conditions including evaluation, diagnostic and referral services of rare and complex disorders. A neuro ophthalmologist caters to:
- Patients who suddenly lose part of their side vision.
- Patients suffering from double vision.
- Patients with unequal pupils.
- A patient suffering form a stroke.
- A patient with brain tumor
- Patients who suddenly have their vision out of focus
- Any and every patient with unusual vision problems.
In addition to the above, a neuro ophthalmologist provides emergency evaluation of a wide variety of disease that can cause visual loss. Unexplained visual loss can arise out of uncommon disease conditions like myasthenia gravis, multiple sclerosis, mitochondrial disease and other muscular diseases that affect the eye. The neuro ophthalmologist uses special testing techniques including visual fields, visual evoked response, imaging studies such as CT, MRI and angiography and ultrasound to diagnose the disease patterns. It becomes necessary for the neuro ophthalmologist to work closely with other medical specialists to offer multidisciplinary care and solution for complex cases.
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