Does a "pale" optic nerve stay "pale"?

[6-paq]

If you've been told that your optic nerve is pale, will it appear "pale" on subsequent exams?

Background:   I've not had any apparent signs of ON.   I have been checked for 1.5 years by my ophthalmologist.   During July 2008, he takes a digital pic of my right optic nerve and states that it appears "pale" and he is suspecting ON, since I am suspect for MS.  

My visual field tests have all been normal and I have no noticeable difference in color saturation (and my VEP was normal).   He tells me that it is "questionable" and the picture could be over-exposed, but didn't re-take a picture.  Said to come back in 6 months.

At my neuro visit in Dec 2008, he didn't see anything abnormal (but I know that he isn't the definite answer on that).

I had a recent eye exam 3 weeks ago with an optometrist who performed a retinal digital scan and also dialated my eyes and did a visual exam.   He stated (and I also looked at the digital pic) that both optic nerves appear normal.   He said that he has been looking at optic nerves for 15 years and did not see any abnormality with my optic nerves in either eye or any suggestion of ON.

Sooooo, now I don't know what to think.    If my right optic nerve was pale back in July 2008, wouldn't it still be pale now?

Could this mean that the ophthalmologist was incorrect in suggesting that the photo appeared pale and that I possibly have ON?   He didn't say anything about it appearing pale on examination, just when looking at the photo.

If I'm not having any symptoms of ON, should I even pursue this or wait until I am showing any sx?  

[Quixotic1]

Yes, my neuro, who is also a neuro-ophthalmologist and a neuro-otologist ordered and did the OCT in his office.  It is not yet widely available, but should be appearing soon.

OCT is not yet validated as a diagnostic tool, only as a way to monitor subtle increases in brain atrophy by looking for otpic nerve atrophy.

I am feeling better, thanks.

Quix

[6-paq]

Hey Quix!!

Thanks for your insight and confirmation about what I was thinking about my ophthalmologist and the pale optic disc.  I really think he's off his rocker too!!  :-P

Yeah, my neuro also said that if there is nerve damage (which he didn't see any evidence of after that ophthal appt) that it would be permanent and that there is nothing that can be done.

Also thank you for the info on the OCT.  I'll have to investigate that.  It sounds like a simple way to monitor damage.   Did your neuro order that test?

Take care and I hope you are feeling well!
Pat :-)

[Quixotic1]

Hi, Kiddo!  I think the ophthalmologist was off his rocker.  Your neuro was right on about his assessment of the behavior of seeing it on the photo and not repeating the photo yet telling you about it.

Now, true optic pallor is from atrophy of the optic nerve.  That kind of nerve loss does not grow back. Period.  It should be pale until dommsday.  or doomstay, whichever comes first.

Yes, you can and many people do have optic neuritis without any clinical symptoms.  That is what they found when they validated OCT as a way to document increasing brain atrophy in following someone with MS.   OCT is Optical Coherence Tomography  which is a new, quick, noninvasive way of measuring the thickness of the optic nerve at its edge.  Researchers have discovered the OCT is an accurate method of monitoring a known MS patient for progression of disease which includes brain atrophy.  As their disease progresses progressive optic nerve atrophy can be shown WHETHER OR NOT that person has had signs and symptoms of optic neuritis.

I had OCT two years into my disease which showed mild atrophy on one side and borderline atrophy on the other - despite the fact that I have never had visual symptoms.

Pat - if your nerve is not pale now, the first eye doc was mistaken and too hasty in his Dx.

Quix

[6-paq]

Thanks for your insight!

At every 6 month visit my Visual Field Test was normal and my optic discs looked fine.  Then one visit the ophthal says "maybe ON".  I've had no pain, no blurriness (other than what comes from my astigmatism) ~ nothing.

Now, I'm back to "normal" after a digital scan and exam by the opto.  

My neuro said that if my ophthal only suspected ON based on the photo (and not sx) and would not re-take the photo, then he shouldn't have said anything to me at that time.  I've spoken with another ophthal that said the same thing.

I have heard that you can have ON and not know it.   My neuro confirmed that as well. Since my optic discs appear "normal" only 9 months later, then I'm going to assume that my ophthal was wrong and that there was an "over-exposed" photo (in his words).

Thanks for your input!   I appreciate it!
Take care,
Pat :-)

[poorkid]

My neuro who is also a neuro opthomologist, said that my optic nerves are pale.  
I had an eye exam by a regular optho, and he could not see it.

Back to the neuro optho and yes, he still see the paleness.  

I don't quite get it, except my neuro says that HE knows what to look for and that was that.  I have never really experienced an acute attack of ON although have had some issues with pain and blurriness.  My neuro says at some point, I did have ON.  

I opt to go with what the expert sees.  It did not, however, have any factor in my diagnosis.

[Udkas]

Hi,
I am not sure about the correct answer to your question but can only speak for my own eyes and experience.  I had what was suspected Optic neuritis over 14 years ago now and was told at the time that my optic discs were pale.  I had no colour saturation problems but I did have the nerve pain at the back of eye with movement of eye and some blurring of vision etc.. My field tests were abnormal and my VEP tests were abnormal.  My fields showed damage consistent with my area in my eyes that were thought to be abnormal. My last lot of fields were normal but I am awaiting of some results for some that I had done last week...so you fields can go back to being normal...

14 years on and my discs are still pale.  If I go to an optometrist for an eye test they always want to check me for glaucoma because my discs look funny.  I am at present having more testing done and get results on Wednesday but my discs still indicate an episode or maybe more of optic neuritis according to the eye specialist.  I could see the difference between my two eyes on the pictures but the palor is seen also during a normal eye exam.. so I am assuming they still stay pale..well that's what they tell me.. :-)

Best wishes.