Dr. Smith (new ophthalmologist) Dr. Cooke (neurologist)
(with explanations by Shaylee in italics)
Dear Dr. Cooke:
Joseph returned for a follow up. As you know he is a 28 year old young man with markedly decreased vision secondary to previous episodes of optic neuritis related to his Multiple Sclerosis. Optic neuritis is swelling in the optic nerve. It can also be one of the first symptoms of Multiple Sclerosis.
On examination his best corrected vision is 20/300 OD and count finger at three feet OS. The exam is pertinent for rotary nystagmus in all positions of gaze. Nystagmus - involuntary eye movements from side to side, up & down or rotary. Joseph's nystagmus would be considered "acquired nystagmus" because it developed later in life and as a result of his Multiple Sclerosis. His visual field to confrontation show dense loss of his central field. Joseph has extreme blurriness in his central field of vision exclusively, while his peripheral vision remains less blurred. The optic nerve show severe bilateral optic nerve pallor. Pallor also means atrophy meaning the loss of some or most of the fibers of the optic nerve, or damage. The optic nerve is part of the brain and has no capability for regeneration. Hence, the term may refer to serious or mild but always irreversible visual loss due to damage to the optic nerve. Bilateral optic atrophy: Loss of vision in both eyes. Joseph would have the "acquired" type of optic atrophy, secondary to swelling within the optic nerve (optic neuritis). Optic neuritis a result of a Multiple Sclerosis exacerbation or "flare up". We will see him again in one year.
Sincerely,
Dr. Quinn Smith
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