Vision issues - Dr. Sending to neuro-opthamologist. Is this necessary?

[drosophila]

Hello,

I went to see my PCP last week because I've been experiencing some strange visual disturbances.

I am experiencing a graying of vision. This graying is mostly noticeable in dim light.  In bright light it appears like blurring.  I'm also having (for lack of a better way to put it) flickering.  It's almost like lights are flickering in the room or outside, but it's my eyes.  The flickering is not as common as the graying/blurring.  It's happens randomly and with no rhyme or reason and generally only lasts at most 15 - 20 mins at a time.  I was also seeing a spot similar to a camera flash on my eye for several days.  That spot has now resolved.

My PCP sent me to an ophthalmologist.  I saw her today. My eyes were dilated and numbed, then looked at with a microscope(?) (It's some sort of glaucoma test but without the puff of air - sorry, I don't know the name), did a typical slit lamp exam and what I thought they called a visual field test - I had to stare at the center of a field & push a button whenever I saw a small red flash of light.  They also checked for color blindness.

My PCP sent me to see her to rule out optic neuritis.  He had mentioned that he wanted to rule out multiple sclerosis. Optic neuritis was not present; She said everything looks perfectly normal & healthy, but wants to send me to a neuro-opthamologist.

I'm just not sure if a visit to a neuro-opthamologist is necessary.  It's a 3 hour drive from my home.  I asked her why she didn't want to send me to a regular neurologist, and all she said is "they don't know vision issues like neuro-opthamologists do".  I spent 3 hours having different tests done and she only spent 5 minutes tops with me and walked away from me before I could ask any other questions.  I am frustrated and confused - why on earth does she want to send me to a neuro-opth if my vision appears normal & healthy?

Is this referral really necessary?  What tests could a neuro-opthamologist run that a neurologist could not?  If MS is still a suspicion, why not just have an MRI done by a neurologist? That can be done here locally.

There is obviously some kind of issue, but I don't understand her referral.

Thank you for your time and any help you might be able to provide.

Other information that might be useful:
33 year old female nursing student
Lazy eye as a child in right eye.
Hx of endometriosis - taking seasonelle (no inactive pills) to hold off pain & another surgery until I'm finished with school.
Daily 2000 units Vit D (for previously diagnosed deficiency) and a daily multivitamin
Random numbness/tingling of feet and hands, mostly left hand.  Once experienced a buzzing/vibrating in my left hand as well.
Diagnosed with a balance disorder (bilateral vestibulopathy) three years ago.  

[Londres70]

All the best to you.  :)

[drosophila]

Thanks for the input Londres & Cobob.  I certainly hope it's not MS, but it would be nice to have some answers so I can just keep moving on you know?

[Londres70]

See what your PCP thinks about ordering the MRI per MS protocol and a Neuro consult.  I doubt the MRI you had a year ago will fulfill the MS protocol; it was of your brain/head, but I am not sure if you had contrast or not, so in other words, the scan should be repeated according to MS protocol standards.  

After reading your initial post again, this does not sound like MS to me, sounds definitely Neuro, but I can't agree about the MS.  Do have it ruled out of course.  

[COBOB]

Most Neuro-Ophthalmologists (at least in the US) have a residency in Neurology under their belt.  They are better at evaluating VEP and can figure out what vision changes are due to refraction vs. Cranial Nerve 2 damage.  My right eye thinks things are further away than my left eye.  That is due to decreased conduction velocity in the optic nerve of my right eye.

Bob

[drosophila]

PS - he said the headaches were cluster headaches.  I haven't had much problem with them since.  I've only had "normal" type headaches.  These felt like an ice pick was being stabbed through the right side of my head.  Very painful.

[drosophila]

Hi Londres, thanks for your reply.

Yes, I still have some issues with the dizziness.  I have been through vestibular rehab twice and it does help.  Now I just do the exercises at home a couple of times a week and more as needed when I feel more "off balance".  When it originally started happening 3 years ago, it was very scary and very severe. I couldn't drive and had issues with falling.  No more of that thank goodness, but yes, I do have flare up from time to time.  It's much worse in the dark too.  I have to have some lights on or near by at night or else I have to walk like an old lady through the house lol.

After I posed, I did realize I forgot to mention that I did have an MRI about a year ago due to headaches.  He wanted MRI because of family history of aneurysm. That MRI was normal.  But I do wonder - did they scan the entire brain & was it to MS protocol (including cervical & thoracic spine?).  

I think I will put in a call to my PCP and see what he thinks about all of this and see how he would like to proceed.

Thanks again Londres.  And thanks for the good luck wishes for school!   So far things are going great - 7 classes & 4.0 GPA!