eyes

If it's on your mind and it has to do with multiple sclerosis in any way, post it here.

Postby msmything » Fri Feb 13, 2009 6:41 pm

At my last eye exam the Doc took a picture of my optic nerves, There was some damage, but atleast he's got a baseline for yearly comparison now.
Oddly enough, I had visual disturbances dx years and years ago, one eye dilated at a different rate than the other.
Turns out it was probably MS.
Be kinder than necessary, for everyone you meet is fighting some kind of battle..
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Postby EyeDoc » Thu Feb 19, 2009 7:06 pm

cheerleader wrote:Wilson's disease is caused by excess copper in tissue and nervous system, and causes brown/copper colored rings around the iris...right Eyedoc? Are there other metals that can change eye color? Here's one for ya...how about excess iron?
AC


Off the top of my head I can think of a few diseases that can change eye color:

Wilson's disease, pigmentary glaucoma, Horner's syndrome, and Fuch's heterochromic iridocyclitis (how's that for a mouthful). These are all very rare. I have only seen one or two of these in 10 years.

One thing that is common and looks like a color change is something called arcus senilis. In it, cholesterol deposits in the cornea in front of the iris and the iris appears to lighten. The iris is really not changed though. This is seen frequently in older black people (the color change...all races get arcus).

EDIT: I am not sure about excess iron...I'll have to do some homework :)
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Postby cheerleader » Thu Feb 19, 2009 7:53 pm

EyeDoc wrote:.

EDIT: I am not sure about excess iron...I'll have to do some homework :)


Thanks, Doc! I've wondered about Jeff's optic disc drusen. He's had no peripheral vision since he was a kid...it hasn't progressed too much, and the neuro said it's not related to his MS. Just wondered if you knew of any relation to iron deposition/optic nerve hemodynamics and drusen. Especially since I don't have to pay for your knowledge :) (well, yet!)
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Sharon » Thu Feb 19, 2009 9:39 pm

Cheer - has Jeff had an OCT test completed by the optometrist? It will be paid for under medical expenses if you have insurance coverage. It is good to have a baseline test and then repeat each year for comparison. The test is relatively new for MS - see the link below for more info

http://www.medscape.com/viewarticle/558111

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Postby Sharon » Thu Feb 19, 2009 9:43 pm

Cheer - I do not think the link worked, so here is the copy of report
Optical Coherence Tomography May Help Detect MS Disease Processes


Jacquelyn K. Beals, PhD
Information from Industry
Find out about a head-to-head comparison of MS treatment options
Dr. Daniel Mikol discusses the findings from the multicenter REGARD study.Click here.

June 12, 2007 (Washington, DC) — Use of optical coherence tomography (OCT) to quantify retinal nerve fiber layer thickness (RNFLT) may offer advantages over MRI in detecting MS disease processes, a new study
suggests.

Lead investigator Erica Grazioli, DO, a fellow at the Baird Multiple Sclerosis Center, Jacobs Neurological Institute, Buffalo General Hospital, in New York, and currently in the department of medicine, division of neurology, at Hamot Medical Center, in Erie, Pennsylvania, presented the study here in the Whitaker Research Track presentations at the Consortium of Multiple Sclerosis Centers 21st Annual Meeting.

The study included 30 patients with relapsing/remitting MS. Eighteen of these had quantitative magnetic resonance imaging (MRI) measurements of T1- and T2-lesion volumes (T1- and T2-LV) as well as normalized brain, cortical, white-matter, and gray-matter volumes. Twenty-one patients had a history of optic neuritis (ON): 13 unilateral and 8 bilateral.


Dr. Grazioli reported she was surprised to find a significant association between T2-LV and average RNFLT (P = .002). A weaker association of T1-LV and RNFLT (P = .041) was also observed. RNFLT also showed strong, statistically significant associations with normalized brain volume and normalized white-matter volume; a borderline association was seen with normalized gray-matter volume. The correlation between average RNFLT and expanded disability status scale (EDSS) was negative — that is, decreased RNFLT correlated with increased disability scores.

"OCT is much quicker — it takes 5 minutes, as opposed to an hour to do an MRI. It's cheap compared with MRI, which is certainly costly," Dr. Grazioli told Medscape. "And it's looking as though it's going to be more specific for neural degeneration than MRI is." Dr. Grazioli noted that the MS community in general is exploring neural degeneration more than in the past, and that is where this new technique is heading.

The difference between RNFLT in ON-affected and nonaffected eyes was significant, although decreased RNFLT was also seen in nonaffected eyes. Dr. Grazioli observed that this "probably represents subclinical disease activity, in the same way we can see on an MRI that some patients will develop atrophy over time, independent of their T2-LV. The neurodegeneration we see of the optic nerve without a clinical history of ON probably represents the atrophy and neurodegeneration components of the disease that we're not picking up well now."

Michael Racke, MD, chair of the department of neurology of Ohio State University and moderator of this session, told Medscape that a typical MRI takes about an hour and with gadolinium it is a bit longer. "I think OCT is going to be an interesting surrogate, although I'm not sure it's going to replace MRI. The other big advantage is the cost. OCT is around $100 vs $1000 or so for MRI. That's a significant thing."

He also added that Dr. Grazioli had not gone into as much depth on the RNFLT thinning in patients who have not had optic neuritis. "So, is it going to be a helpful outcome measure? It may be a more valuable outcome measure when we start doing trials specifically to look at neuroprotective agents. I think you're going to have to hook OCT up to 1 of the big clinical trials to really validate it. And once it's validated, then it can be another outcome measure that will be used."

Consortium of Multiple Sclerosis Centers 21st Annual Meeting. John Whitaker Research Track. Presented June 1, 2007.




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Postby jimmylegs » Fri Feb 20, 2009 5:08 am

soooo back to the zinc idea from page one? i guess we've established that it doesn't have much to do with the iris, but now we're back to the retina. here's a related study, rat sciatic nerves sure, but interesting given what we already read about zinc and the retina

Zinc (Zn) is an essential trace element for humans and animals. It is required for normal growth, gene expression, wound healing, protein metabolism, immune function, and membrane integrity. In this study, unbiased stereological methods have been used to quantify the effects of Zn deficiency on the sectioned surface area and the number of myelinated axons in the sciatic nerve of rats... The sectioned surface area of nerve cross-section and myelinated axon number in Zn-deficient rats decreased by 20% and 29%, respectively, compared to the control group... Morphological findings were as follows: on light microscopy, it was determined that certain abnormalities occur specifically in the experimental group, such as collapsed nerve fascicles, irregular profiles of and degeneration in myelin sheaths, and on electron microscopy, extensive myelin damage was seen in Zn-deficient groups compared with control groups. This study suggests that peripheral nerves require Zn for development and preservation of their structure.


and for some human interest:

Zinc, an essential mineral in human nutrition, has multiple and complex ocular and systemic functions... Observations of Denver children have suggested that suboptimum zinc nutriture may be quite common in otherwise normal infants and children in the United States. The most likely cause of this deficiency is dietary insufficiency. High concentrations of zinc are found in human ocular tissues and are closely related to visual function. When zinc levels are inappropriately low, results can include ocular birth defects, reduced ability to dark adapt, excessively low IOP, and optic neuritis. Correction of zinc deficiency with zinc supplementation must be done cautiously because excessive zinc can interfere with the metabolism of copper and zinc.


thoughts?
my approach: no meds so far - just nutrient-dense anti-inflammatory whole foods, and supplements where needed
info: www.whfoods.com, www.nutritiondata.com
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Postby EyeDoc » Fri Feb 20, 2009 4:04 pm

You guys are killing my MS-affected brain with all these complex thoughts!

Cheerleader: Optic disc drusen are due to calcification. I believe this would be unrelated to an iron deficiency. This is my opinion on the matter, and I have not seen anything in the literature to suggest otherwise.

Sharon: I am not sure that OCT is covered by medical insurance for MS as a diagnosis just yet. Some insurance may cover it, but not all. I hope it will be fully covered soon, though. As an aside: The OCT is a wonderful tool for measuring the thickness of the retinal nerve fiber layer. This is the layer that carries light signals into the optic nerve which allows us to see. OCT is currently covered by insurances and used for diagnosing and following glaucoma patients. There are other disease that can affect this layer, including MS, but medical insurance coverage is not complete. Irregardless, I do baseline OCT measurements on all MS patients whether I can get paid for it or not. I don't have a good baseling measurement for myself, though. I have cataracts in each eye that are caused by steroid treatments I have received in the past (thank you again, MS). My catracts are smack dab in the way of the OCT getting a good measurement. Crud. Maybe I should try again. Aside #2...as great as the OCT is, it costs about $60K. Don't expect all eye doctors to have one.

Jimmylegs: I think the link between zinc and retinal health is well established now by the scientific community. The moral of the story is that we should all take at least a multivitamin daily that will supplement our zinc intake.

Phew! Ok, back to work...:)
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Postby jimmylegs » Fri Feb 20, 2009 5:07 pm

i agree eyedoc. i think it's interesting that given that well known link and the well known suffering of optic neuritis in ms patients, and the lower zinc level in ms patients, that it's not sort of up front and centre a little more. when i presented my list of supplement ideas at the ms clinic at the hospital they were dismissive and i had to find out on my own a couple of years later about my zinc deficency!
my approach: no meds so far - just nutrient-dense anti-inflammatory whole foods, and supplements where needed
info: www.whfoods.com, www.nutritiondata.com
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Postby EyeDoc » Fri Feb 20, 2009 7:10 pm

I am certainly no expert in supplements and diet deficiencies, but I agree at least to the point we should all be taking supplements. I don't really believe any one or any few deficiencies have caused MS, but it can't hurt to try and gain any advantage we can in our fight.

I think we hijacked this thread :twisted:
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Postby jimmylegs » Fri Feb 20, 2009 8:21 pm

well, it's about eyes still... hehe
i dont know about the chicken or egg factor as far as the nutrition element goes, but i think if there are known nutritional problems among patients, why not go for optimal so your bod has the best chance of beating symptoms? most ms patients' zinc level is inside the normal range, but that's not good enough.
my approach: no meds so far - just nutrient-dense anti-inflammatory whole foods, and supplements where needed
info: www.whfoods.com, www.nutritiondata.com
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