Stephen F. Austin State University
February 20, 2002
Joyce Bohen recently wrote a book about her experience with multiple sclerosis. She told about her battle with multiple sclerosis and one of her major symptoms, optic neuritis. In this book, she told each individual to imagine life from one day being able to see bright colors and distinct pictures to only realize that as each day goes by the world is beginning to look darker and darker until you can see nothing but black. Not only did she experience blindness but also came the intense pain. After seeing a neurologist many times and continuously being treated with steroids to help her vision return, she finally gave up her battle and began to accept the idea that she would never be able to see again. The goal of her book was to help those with low vision accept the idea that life will never be the same and that there are strategic ways to get around this disability. One of the coping mechanisms she suggested was to outline doorways, steps, and wall switches with high contrast or textured tape. This story of one woman's dedication and perseverance to get through her disability should give researchers all the persuasion needed to continue on discovering permanent treatments or even preventive methods for optic neuritis (Cohen, Dinerstein, & Katz, 2001).
Another woman's determination went beyond coping mechanisms. After being touched by her brother's battle with multiple sclerosis Silvia Lawry created the National Multiple Sclerosis Society. Her goal was to begin research that could help end the suffering of all those individuals who were diagnosed with multiple sclerosis. Her dream is to try to help discover a cure for symptoms such as optic neuritis (Scott, 2001).
Multiple sclerosis can be defined as an inflammatory, autoimmune, and demyelinating complex disease of the central nervous system (Kidd, 2001). More common in women than men, the disease can strike at an early age, "especially when reproduction is a major consideration" (Sadovnick, Guimond, & Dwosh, 2001 p374). It is known to be the most common cause of "neurological disabilities in young adults" (Kidd, 2001 p540).
The most common type of multiple sclerosis is the relapse remitting which later turns into secondarily progressing. This means that the patient will no longer go into relapse but rather begins progressing farther into the disease. There is a disability scale called Kurtzke's Extended Disability Status Scale that determines the status and progression of the disability. For example with a rating of 6 at twelve to fifteen years of the illness, individuals are no longer able to walk on their own. No single gene has been identified yet researchers are finding a familial component (Kidd, 2001). Yet some of the symptoms that are related to the disease researchers are able to explain their components. Some of the symptoms associated with the disease are loss of balance, muscle weakness, and impaired vision. One of the most common vision impairments is known as optic neuritis.
Optic neuritis can be defined as an inflammation of the optic nerve. This inflammation can cause the signals sent to the brain to be interrupted. The end result is blurred vision, loss of color vision, an inability to see low contrast, high sensitivity to bright light and pain during eye movement. Optic neuritis rarely effects both eyes at the same time. Therefore a patient could have blurry vision during one period of the illness in the right eye, and later on during the illness the blur may move to the left eye. The blindness that does occur in the eye only lasts for a two to four days, and after reaching its maximum point, vision begins to return in about four to twelve weeks. Optic neuritis can either be a symptom of multiple sclerosis or can be the "initial manifestation of multiple sclerosis" (Newman, 1999, p781). Newman also states that if it is the initial manifestation then this may indicate a shorter life expectancy.
Palace (2001) points out that understanding the visual system, especially the anterior pathways, can be beneficial in diagnosing multiple sclerosis. Neurologist can look at the visual evoked potentials and recognize any abnormalities. The most common abnormality is the delay in the P100, which occurs due to an interference with demyelination. When optic neuritis has reached its acute phase, the firing rate can be either greatly reduced or absent.
Researchers over the years have determined that there are 3 treatment categories for the disease: (1) symptoms specific; (2) relapse/exacerbation management and (3) disease modifying (goal is to reduce that amount of lesions that appear on the MRI). Optic neuritis can be categorized under symptom specific.
While there is currently no cure for multiple sclerosis, researchers are trying to find certain preventive methods and ways of slowing the disease down. Kidd (2001) notes in his research that the early stages of the disease are the hardest to detect because the symptoms are not static; rather they are dynamic. He also points out that over one half of the victims die of suicide rather than of natural causes.
Researchers searching for treatments of multiple sclerosis have brought about many new types of drugs, none of which have been proven to be fully effective. For the most part researchers are now focusing on reducing the relapse rate and progression. For example Interferon is used to reduce the relapse rate and progression of the disease. However, these drugs do not come freely; they come with consequences of unwanted side effects and costly expenses each month. As of now, Interferon has not been studied on its long-term benefits for lengthening of life.
What about treatment of optic neuritis? Like multiple sclerosis, patients suffer from relapse or progression in this symptom as well. Studies have shown that there is a type of steroid that can reduce the chance of relapse and slow down progression (Lee, 2001). Nancy Newman (1999) created an Optic Neuritis Treatment Trial in which individuals received "high-dose intravenous methlyprednisolone treatment followed by tapering dose of oral prednisone." There was an increase rate in the recovery of vision loss, without any further side effects to the final visual outcome. The rate of progression was decreased with the intravenous methlyprednisolone, than compared to the dose of oral prednisone. After performing an post hoc analysis after eight weeks, Newman determined that those who had severe visual dysfunction at the beginning of treatment had more of a positive response. Ophthalmologists have begun to take this study into consideration and have been giving patients more intravenous methlyprednisolone.
Current research performed by the National Multiple Sclerosis Society has taken the idea of steroids a step further and focused on an immune system protein, either immunoglobulin or liomide (the chemical that stimulates production of key immune system cells) that aid in the recovery of vision loss (1995). As of 2001, corticosteroinds remain the number one treatment option for acute optic neuritis in patients.
Today researchers have begin to focus on the idea that some type of treatment whether it be steroids or immunoglobulin, is better than no treatment at all in recovery of vision loss. While society is advancing so is technology. Unfortunately, the rate of technology is not climbing at a steady pace to where each individual can have a dramatic change in their illness. The researchers are out there and they are trying to find some type of cure for both multiple sclerosis and optic neuritis. Yet, there are many drawbacks to the advancement in finding a cure. For example, lack of participation and the participants not getting the type of results (improvement) in the studies. Individuals may be either too scared to participate and fear that something worse may happen or they may participate but become discouraged after a few weeks because they are not getting the results they are wanting.
Another circumstance that needs to be looked at is the amount of funding that goes into research. There are marathons, and different type of fundraisers. However does this really raise the concern of those individuals not affected in any way by the disease? Over half of all individuals may not have a full understanding about what this disease is and its symptoms. Most of the time all that is seen on the fundraisers are the physical symptoms such as muscle deterioration. No one really sees the child who has lost vision in one eye because of a symptom of multiple sclerosis, or the psychological troubles that they are experiencing inside. It is time to take the disease deeper and let the people know, especially women, just how serious this disease can be.
Cohen, J.R., Dinerstein, G.R., & Katz, E.R. (2001). Living with low vision. Inside MS, 19, 46.
Kidd, P. (2001). Multiple sclerosis, and autoimmune inflammatory disease: prospects for its integrative management. Alternative Medicine Review, 6, 540(27).
Lee, A.G. & Galetta, S.L (2001, January 1). Something you should know about optic neuritis. Ophthalmology Times, 26, 10.
Lee, A.G. (2001, May). Treatment of optic neuritis: an evidence-based update.Ophthalmology Times, 26, 6.
a. Newman, N.J. (1999). A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis. American Journal of Ophthalmology, 128, 264.
b. Newman, N.J. (1999). Optic neuritis as onset manifestation of multiple sclerosis: a nationwide, long-term survey. American Journal of Ophthalmology, 128, 781.
Palace, J. (2001). Making the diagnosis of multiple sclerosis. Journal of Neurology, 71, ii3.
Regaining vision lost to optic neuritis? (1995, Fall) Inside MS, 13, 10-11.
Sadovnick, A.D, Guimond, C., & Dwosh, E. (2001) Treatment of multiple sclerosis: teratogentic concerns and other aspects of reproductive counseling. American Journal of Human Genetics, 69, 374.
Scott, Whitney. (2001) Courage: One Woman's Dream and the Mighty Effort to Conquer Multiple Sclerosis. Booklists, 98, 366.