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The Eye and Multiple Sclerosis (MS)

The eye does not only allow us to visualize our external world-it also provides insight into our internal environment. The eye consists of three main layers: the outer layer, the middle layer, and the inner layer. The inner layer is the neural retina which indicates that the retina is a layer of nervous tissue. The retina is an extension of the brain through the second cranial nerve (CN II) otherwise known as the optic nerve. Because the retina is a part of the central nervous system (CNS), changes in the CNS may be reflected in the retina.



Understanding Multiple Sclerosis


According to the Oxford English Dictionary, sclerosis simply means the abnormal hardening of body tissue. Multiple sclerosis (MS), as its name implies, is the formation of many hardened tissues or scar tissues or lesions. Usually, in the presence of foreign bodies or harmful substances, the body automatically triggers its immune system to defend itself and restore health. However, in autoimmune conditions, the body’s immune system mistakes healthy cells for harmful cells and then elicits inflammatory reactions that attack the healthy cells instead of protecting them. MS is an autoimmune disease that attacks the protective sheaths surrounding nerve cells (myelin sheaths) in the CNS (brain and spinal cord). The process of inflammatory demyelination damages nerve cells resulting in the formation of lesions (small or large) that affect the communication between neurons.


MS is the most prevalent inflammatory disease of the CNS with no known specific cause. It can be described as a complex, multifactorial disease with genetic and environmental variations. MS is a potentially disabling disease that globally impacts over 2 million people and initial diagnosis typically occurs in adults between the ages of 20 and 50. The diagnosis of multiple sclerosis involves several tests including but not limited to magnetic resonance imaging (MRI) exams, blood tests, and lumbar puncture tests.


Scientists have discovered gender and racial disparities in disease onset and progression. For instance, women are three times more likely to develop MS than men. MS is also more prevalent in individuals of European and African descent compared to Hispanics and Asians. Mostly, MS is not life-threatening and although MS can lead to severe disability (both physical and cognitive), some individuals are minimally affected and can live long, active, independent, and fulfilling lives.


Main Types of MS


Relapsing-remitting MS (RRMS) is the initial relapsing MS characterized by recurrent cycles of relapses and remissions. It is also the most common type of MS.


Secondary progressive MS (SPMS) is a more debilitating type of RRMS where disease progresses regardless of relapsing inflammatory activities.


Primary progressive MS (PPMS) is not affiliated with RRMS. It is the gradual worsening of neurological functions that starts with disease onset and it occurs without the initial RRMS.


Progressive-relapsing MS (PRMS) is the rarest form of MS and it is characterized by a steady progressive worsening of nerve damage that occurs between cycles of relapses and remission.


Common Symptoms of MS


Common Eye-related Manifestations of MS


Disease activities in neurodegenerative diseases such as MS affect the structure of the retina and manifest under a wide range of ocular symptoms or vision anomalies such as


  • Pain

  • Vision loss (usually temporary)

  • Light sensitivity

  • Double vision

  • Poor color vision, and

  • Blurriness.


It might interest you to know that an eye care physician is often the first doctor to diagnose MS because sudden vision problems-usually in one eye-is a common first sign of MS. The most common eye-related symptom of MS is optic neuritis (MSON). Optic neuritis is the inflammatory demyelination of the optic nerve that affects the transmission of visual stimuli to the brain and therefore causes vision anomalies such as blurred vision.




Changes to the retinal layers due to neurodegeneration can be assessed through various retinal imaging techniques. One such technique is optical coherence tomography (OCT), which is the gold standard retinal imaging modality that provides a rapid, noninvasive, reliable, reproducible, and high-resolution cross-sectional or three-dimensional images of the retina.


Treatment

There is no cure for MS yet, but there are several therapeutic approaches which include medications that can modify the course of the disease, treat relapses, and manage symptoms.


Self-Care Tips

Self-care authentically begins from within. It means you are intentionally taking ownership of your health. Here are a few guides that may help:


Attune yourself to elements that can build you up and improve your energy flow. Discovering ways to responsibly manage stress and relax can be beneficial.






Healthy diet is crucial in maintaining a healthy lifestyle. Foods high in antioxidants may be particularly helpful in alleviating inflammation by reducing oxidative stress.







Exercises such as swimming, yoga, walking, and the likes can be beneficial. Exercise may improve your stamina, flexibility, balance, and overall health. Discuss with your health provider to ensure that your choice of exercise is safe for you.




Support groups can be another great way to boost your health. Surround yourself with loving family members and friends. This also includes choosing doctors and healthcare teams that you are comfortable working with.





Smoking is a risk factor for the development of MS and several other diseases such as cancer, diabetes, and cardiovascular diseases. Smoking may worsen MS by aggravating the inflammatory progression of MS. Quitting smoking can help slow down the progression of the disease and reduce the risk of developing additional diseases.



Monitoring your health by maintaining your clinical appointments with your healthcare provider and complying with your treatment plan can be beneficial. Monitoring your eye health through a simple DIY eye care routine may also be helpful since vision symptoms are usually the first indications of MS.


Be intentional, take care of yourself - you are a precious being!





Sources

1. Langer-Gould, A. M., Gonzales, E. G., Smith, J. B., Li, B. H., & Nelson, L. M. (2022). Racial and Ethnic Disparities in Multiple Sclerosis Prevalence. Neurology, 98(18), e1818–e1827. https://doi.org/10.1212/WNL.0000000000200151


2. Walton, Clare et al. “Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition.” Multiple sclerosis (Houndmills, Basingstoke, England) vol. 26,14 (2020): 1816-1821. doi:10.1177/1352458520970841


3. Talanki Manjunatha, Ramya et al. “Multiple Sclerosis: Therapeutic Strategies on the Horizon.” Cureus vol. 14,5 e24895. 10 May. 2022, doi:10.7759/cureus.24895

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