Optic Neuritis

[Youarethecure]

MsandI, is your eye also extremely painful to touch and movement?

Steroid treatment is the fastest... and the only thing to restore it faster (I think). But over time it should get better and hopefully back to normal or close to it. Ether way it will heal to whatever it is going to get to, the steroids just make it a faster healing. The overall healing will be the same with or without steroids. Steroid treatments are intense and have many many many side effects. For me, its my very last option if something is too severe.

[kengriff]

The inflammation of the optic nerve can cause a complete or partial loss of vision, this condition can be defined as optic neuritis. This is a multi-etiological condition . The most common etiology is multiple sclerosis.

[MSandI]

Hi youarethecure
I had steroids for 3 days. The pain in the eye is gone (thank goodness). I still get a wicked headache, I can see better when I cover the right eye, I am more fatigued than I normal, and my walking is better when I close the right eye.
I went to the eye specialist, had some testing done and he says optic neuritis. One thing very strange though, my pupil acts differently during the flashing light test when I am in a room that has light in it, verses a dark room. He says he has not seen that before. He said it was called afferent?
It is nearly impossible to read right now. Glad I have touch screen so I can enlarge the writing. I have to admit, I am scared but trying so hard to stay positive and hopefuuly regain my sight.

Have a good day everyone
Ann

[jackD]

A caution on oral prednisone treatment for optic neuritis.

jackD

N Engl J Med. 1992 Feb 27;326(9):581-8.

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis.

The Optic Neuritis Study Group.
Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR, et al.
SourceDepartment of Ophthalmology, University of South Florida College of Medicine, Tampa 33612.

Abstract
BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period.

RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95).

CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.
Comment in
N Engl J Med. 1992 Feb 27;326(9):634-5.
PMID:1734247[PubMed - indexed for MEDLINE]

[MSandI]

Hi jackd
Thank you for the information. I only had the 3 day course of intravenous, but no oral steroids afterwards. I am just waiting to regain the sight in my right eye. They tell me the wait time is different for everyone, but no guaranties either. His words were.... "I am not telling you that you will regain your sight, but I am not telling you won't either"
Ann

[jimmylegs]

hi fyi

Nutritional effects of zinc on ocular and systemic physiology.
http://europepmc.org/abstract/MED/6454715
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.

serum zinc in ms = low to mid normal; serum zn in healthy controls = high normal

choosing more zinc rich foods, and fewer zinc depleting anti-nutrient foods/meds, may help

[MSandI]

Thank you JL,
I will be on the search for foods rich in zinc. I am grateful for your insight in this matter.
Ann

[jimmylegs]

np

zinc-dense food chart
http://www.whfoods.com/genpage.php?tnam ... #foodchart
(tally up daily mgs per serving)

mineral balanced zinc-rich recipe
http://www.whfoods.com/genpage.php?tname=recipe&dbid=32

zinc (and other mineral) depleting influences include imbalanced/improperly prepared/excessive intakes of high phytate foods, gluten, alcohol, dairy, sugar.. and that's all i can think of off the top of my head

if studies exist which examine specific effects on zinc status of different levels of intakes of these various dietary influences, on their own and in combination, i haven't run across them yet. in the meantime if oysters don't appeal, a supplement (carefully selected for form/balance) on the order of 25-50mg per day can help meet daily intake requirements.

hope that helps too

[jimmylegs]

also i was just reading back over the thread and noted with interest the part about some people noticing an odd taste with the saltwater/med preparation - zinc is linked to smell and taste perception as well. wonder if there might be a connection there...

[jimmylegs]

related study:

Zinc supplementation at conventional doses does not improve the disturbance of taste perception in hemodialysis patients http://www.jrnjournal.org/article/S1051 ... 4/abstract "Sour was often confused with salt. Sour solutions of different concentrations were not distinguishable. Taste scores were not different after 6 weeks for either group. There was no significant increment in zinc levels or normalized protein catabolic rate for either group."

end plasma zinc levels in the treatment group: 10.4 +/-1.4 umol/L. normal range for serum zinc (not a huge difference vs plasma zinc) at my hospital's lab is 11.5-18.5 umol/L so by that standard, most of the zinc treatment group remained deficient throughout the study.

the problem is not zinc supplements failing to affect taste perception. a more nuanced assessment would be that the selected supplement regimen, given the study context, failed to restore healthy zinc levels and associated functionality.

[mkbmomma]

Hi, I was diagnosed with MS in April after a short time of initial symptoms. I have been on Tecfidera since May. I had never had vision problems until recently. It began with a stabbing pain behind my right eye, headaches in the back of my head, neck pain and pain when looking over my right shoulder. I had those symptoms for about a week and then I started having vision loss in my right eye on September 19th. I saw my regular eye Dr. who confirmed it was ON and then I saw an Ophthalmologist on September 30th. He also confirmed the ON and prescribed me Feldene (non-steroidal anti-inflammatory). He and my Neurologist did not want me on Solu-Medrol because I had had a 5 day course in May with no relief of my other symptoms which were numbness and tingling from my waist down.
I have been handling the vision loss alright up until now......I am beginning to get depressed and am gaining weight from the Feldene (I think) and generally am not feeling like myself. I see both my Neuro and Ophthalmologist on Tuesday for a recheck. I'm trying to remain calm since my left eye is still 20/20 and I am able to drive, though I have not driven at night yet. Stupid as it sounds, I am concerned about the time change when it will get dark sooner. I work full time and have 3 young boys ages 7, 5 & 2. It takes all my strength to not cry while trying to watch my son's football game and not really being able to see. I should be wearing a patch all of the time on my right eye, but I don't like explaining to people why I am pretending to be a pirate. I have hopes for full vision recovery, but the waiting game is almost becoming too much. Thanks for listening and any encouragement would be helpful....

[MSandI]

Hi mkbmomma,
I am much like you with my ON. I have seen my ophthalmologist 2 times since sept 20th. I saw my neuro yesterday, they are both in agreement that I do not cover my right eye. It was explained to me that both eyes need to look straight ahead. If you cover the blind eye it MAY lose its spot by 5 to 10 degrees, then it will not regain its sight. I know how hard it is, I to live it everyday. My doc put me off work and has told me not to drive, and if I do he will write a letter to the DMV and have my licence revoked. I would not drive now, I am to scared. Neuro wants another mri, because I started aubagio about 5 months ago now. Good luck, stay positive and gets lots of rest. That is my plan and it seems to be working.

Hi JL,
Good article on zinc, thank you. Any other suggestions would be greatly appreciated. Have a good day everyone.
Ann

[mkbmomma]

Hi MSandI, Thanks for the response. My Ophthalmologist didn't mention about losing sight in my bad eye by covering it and letting my good eye do the work. He explained it that it's actually harder on my good eye because the brain signals are getting crossed. So this is why the field of medicine is frustrating sometimes.....because of the conflicting information and opinions of MD's out there!
Did you start taking the DMT 5 months ago because that's when you were diagnosed or because you were having symptoms that prompted you to start on treatment? I keep hoping that the reason I've had a relapse is because my body has not been on the Tecfidera long enough, not because my disease is progressing DESPITE being on the DMT. It's the "unknowns" and "everybody's different" part of this disease that I am struggling with. I want ANSWERS that nobody can give me. Not because they don't want to, but because they just don't know. I will just keep plugging away, that's about all I can do. I hope you find relief and restored vision soon! Take Care.

[MSandI]

Hi mkbmomma
I do agree with you about different drs having different opinions. I have chosen not to cover my right eye for the reason the two gave me. I was on avonnex for some time, got some bad side effects then went of all dmds for 8 months. I thought I was going to cure myself through diet, exercise and vitamins. Did not work for me...mri indicated more plaques in the brain. Neuro then startrd me on aubagio. Five months later, relapse(ON). I did 3 days of steroids. My neuro also told me yesterday if on the Oct 20(1 month later) I stll have no improvement he wants me on a 5 days course of iv steroids.
If I can tell you one thing that I kept telling myself everyday, Tomorrow is a brand new day that has never been touched, so lets just wait and see. It is working for me, I get scared easily and this one threw me for a loop. I also meant to ask you, is your neuro asking for another mri because you had a relapse?
Ann

[mkbmomma]

Hi Ann, I went to my Neuro and Ophthalmologist yesterday. Interestingly enough, the Optho. retracted his earlier statement about patching the bad eye! He said only patch it if I was feeling dizzy or just couldn't function. Vision in my right eye has actually improved slightly. He has kept me on the Feldene and then also gave me glaucoma eye drops just to help with the blood flow even though my pressure is fine. I'm having some muscle spasms in my good (left) eye due to the strain of it doing all the work. I go back in 1 month for a recheck of my vision.
The Neuro did not order another MRI because he felt that it wouldn't change the course of treatment. He said I am doing better than I think I'm doing. He actually didn't think my ON was a relapse, but actually just part of my MS. I guess he feels that even though most of my symptoms have subsided, I've still had symptoms since May (my feet still tingle) and so he considers it just having a new symptom of MS, but not a relapse. I am starting to understand that I need to be grateful for the 20/20 vision I have in my left eye and just keep putting one foot in front of the other. Both Dr.'s do NOT want me on IV steroids. I believe it is because of how hard it is on the body and the fact that I did not have much response (in terms of symptom relief) to 5 days of IV solu-medrol back in May. So for now I just will stay the course and wait. He did recommend that getting through the work day was most important, but to continue to do my daily activities such as reading/watching TV, but to rest when I can because that will help also with the strain.
I hope you show improvement on your October 20th appt.!!
Stay strong.