Expert Q&A with Sonalee Kulkarni, MD, Inova Neurosciences
Q: What does a neuro-ophthalmologist treat, and how is it different from what an eye doctor treats?
Neuro-ophthalmology combines areas of both neurology and ophthalmology. It requires specialized training and expertise in problems of the eye, brain, nerves and muscles. Neuro-ophthalmologists are board certified in neurology or ophthalmology and have successfully completed a fellowship in neuro-ophthalmology.
Neuro-ophthalmologists specialize in vision problems that relate to your nervous system. Certain neurological conditions can cause eye problems. Such issues include vision problems due to brain injuries or diseases, including trauma, a stroke or an infection.
Q: What is optic neuritis?
Optic neuritis happens when swelling (inflammation) of the optic nerve occurs. When the myelin sheath or covering of the optic nerve fibers is damaged by inflammation, the condition is called optic neuritis. This condition can affect adults and children.
Q: What will I notice if I have optic neuritis?
You will have difficulty with your vision. It may be a patchy loss of vision, a loss of central vision or a loss of peripheral vision. You may notice blurry vision or loss of color vision. You may feel like things look dim compared to the normal eye. There may be pain when you move your eyes. Some people may notice flashing lights in vision.
Q. What are the causes of optic neuritis?
The underlying cause isn’t completely understood. Most experts believe that a viral infection may trigger the immune system to attack the optic nerve as if it were a foreign invader. This is the most common reason in the majority of cases I see – an autoimmune reaction. Your immune system malfunctions and produces antibodies that attack the optic nerve.
The commonest underlying autoimmune condition is a neurological condition called multiple sclerosis, or MS. It can also be caused by other autoimmune conditions such as neuromyelitis optica, also called NMO or Devic’s disease, which is a rare yet severe demyelinating autoimmune inflammatory process affecting the central nervous system. Most people with NMO have proteins in their blood called antiaquaporin 4 antibodies (AQP4), which are the cause of the disease. Optic neuritis specifically affects the myelin, which is the insulation around the nerves. It can also be caused by MOG antibody, which is another autoimmune neurological condition that causes attacks of inflammation in the optic nerves and/or the spinal cord. Optic neuritis can be caused by infections as well.
Q. Whom do I consult with for optic neuritis?
You may see your regular eye doctor or optometrist, who should refer you to a specialist like a retina specialist or a neuro-ophthalmologist. Neuro-ophthalmologists specialize in the treatment of optic neuritis.
Q. What type of testing will I undergo?
Aside from a regular eye exam, you may be assessed for color vision. Your doctor will order a visual field test to map out your peripheral vision. Your doctor will order an MRI of your brain and orbits with and without contrast to confirm the optic neuritis. Your doctor may order blood tests to evaluate for infection, inflammation or other autoimmune causes for optic neuritis.
Q. Why may I need to get an MRI of my brain to help diagnose optic neuritis?
People who get optic neuritis are at increased risk of getting MS. Optic neuritis may be the first sign of MS. An MRI of the brain helps to determine if you have an increased risk of MS and whether you need additional treatment for MS.
Q. What is the usual treatment for optic neuritis?
Treatment may not be necessary in typical cases. However, if the MRI is abnormal or if the vision is significantly affected, then treatment can speed up recovery. Typically, intravenous steroids are used for three to five days followed by one to two weeks of oral steroids. Steroids can have many side effects including high blood pressure, diabetes, stomach ulcers and thinning of bones, to name a few. Hence, treatment may vary depending on the individual.
Q. What is my prognosis after being diagnosed and treated for optic neuritis?
Most people will get better in a few weeks with or without treatment. Most will have complete recovery of vision. Many people may continue to notice that there is something off with their vision even though they can read the 20/20 line on the vision chart. The recurrence rate can be up to 35 percent, but at this time there are no medications or supplements recommended for prevention.
Treatment of underlying conditions like MS is important. Recovery of vision after optic neuritis may not be complete with certain infections or autoimmune conditions like lupus. Specific treatment for these conditions is essential.
Q: When should I contact a medical professional?
If you have eye pain or any trouble with your vision, see your doctor for an eye exam. If you’ve already been diagnosed with optic neuritis, call your doctor if your symptoms change, worsen or don’t get any better.
Additional Reading, Resources and Support Groups:
Optic Neuritis (National Library of Medicine
Optic Neuritis (Mayo Clinic)
Optic Neuritis (American Academy of Ophthalmology)
National Multiple Sclerosis Society
Multiple Sclerosis Foundation
Optic Neuritis Facebook Support Group