Monday, April 16, 2007

Optic Neuritis



That picture doesn't even begin to show you how I see things. Actually, it does, but it seems so much worse sometimes!
I'm still going through a steady bout of optic neuritis. Dr. E said that I scored a 110... if I had scored a 120 I would have been immediately diagnosed with O.N. and given a steroid IV again. But since I was under, I can't imagine seeing any less out of that eye, I don't have to. In fact, it's not recommended. I'm going to try some self medication, though.
You see, ON is brought on by an inflamation of the optic nerve. So maybe if I take some anti-inflamitories it'll help. Don't worry, I'm not going to over do it or anything, I just want the adjacent headaches to go away. Remember folks I do stare at a screen for most of my day.
Anyway, this has been going on for a week now. It started very lightly on Monday, the 9th, and quickly progressed the next day, where I had to take part of my day off of work... and the next day fully off to go see dr. E.
Ideas of why: Stress, both mentally and physically. It was the first stages of buying the house and getting the money figured out as well as a weird week of spring where my sinuses were crazy... in fact I thought it was my sinuses, until I couldn't see the next day. I got a VEP done while I was at the drs.
A VEP is: Visually Evoked Potential. To me it's a TV with black and white squares that move around like they were on crack while I concentrated on a red square in the middle. You wouldn't believe how hard this is when you can't really see the red square.

The Visually Evoked Response test (VER), also known as the Visually Evoked Potential test (VEP), is a test for Optic Neuritis or other demyelinating events along the Optic Nerve or further back along the optic pathways.
The test involves watching a black and white checkered pattern on a TV screen in a darkened room. The black and white squares alternate on a regular cycle which generates electrical potentials along the optic nerve and into the brain. These can be detected with electroencephalographical (EEG) sensors placed at specific sites on the top of the head (the occipital scalp). Each eye is tested independently while an eye patch is worn on the other eye.
VEPs are very sensitive at measuring slowed responses to visual events and can often detect dysfunction which is undetectable through clinical evaluation and the person is unaware of any visual defects.
Because of their ability to detect silent lesions and historic demyelinating episodes, they are very useful diagnostic tools. A definite diagnosis of multiple sclerosis requires at least two distinct demyelinating episodes, in two different central nervous system sites which are separated by at least one month (the Schumacher criteria). VEPs can often provide evidence of such episodes when other tests, even MRI, cannot.
Each pattern reversal stimulates a nerve transmission along the optic nerve, the optic chiasm and the optic tract to the lateral geniculate body. From there a second axonal signal moves along the optic radiations and the posterior periventricular white matter to the occipital cortex. This stimulates the striate cortex to generate a large electrical potential which is detectable on the EEG sensors.
The whole trip (the latency) normally takes about 100 milliseconds. This latency is called the P100. White matter lesions anywhere along this pathway will slow or even stop the signal.
Almost everyone with optic neuritis will have an abnormal VEP latency. Studies show that 85-90% of people with definite MS and 58% of people with probable MS have abnormal VEPs.
Other conditions including Friedreich's ataxia, vitamin B12 deficiency and neurosyphilis can also slow the P100 latency.


Anyway, besides the constant lack of vision in my left eye and the on-again-off-again headaches... I'm actually doing fine.
I turned up to work on Saturday, Avonex recovery day, for a quick brunch and ended up doing two tours instead. It was unexpected, but fun. It wore me out more than I thought, but I stayed up for the rest of the day anyway. I did get winded going up the stairs, though. Boy am I out of shape.

3 comments:

cardiodude said...

I had my first VEP today, my left eye as well has been blurry for a few weeks now. The thing that is most annoying is the constant light show when I close my eye, I believe they are called phosphenes. They put me on the IV steroids for 3 days, now I am on the PO. I have already gained 5 pounds. reading through the papers in the literature, I don't even see why anyone thinks the PO steroids are worth taking. How did your doctor decide between steroids and interferon?

Helen said...

I had a VER in Nov. 07 which said that I have mild optic neuropathy left eye...mildly prolonged at 116.8 msec.
The above test was ordered by a neurologist.
Mar 9 08 I had an ophthamologic exam. The ophthamologist said that I do not have optic neuritis. Can OPtic neuritis be dxd by a routine ophtho. exam..including slit lamp?
Helen

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