Does MS alter distance vision?

Question:

​Four days ago I noticed that my distance vision was much worse than usual. While driving to an appointment I noticed that I could not read road signs until I was right under them. Three days before that I had no problem. (I did not go anywhere the other 2 days but did not notice a problem around the house.)

In February 2016 at my annual ophthalmologist exam my corrected vision was 20/20 near and far.

I have never had this problem before but I had become moderately over-heated that day so I went home and rested with the A/C on. But my vision did not improve. I could not read the banners on the TV at all either.

So yesterday I went to the emergency room (holiday weekend, my neuro unavailable) where a neurology PGY3 did a very thorough exam and found nothing abnormal except my usual mild hyper-reflexia and poor distance vision of 20/200 in BOTH eyes with my glasses on. My near vision was still 20/20 with my glasses.

An ophthalmology resident (? PGY3) also saw me and did a detailed exam including a dilated fundoscopic exam. She saw no abnormalities except for the poor distance vision. I saw colors fine and had grossly normal visual fields.

Neurology says it is not from MS or otherwise neurologic and ophthalmology said I should see my eye doctor to get new glasses. They admitted they don't really know what is wrong or why this happened.

I know it is not like optic neuritis which I may have had 6-7 months ago for the first time, though I doubt it. (At that time I had 3 days of right eye pain with eye movement and no other symptoms or findings on exam by my own ophthalmologist but doc said mild ON. It went away without treatment.)

But how can you have a refractive change from 20/20 to 20/200 over a period of hours?

I feel fine otherwise except that I am getting a headache from squinting.

I hope I can see my own ophthalmologist in the next couple of days and that new glasses will help because I am homebound until I can see better.

Should I have an MRI? It has only been a year since my last one but I had no vision problems then.

I am so happy that my near vision has been spared because I don't know what I would do with myself if I could not read and knit. But I worry that it might become affected too.

I am 59 yo and have had MS since 2003.

Answer:
Your change in your distance vision that is correctable with prescription eyeglasses is called myopic shift (you have become more near sighted).

This is not a manifestation of multiple sclerosis or optic neuritis.

One of the most common causes of myopic shift is cataracts (some patients with MS may develop cataracts if they have had frequent doses of steroids over the years for treatment of MS relapses)
Other causes of myopic shift may include medication side effects (for example topirimate (also known as Topamax) may cause myopic shift).

I recommend you follow up with your ophthalmologist to review if you have any medications or cataracts that could be causing this change in your vision.

Benjamin Osborne, MD
Associate Professor
Departments of Neurology and Ophthalmology
Georgetown University Hospital

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