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Optometry's role in multiple sclerosis

Optometry times, 2020-03, Vol.12 (3), p.1-30

Copyright MultiMedia Healthcare Inc. Mar 2020 ;ISSN: 0890-7080 ;EISSN: 2328-3904

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  • Title:
    Optometry's role in multiple sclerosis
  • Author: Steele, Elizabeth A
  • Subjects: Atrophy ; Edema ; Inflammation ; Multiple sclerosis ; Nervous system ; Optic nerve ; Patients ; Quality of life
  • Is Part Of: Optometry times, 2020-03, Vol.12 (3), p.1-30
  • Description: TECHNOLOGY Imaging aids diagnosis and treatment of optic neuritis, the presenting sign of MS Together with optometry's expertise in examining the physical appearance of the prelaminar optic nerve, the technology at our fingertips-namely spectral domain optical coherence tomography (OCT)-positions ODs to play a pivotal role in the care of patients with multiple sclerosis (MS). The severity, duration and rate of progression for a given patient vary and depend on which of the four the types of MS is present:7 - Relapsing-remitting is the most common, occurring in 85 percent of MS patients - Secondary-progressive (which often progresses from relapsing-remitting) manifests with symptoms worsening over time, with or without relapses and remissions - Primary-progressive is uncommon, occurring in 10 percent of patients, and symptoms slowly worsen over time without relapse/remission - Progressive-relapsing is the most rare, occurring in only 5 percent of patients, and includes continuous progression with acute relapses and no remissions, often without recovery Treatment for MS patients (see Table 1) is aimed at decreasing/eliminating disease activity and delaying/preventing progression. An OCT and dilated fundus exam are recommended initially and again every four weeks for the first four months of treatment.8 Diagnosis and early intervention As optic neuritis is the presenting sign of MS in up to 30 percent of patients, the eye exam can lead to the initial systemic diagnosis.1-4 As such, this discussion of diagnosis and early intervention will focus on the findings by the eyecare provider. When optic neuritis presents, considering NMO with caution is important because the treatment is often very different than for patients with MS. While optic neuritis secondary to MS generally responds to steroids (discussed in more detail below), optic neuritis from NMO may require immunomodulators to prevent progression.14 When NMO is suspected, lab testing for the anti-aquaporin-4 (AQP4) or anti-myelin oligodendrocyte glycoprotein (MOG) antibodies are diagnostic.12-13 Imaging and other testing Without a known diagnosis of MS or other cause of optic neuritis, MRI with fluid-attenuated inversion recovery (FLAIR) is preferred for detecting white matter lesions in demyelinating disease.
  • Publisher: Monmouth Junction: MultiMedia Healthcare Inc
  • Language: English
  • Identifier: ISSN: 0890-7080
    EISSN: 2328-3904
  • Source: ProQuest Central
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