ABSTRACT
The human visual system relies on the constant and rapid transmission of information along myelinated nerve pathways and, therefore, is exquisitely vulnerable to the effects of a demyelinating disease such as multiple sclerosis (MS). Visual symptoms are very common in MS. They may be transient, lasting for several weeks at a time, or they may be more permanent or chronic and result in persistent visual impairment. In the latter situation, they may be a source of signi„cant disability among clients of rehabilitation services.1 Symptoms can be roughly categorized into two groups: symptoms that suggest a visual problem in one or both eyes (e.g., blurred, foggy, or cloudy vision in one or both eyes) and symptoms that suggest a problem with eye movement (e.g., double vision that goes away with either eye closed or a sense that whatever is being looked at is moving). MS can affect both the afferent visual stream, by which information from the eyes is transmitted to the brain and processed as visual information, and the efferent pathways that coordinate the movement of the eyes. In this way, MS can cause both visual blurring or loss in one or both eyes, as well as impairment of moving the eyes together that often manifests as diplopia (double vision). Few disease conditions have the potential to inuence both the afferent and efferent aspects of the visual system, and evidence of both in an individual is highly suggestive of MS. After reading this chapter, you will be able to:
1. Review the underlying neuroanatomy and pathophysiology of both afferent and efferent visual impairment in MS,
2. Identify the impact of visual symptoms on the everyday lives of people with MS, 3. Provide an overview of the neuro-ophthalmologic history and assessment of an
MS client with visual symptoms, 4. Discuss the roles of the different members of the vision rehabilitation team, and 5. Discuss the assessment methods and intervention strategies employed by the
members of the rehabilitation team to address visual symptoms and reduce their impact on clients with MS.
