Showing posts with label Optic Neuritis. Show all posts
Showing posts with label Optic Neuritis. Show all posts

Wednesday, February 28, 2018

Marcus Gunn Syndrome and Multiple Sclerosis

One test which my neurologist, ophthalmologist, and primary care doctor each conduct during every office visit is the “swinging flashlight test.” You know the one. The doctor asks you to look ahead then shines a penlight first toward one eye, then the other, alternating quickly to observe your pupils’ response to light.

I strangely enjoy this test because I know that my pupils will show something unique. Something which proves that I have damage to my optic nerve. My pupils show a Relative Afferent Pupillary Defect (RAPD) or Marcus Gunn Sign.

What does the doctor look for during the “swinging light test”?

The pupils (the black centers of the eyes which dilate or constrict in response to light) are inspected for size, equality, and regularity. Did you know that the pupils will constrict or dilate when you look at objects far or near? They do, which is kinda cool.

More importantly, each pupil should constrict quickly and equally during exposure to direct light and to light directed at the other pupil (the consensual light reflex). Using the swinging light test, the doctor can test and observe the pupillary response to consensual light in order to determine if there is a defect present.

Normally, the pupil constriction does not change as the light is swung from eye to eye. When the light is moved quickly from eye to eye, both pupils should hold their degree of constriction.

What is a Relative Afferent Pupillary Defect?

The Afferent Pupillary Defect (APD) or Relative Afferent Pupillary Defect (RAPD) is an abnormal and unequal response in the pupils of the eyes when exposed to light. It basically demonstrates that one optic nerve transmits a different message to the brain than the other one. Testing for RAPD is a good way to implicate or rule out optic nerve damage such as is caused by optic neuritis.


My temporarily blinding case of optic neuritis in 2000 left my right eye impaired. It doesn’t register light in the same way as my left eye as the optic nerve has permanent damage. When the doctor shines the light in my left eye (the “good” eye), both pupils will constrict. This is normal. When the doctor quickly moves the light to my right eye (the “bad” eye), my pupils begin to dilate since the brain thinks that less light is coming in. This shows that there is damage to the corresponding optic nerve.

Read this post in its entirety:

MS Signs and Symptoms: What is Marcus Gunn Syndrome?

Tuesday, February 14, 2017

What is optic neuritis?

Optic neuritis (ON) is an inflammation of the optic nerve, a bundle of fibers that transmits visual information from your eye to your brain. Symptoms of ON are varied, often including pain behind the eye and different degrees of vision loss. People with ON may experience blurry vision, blind spots, a graying out of vision, or dull colors. ON can, but does not always, result in temporary blindness and usually affects only one eye at a time. ON may be accompanied by flashes of light or new floaters which should be reported to your eye doctor and/or neurologist.


What causes optic neuritis?

Common causes of optic neuritis include demyelinating diseases, such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD, formerly known as neuromyelitis optica or Devic’s disease). In MS and NMOSD, the immune system attacks the myelin surrounding nerve fibers of the brain, optic nerves, or spinal cord resulting in inflammation and/or lesions that disrupt nerve signals to and from the brain. If NMOSD is suspected, a blood test can help distinguish it from MS and facilitate diagnosis.

Other causes of optic neuritis may include bacterial or viral infections (e.g., Lyme disease, cat-scratch fever, syphilis, measles, mumps, herpes), other autoimmune diseases (e.g., sarcoidosis, lupus), or drug side-effects (e.g., quinine, some antibiotics), according to the Mayo Clinic.

When I had the blinding case of optic neuritis in 2000, the results of my MRI showed inflammation of the optic nerve but no lesions.

I was not diagnosed with “post-infectious optic neuritis.” I had had a severe cold during the prior weeks. The MRI helped to eliminate the other potential diagnosis suggested, which was brain tumor. Fortunately, I did not have a brain tumor.

Read this post in its entirety:
MS Signs & Symptoms: Optic Neuritis

Thursday, February 18, 2016

Being In MS Limbo

The road to diagnosis for MS can be long and winding for many patients. I’m happy for patients who receive their official diagnosis within just a few doctors’ visits. Not happy that they have MS, but happy that they can jump right in and get on with things; attacking the beast with medication, therapy, and determination.
For those of us who are not immediately diagnosed with MS, the feelings involved with the ‘not knowing for sure’ can be frustrating. Especially disturbing is when you suspect that your doctors do not believe you or your symptoms. The worst part may be when there is some clinical evidence that ‘something’ is not quite right, maybe there are lesions in the brain and obvious neurological symptoms, but your tests do not meet the standard diagnostic criteria for an official MS diagnosis.
That’s when the waiting game begins.
I was one of those patients who didn’t receive an immediate diagnosis. In fact, it took more than five years from what was my first obvious and debilitating attack (blinding optic neuritis) to the relapse that prompted additional testing that led to a diagnosis.

Read this post in its entirety:
What Is It Like to NOT be Diagnosed with MS?

Tuesday, March 9, 2010

Going Blind 10 Years Ago

"Ten years ago on this Tuesday in March, I woke up not able to see out of my right eye...."

That's how one version of my story begins. Please watch this 6 minute video in which I speed you through my journey to an MS diagnosis. A journey which took 5-12 years, even if I didn't know that I was on that road at the time.

I started writing about my story on my personal blog some time ago, although I haven't added to it recently. If you'd like to read the longer version which began in college, I recommend starting with "Eyes in the Back of My Head."

Watch a video of me telling my diagnosis story:

MS Awareness Month: My Diagnosis Story - A 10 Year Anniversary

Wednesday, October 15, 2008

Questions, Answers, and More

Thank you readers for sticking with me. Things are hectic around the homestead and I'm trying to stay above the surface.

I have been, however, doing some writing related to MS topics over at Multiple Sclerosis Central. If you don't already know, I'm a featured writer over there - a "patient expert" - or I'd like to say a "patient advocate." I invite you to read and subscribe to my twice weekly blatherings.

Here are some of the things I wrote recently:

"Pass the Power Please- kthnx" in which a discussion of social communities, forums, and patient empowerment is key.

This fits in perfectly with the presentation and panel discussion of which I will be a participant next Wednesday. I'm still coming up with thoughts to share, so if you have any to add, please do so.

"Need Help Paying Drug Bills? Who ya gonna call?" in which I provide links to sources of financial assistance for MS patients needing help with the DMDs.

"Hey!! Turn Up the Lights and Pass Me Some Color!" in which I discuss the onset of Optic Neuritis 8 years, 7 months ago, pre-dating MS diagnosis considerably.

Also today marks the 3rd anniversary of my final "DEFINITE MULTIPLE SCLEROSIS" diagnosis. Whooohooo. Or is that really a day to celebrate? Not sure.

And...... There's this cool feature over the MS Central where folks can ask questions and folks can answer questions. Kinda like a forum of sorts.

Anybody can ask or answer, but I'll let you in on a little secret, just between you and me.

I actually get a token payment for researching and answering the inquiries. Shhhh... you didn't hear that here. So if you are so inclined, please feel free to help a girl out and ask some MS-related (or not) questions over there.

Ok, enough self-promotion.

I hope that you are having a nice day. :-)

Monday, June 9, 2008

Red to Brown and the Great Gray Blob

[Begin reading with Eyes in the Back of My Head]

To continue with the story, on that Tuesday morning I immediately went in to see my optometrist to determine why the vision in my right eye now looked smeary. One of my lifelong (well maybe since my teens) fears has been to lose what vision I do have. I began wearing glasses when I was four years old and in kindergarten. By the time I was in Jr. high school, the near-sightedness of my vision had surpassed that of both my myopically-challenged parents. And now my vision is so poor without correction - I can still achieve 20/20 with appropriate lenses - that I am not a candidate for the current offerings of laser vision correction. Maybe someday when they perfect the technique of inserting permanent lenses underneath the cornea. I hear that's about as simple as cataract surgery.

So back to that morning, the visual exam was not turning up any clues until my optometrist brought out a collection of colored pipecleaners. You know the kind used for crafting projects and are available at stores like Michaels or Hobby Lobby. Well, Dr. Obremsky asked me to pick out different colored pipes using only my right eye. This is the test I failed. I had my pinks, whites, reds, and oranges all confused. So the doctor called ahead to get me an emergency appointment with a Retinal Specialist.

By this time it was apparent that I was not going to make it to the concert hall by 9:45am for the first performance at 10:00am. I called the personnel manager and explained a little about what was going on, although I really didn't know that yet myself. During this appointment, I was put through all the standard visual hoops and a few new ones. They determined that there was nothing physically wrong with my retina to explain the visual disturbances, but that I needed to see someone even more specialized. So they called ahead and informed the office of a neuro-opthamologist in Rockville, MD, that I would be arriving that afternoon to be seen.

From this 2nd eye appointment, I made it to the Concert Hall at George Mason University for the second 'Kiddie' concert at 11:30am. Here I am scared, vision blurry, pupils dilated, and a tad bit stressed. But perform and try not to show weakness I did. After this, my Mom and I - remember my Mom was kindly accompanying me all day - ate lunch before heading to Rockville to meet Dr. Katz, a neuro-opthamologist.

Dr. Katz's team put me through yet more tests, including a visual fields test on a massive machine. While trying to stare at the center dot and press the button when I saw lights flash elsewhere, my vision kept getting darker. I think it was this test which finally gave me a huge headache and I just wanted to curl up under a blanket, close my eyes, fall sleep to later wake up with perfect vision. We can all have fantasies, right?

He conducted a thorough exam, including color vision, again. But the most telling diagnostic tool came from an amazingly unofficial item. Dr. Katz used an eye-drop bottle with a bright red lid to hold directly in front of my line of sight. He asked me what color is was. Red, I said. He moved it slowly into my peripheral vision.

Whoa!!! Wait a minute.... The lid turned brown. No longer red, but brown. Did he pull a fast one and switch bottles, I thought. I knew he had not, but I also knew that it looked brown. How the heck did that happen?

Thus began the conversation about MRIs, brain matter, white spots, possible brain tumor, inflammation, multiple sclerosis, testing for lyme disease, and a bunch of other stuff which I couldn't digest. He ordered massive amounts of blood tests in addition to a round of MRI scans. He also discussed immediate treatment options which included going to the hospital three times a day for three days to receive an infusion of steroids or take an equal amount of steroids orally by using large amounts of cheap prednisone. The latter is what I chose primarily for convenience and cost sake.

On Wednesday, opera rehearsals began for Wagner's Tannhauser with the Baltimore Opera in which I was performing one of the backstage horn parts. An interesting tidbit about playing one of these horn parts in this particular opera is that you play near the beginning of the show and then must wait 2 hours to play again near the end. Lots of time for reading, talking, playing cards, or napping. Good thing, too, as I needed alot of downtime to deal with the horrible effects of the prednisone.

Probably the kindest word of caution that Dr. Katz gave me during that preliminary visit was that my vision would continue to get worse during the following days. I had responded so quickly to the changes that I still could see something out of that right eye and it was noticeably deteriorating throughout the day and becoming more painful to move.

By the following evening, all I could see out of my right eye was a wall of gray. It was as though someone had plastered gray paint over the window pane which is my cornea, but had left the outside light on. Funny. When I had thought of going blind, even if temporarily, I always thought that it would become pitch black. But in my case, it was a Great Gray Blob.

On Thursday, I went back to George Mason University to perform in two more 'Kiddie' concerts with the Fairfax Symphony and repeated those events the following week. On Friday, I caught a ride with another musician who was performing in Tannhauser. He was a violist who is married to a hornist in the National Symphony. He was very kind to carpool me up to Baltimore during the entire run. I wasn't comfortable driving while blind in one eye and the prednisone didn't agree with me.

When the radiologist report came in after the brain MRIs, I was relieved to learn that there was no tumor and more importantly that there was "no evidence of any demyelinating disease." I was lucky. It couldn't be MS. Dr. Katz put down in my records that I had experienced an isolated occurrence of optic neuritis with inflammation most likely due to the cold virus I had experienced the week before.

Who was I to argue. He also informed me that I now had an increased chance of developing multiple sclerosis. But if I made it five years without another event, then my risk reverted back to that of the general population. Whether this opinion holds true today, I do not know.

It took two months for my vision to return and about six months for my body to fully recover from the high doses of prednisone. Even to this day, lights are not as bright in my right eye and colors look slightly different when I compare the vision between my eyes. So now I have another barometer when it comes to MS. If pinks start to fade, it's time to call the neurologist.

Next: The Purple Jumper

Sunday, June 8, 2008

Looking Through Vaseline-Covered Glasses

[Begin reading with Eyes in the Back of My Head]

In the spring of 2000, I maintained a very busy performance schedule in the DC/Baltimore area and a growing private lesson studio in Falls Church, Virginia. One of the finer details to freelancing I learned after moving to the DC area in mid-1998 was that in order to work, you must work. I know that sounds redundant, but let me explain.

In an area flush with qualified performers, it is vitally important to maintain networks, provide quality and reliable service, and to exhibit a desire to supply that service without any hint of desperation. Nothing makes you less qualified (if only in others' perceptions) than a desperation for gigs, inaccuracy or a sloppiness to detail, or the worse curse - unreliability. The axiom that you are "only as good as your last performance" remains true.

I remember vividly during March 2000 being booked solid with playing gigs. There was one week I was doing some extra work performing at a special convocation at Howard University. This was a good-paying job at union scale. We always want to play at union scale (or above). On that Thursday, I had a massive, snotty-nosed, purse-filled-to-the-brim-with-wet-tissues, ears-plugged kinda cold. The type of cold where others stay clear and you don't even bother trying to approach anybody. A nasty cold.

On the following Monday, I noticed something slightly off with my eyes. It was hard to explain but I called the optometrist anyway. With eyes as near-sighted as mine, I had been repeatedly warned over the years about the dangers of a thinning retina. I got myself into the doctor's office to get it checked out. Without anything obviously amiss, he instructed me to return immediately if it got any worse.

Last same week I was scheduled to perform with the Fairfax Symphony in their annual 'Kiddie' concerts presented for the 4th graders of Fairfax County Public Schools. The county school district is so large that even with busing the children to the 1935-seat GMU Performing Arts Center for the concerts, it took scheduling nine performances to get everybody in for the 50-minute show. That's a lot of 4th graders. The first day of 'Kiddie' concerts was on Tuesday of that particular week.

On Tuesday morning I woke up early to get ready for the mid-morning concerts. As soon as I put my glasses on, I KNEW something was terribly wrong. It looked as though someone had smeared vaseline on my lenses. I called my Mom and began crying uncontrollably. My greatest fear was that my retina had already detached and that it was too late to fix it. My Mom tried to calm me down and offered to take me back to my optometrist's office.

Once there, the doctor performed a standard eye exam and it seemed that all was well, until.....

Next: Red to Brown and the Great Gray Blob

Tuesday, May 27, 2008

Eyes in the Back of My Head

We've all heard the phrase - "hindsight is 20/20" - but what does that really mean? Are events in the past truly crystal clear when we examine them from afar?

I've been thinking about the history of my personal multiple sclerosis journey. A neurologist officially upgraded me to Definite MS in October 2005. So is that where my journey began a mere 31 months ago?

I went completely blind in my right eye for two months in March-April 2000 due to Optic Neuritis, but with "no evidence of any demyelinating disease" according to the MRI report. Was that the beginning of the road?

Or maybe during the early years of my doctoral studies when I was having such headaches and vision issues. At that time, I made a number of visits to the Optometry School on campus and underwent several tests. But no visual fields or evoked potentials. I ended up with a new pair of reading glasses to use in connection with my contacts and a simple device to "exercise" the focusing ability of my eyes.

But these devices did not really help to resolve the headaches or occasional vision problems. So came my first encounter with an MRI machine, with the goal of eliminating a possible brain tumor. No brain tumor and no answers. That was over 15 years ago.

So far the picture is still blurry. Perhaps with more examination.

To be continued....

Next: A Pain in My Neck