Problems with eyesight are common in MS but often improve or go away completely after an attack. This research paper looked at how often eyesight problems persist in MS, who is more likely to experience them and how much they affect day to day life.
How common are longer lasting sight problems in MS?
13 March 2013
The study in brief
The study in more detail
Problems with eyesight are common in MS and are often one of the first symptoms people experience. They include optic neuritis, double vision (diplopia) and nystagmus (where the eyes move in a more or less rhythmical manner). Attacks of optic neuritis can include complete loss of sight, partial blind spots (called scotomas), blurred or foggy vision, or colour vision disturbances.
Some people find that an increase in temperature affects their vision in some way. This effect is known as Uhthoff's phenomenon or Uhthoff's sign.
Problems with vision often improve or may disappear after a relapse but they can persist.
How this study was carried out
This study examined if longstanding problems with vision were common in people with MS, what caused them and what difficulties they brought.
303 people with MS, who were either in-patients or out-patients at a clinic in France, were asked about any eyesight problems that persisted despite wearing glasses. People who had experienced a relapse in the last three months were not included in the study.
Those people who had persistent visual symptoms then undertook a series of neuro- ophthalmologic tests. These are tests which detect problems due to damage to the nerves supplying the eye or the parts of the brain concerned with vision rather than problems in the eye itself.
The group also completed questionnaires, called the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25) and the 10-Item Neuro-Ophthalmic Supplement, to assess how much impact their sight problems had on everyday life. Questions included:
- How much difficulty do you have reading ordinary print in newspapers?
- How much difficulty do you have reading street signs or the names of stores?
- Because of your eyesight, how much difficulty do you have going down steps, stairs, or curbs in dim light or at night?
What was found
They found that, out of 303 people with MS, just over a quarter (26%) had optic neuritis as their first symptom and one in eight (12%) had oculomotor symptoms (abnormal movements of the eyeball) from the beginning of their MS.
During the whole course of their MS, just over half (53%) had experienced at least one episode of optic neuritis and almost a third (31%) had experienced at least one episode of ocular motor symptoms.
Just over a third of the group reported continuing problems with their vision. Out of this sub-group, the most common symptoms were visual fatigue (59%), diplopia (35%) and visual instability (28%). These symptoms were not related to age or how long someone had MS. These symptoms were more common in men, those who had progressive MS from the beginning and those with a higher level of disability.
People with continuing problems with their sight were more likely (than other people with MS) to have had problems with vision at the beginning of their MS, at least one relapse with these symptoms and to have experienced significantly more relapses where visual symptoms occurred.
70 people from this study continued into the second phase. A variety of problems were detected using the neuro-ophthalmologic tests including optic neuropathy (57%), impaired visual acuity (53%), disc pallor (49%), visual field impairment (59%), contrast sensitivity (58%) and colour discrimination (63%). These problems often affected both eyes. Oculomotor symptoms (abnormal movements of the eyeball) were seen in 85% of the group.
Those with persistent sight problems were more likely to report a lower quality of life.
What does it mean?
This study provides additional evidence on how common problems with eyesight are for people with MS, how they can persist and how they impact on everyday tasks like reading and going up and down stairs.
Jasse L, Vukusic S, Durand-Dubief F, et al.
Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability.
Mult Scler. 2013 Mar 5. [Epub ahead of print]
More about sight problems in MS
Not all problems with eyesight are due to MS so it is important to have any difficulties properly assessed and any aids, like glasses or contact lenses, updated when required. It has been suggested that people should:
- Have regular eye tests and have any new problems treated. Opticians recommend that everyone should have their eyes tested at least every two years, whether they have MS or not
- Double vision can sometimes be managed with the short-term use of an eye patch
- If double vision persists, prisms can be fitted to glasses. The prism compensates for the double vision by altering the way light reaches the eye
- If there is a problem with the messages from the eyes arriving at the brain at different speeds, a tinted lens in front of the good eye can help. An orthoptist can design the lens so that it matches the delay on the affected side
- Be careful of sudden changes in light. If you go from light to dark, or dark to light, stop and give your eyes time to adjust
- If heat affects your symptoms, try to avoid hot environments and keep cool in warmer weather
- Seek medical attention if you think you have an infection as this can raise your body temperature and make visual symptoms worse
Problems with eyesight can make someone more likely to fall.
Difficulties with reading may be helped by using a magnifying glass or printing on different coloured paper. If reading from a computer screen is difficult, most browsers have accessibility features which allow you to change the size of the text, the screen colours and other features to improve readability. You can read more on the Microsoft and Firefox websites. The BBC also offers an excellent accessibility guide on making the web easier to use if you have difficulties with sight, using a mouse or keyboard or have other computer accessibility questions.
Charities like AbilityNet may also be able to help with computer accessibility issues.