How Does Multiple Sclerosis Affect Vision?

Multiple sclerosis (MS) is a disease where the immune system attacks healthy nerve cells. The protective coating of these cells, known as the myelin sheath, is damaged as a result. Damage to these cells can result in long-term scarring in the brain, which can cause a variety of symptoms.

Although MS affects every person differently, the National Multiple Sclerosis Society (NMSS) warns that vision problems are often the first sign of the disease.

Vision Problems Associated with MS

Vision problems in people with MS vary significantly. They can appear and then disappear suddenly and can impair one or both eyes. The problems may worsen before disappearing, or they may remain.

Optic neuritis

According to the Multiple Sclerosis Trust, 70% of MS patients will develop optic neuritis at some point in their lives. For some people, optic neuritis may be the first sign of MS.

The optic nerve connects the eyes to the brain. MS can break down the myelin sheath that surrounds your optic nerve, causing the inflammation of the nerve that leads to optic neuritis. This demyelination may become more extensive and chronic as MS progresses.

Optic neuritis causes blurry or cloudy vision. Mild pain or discomfort may also occur, particularly when patients move their eyes. The most noticeable visual disturbance will most likely occur in the center of your field of vision, although it may also impair your peripheral vision.  Colors may appear less vibrant than usual.

Diplopia (double vision)

In healthy eyes, each eye sends identical information to the brain, which it interprets and develops into one clear 3-dimensional image. When your eyes don’t function correctly, each eye sends a different image to the brain, which the brain cannot fuse together. This causes diplopia, more commonly known as double vision.

Diplopia is a typical symptom of MS once the brainstem is affected. Cranial nerves that flow through the brainstem govern the muscles that move the eyes, so any injury to the route can cause the eyes to become uncoordinated, sending two different images to the brain.

Though advancing MS can cause permanent diplopia, it can also resolve completely and spontaneously.

Nystagmus

Nystagmus is a vision condition where the eyes make repetitive and uncontrolled movements. The movement is usually rhythmic and causes an eye jerking or jumping sensation. As a result of these eye motions, patients may feel dizzy or nauseated.

People with MS frequently have oscillopsia or the sensation that the world is swaying from side to side or up and down.

An MS attack affecting the inner ear or the cerebellum, the brain’s coordination center, is a common cause of this type of visual impairment. It affects some people solely when they glance in a particular direction. Certain activities may aggravate the symptoms.

Nystagmus is a common MS symptom that develops over time or after a relapse.

Vision loss

The symptoms of MS tend to worsen as the disease progresses. Advanced demyelination has the potential to harm your optic nerve and other vision-related components of your body. This can have a long-term impact on vision.

Treatment options

Each type of visual disturbance has its own set of treatment options. What’s best for you is determined by your symptoms, disease severity, and general physical health. The following are some of the most commonly [utilized] treatments:

Plasma Exchange – Commonly known as plasmapheresis, the procedure ‘cleanses’ a patient’s blood. It is sometimes recommended for people with some form of multiple sclerosis to control unexpected relapses or flare-ups. Certain proteins in their plasma may be attacking their own body. When you remove the plasma, the proteins are removed, and symptoms may lessen.

Eye patch – If you have double vision, covering one eye may help you experience less nausea and dizziness.

Systemic steroids – Steroid injections may not improve eyesight long term, but they may aid in the recovery of some people who have experienced MS-related vision problems and help prevent a second occurrence. A doctor will usually provide a course of these steroids over a 1- to 5-day period. Intravenous steroids are commonly given over a 3-day period by a doctor.

Stomach irritation, mood swings, elevated heart rate, and insomnia are all possible risks and side effects of steroids.

Other medications – Your doctor may try to help you deal with some of the visual disturbance’s side effects until it passes. They may, for example, prescribe Clonazepam (Klonopin) to ease the jumping or swaying sensation caused by nystagmus.

A 2017 study published in The Lancet found that over-the-counter antihistamines increased the speed of the neural signals from the eye to the back of the brain. While more research is needed, these medications may provide hope to people who have already suffered from optic nerve injury.

MS-related vision issues are common. However, not everyone is affected in the same manner. Many symptoms will resolve on their own without treatment, and the prognosis is generally favorable.

As MS progresses, however, a person’s vision problems are likely to worsen. The importance of early diagnosis and treatment in reducing symptom severity cannot be emphasized enough. If you have been diagnosed with MS, or notice any changes in your vision, schedule an appointment with an IALVS low vision eye doctor today.

Q: Is there a way to prevent vision disturbances caused by MS?

• A: While visual problems in MS patients aren’t preventable, there are often ways to lessen the severity of the symptoms or decrease their occurrence.

Q: How long do the symptoms last?

• A: Since MS affects every person differently, it’s impossible to predict how long symptoms will last. Depending on the vision problem the person is experiencing, symptoms may persist for a few weeks or for a year or more.