In the Face of Multiple Sclerosis

Worsening multiple sclerosis cases may be revealed through the eyes

/ Author:  / Reviewed by: Joseph V. Madia, MD

There may be some truth to looking in the eye of the beholder, at least for patients with multiple sclerosis.

The eyes may give a glimpse into how the disease can get worse over time, according to a new study by researchers from Johns Hopkins MS Center.

In multiple sclerosis (MS), the protective covering of nerve cells in the brain and spinal cord is damaged. This slows communication between the nerves or even stops it entirely.

The damage is caused by inflammation from the body's own immune cells attacking the nerves, including the millions of nerve fibers found in the eyes. Why immune cells do this is still in question.

Toward the back of the eye lies the retina, a thin tissue containing special cells that change light into electrical signals. These signals are sent to the brain through the optic nerve, which contains those nerve fibers.

All these nerves are connected and can be affected by MS.

What Are the Signs of Multiple Sclerosis?

Patients with multiple sclerosis can have symptoms all over the body that can last for days or months at a time, including problems with the muscles, brain, bowel and bladder, speech and the eyes.

Symptoms dealing with the eyes include:

  • discomfort
  • double vision
  • vision loss, starting typically in one eye and then the other
  • rapid eye movements that can't be controlled

During an eye examination, doctors can also find physical problems inside the eyeball or abnormal pupil responses.

Patients may also notice changes in their peripheral or side vision and possibly have blurred vision, halos or blind spots.

Testing and Diagnosing

Tests to diagnose MS include MRI scans of the brain and spine or spinal tap, which involves puncturing the lower part of the back for cerebrospinal fluid.

Looking into the eyes of a person with MS may help predict how the disease will progress, according to a recently published study.

Researchers, led by Peter Calabresi, MD, from Johns Hopkins University School of Medicine in Baltimore and a Fellow of the American Academy of Neurology, looked at retinas in the eyes of over 160 patients with MS as well as about 60 healthy individuals.

They scanned patients' eyes with an optical coherence tomographer every six months for about two years. MS patients were divided into groups based on whether or not they relapsed and had symptoms return.

Researchers found that retinas in the relapsed patients thinned 42 percent faster than patients with no relapses.

Further, retinas in patients whose conditions continued to get worse during the study thinned 37 percent faster compared to those who remained stable.

And retinas thinned up to 54 percent faster among patients with certain inflammatory lesions compared to those without.

What To Do?

To date, no complete cure exists for the degenerative disease, but a variety of medications and therapies can help reduce the problems it brings to the bladder, muscles and even mental well-being.

Beyond medicines, patients can also seek help through:

  • support groups
  • meeting with an occupational, speech or physical therapist
  • eating and exercising well
  • avoiding stress, extreme temperatures, illness and fatigue
  • using assistive devices to make the home safer, including walkers, bed lifts, shower chairs, wheelchairs and wall bars

“As more therapies are developed to slow the progression of MS, testing retinal thinning in the eyes may be helpful in evaluating how effective those therapies are,” Dr. Calabresi said in a press release.

Even with the precautions and treatments patients can take, MS patients should call their healthcare provider if symptoms get worse.

Dr. Calabresi's study was published online January 1 in the journal Neurology. The National Multiple Sclerosis Society, National Eye Institute and the Braxton Debbie Angela Dillon and Skip Donor Advisor Fund supported the study.

Reviewed by: 
Review Date: 
January 6, 2013