This Is MS Multiple Sclerosis Community: Knowledge & Support

Found this interesting since I have had no visual symptoms yet. I have yearly exams and my optometrist knows I have MS so he does more extensive tests but I wonder if that's enough. I've always had bad eyes but they do seem a little worse over the last few years.


Vision Deteriorates Even Without Sight-Related Symptoms in Patients With MS: Presented at ARVO
By Ed Susman

FORT LAUDERDALE, Fla -- May 5, 2009 -- Researchers suggest that clinicians make a point of checking patients with multiple sclerosis (MS) for diminished vision even when the patients have not experienced any vision-related symptoms such as optic neuritis.

The study was presented here on May 3 at the Association for Research in Vision and Ophthalmology (ARVO) 2009 Annual Meeting.

"Our findings suggest a subclinical axonal loss in the anterior vision pathways of patients with multiple sclerosis that occurs without symptoms," said lead author Esther Bisker, MD, University of Pennsylvania, Philadelphia, Pennsylvania.

More precise studies that can reveal vision loss, such as low-contrast acuity tests, will help identify patients who may have deteriorating sight.

"Our study indicates that these tests should be performed among all patients diagnosed with multiple sclerosis, not just those with a history of vision complications," said Dr. Bisker.

She stated that visual dysfunction and axonal loss commonly occur with MS and that optical coherence tomography has enabled researchers to see the unique correlations between structure and function of the anterior visual pathway in this disease.

The researchers followed 1,011 patients in the MS treatment programs at the University of Pennsylvania; Johns Hopkins University, Baltimore, Maryland; and University of Texas Southwestern Medical School, Dallas, Texas.

High-contrast and low-contrast visual acuity were checked at 6- and 12-month intervals, and optical coherence tomography was used to determine differences in thickness of the retinal nerve fibre layer. The final analysis involved 336 patients.

The patients were separated into 2 study groups -- 1 involving 428 eyes of patients who did not experience optic neuritis and the other involving 220 eyes of patients who did experience optic neuritis. Patients had a mean age of 44 years, and 85% were diagnosed with relapsing-remitting MS.

Worsening of low-contrast acuity was noted in 74 eyes (29%) of people with a history of optic neuritis, whereas similar worsening of low-contrast acuity was seen in 638 eyes (35%) of patients who had no history of optic neuritis.

Dr. Bisker said the difference did not rise to statistical significance but underscored that clinicians need to be aware that visual deterioration is ongoing in MS.

Funding for this study was provided by the National MS Society and the National Eye Institute.


[Presentation title: Clinical and Ocular Imaging Characteristics of Eyes With Visual Loss Over Time in Multiple Sclerosis. Abstract 927-D709]

This is why optical coherence tomography (OCT) should be done on all MS patients. Ask your eye doctor if they have this instrument. Get a baseline measurement done, but be aware that a diagnosis of MS is not considered reimbursable for this test by medical insurances yet so you may have to pay for it out of pocket.

In my clinic I do this test on all MS patients. I don't charge them for it...but I am probably a big ol' softy with MS patients

This is a brand new topic for me. Could you quickly explain what the practical implications of this are? Ie different glasses? Some other treatment?

Thanks!

Jen.

The practical implication is basically just that we can monitor how much the MS is progressing year to year. Prior to this technology the only way to monitor MS progression was through MRI. So theoretically if I see a large change in a patient one year to the next, I could then talk to their neurologist to let them know there was a good bit of progression. Perhaps a neurologist could get more aggressive with this patient's treatment.

The readings from this instrument will not help us with glasses prescriptions.

Optical coherence tomography is a way to track damage to the nerves in the retinal tissue. Here's an article which briefly discusses the technique.

http://www.news-medical.net/news/31252.aspx

NHE

To All -

My insurance has covered OCT tests for two years. Dr.'s office must be coding it without the MS

Eyedoc wrote:


Sharon

Eyedoc or anyone else, do you have any idea how much the OCT might cost if my insurance doesn't cover it?

Here is a breakdown of my eye doctor bill - this was for the OCT and a complete eye exam. I do not know the codes - maybe "eyedoctor" can help

Ophthal-Comprehensive #92014
Refraction-Post Op #92015

Breakout of bill:
x-ray or lab services 85.00 - ***noted-charges...considered to be experimental or investigational
x-ray or lab services 85.00 **same notation as above
x-ray or lab services 130.00
medical services 25.00
office visit 110.00
total 435.00

I paid $40.00 for my deductible - that is all
I had Aetna insurance at the time

Thanks! Very helpful.

Thanks Sharon. I have VSP. I'll have to find out if it is covered.

Scoobyjude -

Glad I could help - good luck. Oh, be sure to get a copy of your report for your records when you get the tests. I have found that if I ask at the time of testing (whether it be MRI's or whatever), I will not be charged. If I ask later, they charge a "copy" fee. I am a strong advocate to make sure that I have a file with my medical tests - all of them - blood tests, annual exams, MRI's, X-rays, doctor's visits, etc., etc.

will do

There you go...look at the notes that says "considered to be experimental". That is indicative that some insurances will not cover it. Believe me. I have tried to get reimbursed many times and been denied. Perhaps some insurance companies are starting to cover it. That is great.

I believe we charge approx $75.00 per eye for the test.