Here is My Question:
Can Optic Neuritis Be Diagnosed After the Acute Stage?
About a year ago, before MS was even on my radar, I experienced blurry vision in my left eye that I noticed one night out of the blue. Over a few days, the blurriness got worse until I could only see detail about 3-5 feet in front of me out of that eye. Before this, my vision in both eyes was 20/10 so a decrease in vision was really, really noticeable! Due to insurance reasons, I never went to a doctor or an ophthalmologist. It eventually got better about 10 weeks later and I no longer worried about it.
I had another episode in the same eye 2 1/2 months later but it wasn’t as bad as the first time and it followed an almost identical course as the time before. I did go to the doctor and ophthalmologist the last time and my vision in that eye was 20/30 and 6 months later 20/20. No bleeding, tumors, increased pressure, etc. The exam was fine.
I had an OCT Scan done a year after the initial event and I have optic nerve thinning in both eyes: RNFL is 92 OD and 82 OS with my superior quadrant being in the 0% OU, the inferior quadrant being in the 5% and a 30 point difference in the nasal quadrant OS. My ophthalmologist did not know what to make of the findings so he just said we’ll check again in a year. He also didn’t seem to know that retrobulbar neuritis existed so I’m not putting much stock in his opinion anyway.
My vision is much better but at the end of a long day, or if I get overheated, the vision in my left eye blurs a bit and everything looks much darker as if I’m looking through two different lenses.
Based on this information, could a more experienced neuro ophthalmologist tell if it was ON a year ago?
Also, does ON always cause pallor of the optic nerve? I was told my nerve had no pallor but once again, I’m not so sure I trust my ophthalmologist.
Yes you can have optic neuritis diagnosed by an experienced neuro ophthalmologist.
It is always easier to diagnosis it when the acute vision loss occurs but if the neuro ophthalmologist is able to obtain a complete history and exam and review your OCT findings (and perhaps an MRI of the brain), he/she should be able to make the diagnosis if you have had optic neuritis.
Benjamin Osborne, MD
Associate Professor of Neurology and Ophthalmology
Director, Neuromyelitis Optica (NMO) Clinic
Director, Neuro-Ophthalmology Clinic
Associate Director of the NIH/Georgetown Neurology Residency Program
Medstar Georgetown University Hospital
3800 Reservoir Road, NW 7PHC
Washington, DC 20007
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