Photopsia: Not Just a PVD Wyatt Messenger MD PGY-2 University of Illinois Chicago

S. A. 21 year-old healthy male presenting with 2 days of visual disturbances in his left eye. He describes seeing a "round circle with lines radiating from it” as well as temporal “flashes.” Several new blind spots with the largest being in the center of his vision. No pain, but endorsed “pressure.” No headache, curtain/veil, double vision, black out of vision or distorted vision. Right eye is at baseline.

S. A. PMHx: Unremarkable POHx: Low myopia FamHx: Non-contributory Social Hx: College student, drinks occasionally, used cocaine three times ROS: Negative

Exam OD OS VA 20/20 20/20-2 IOP 13 14 Pupils 6  4, no rAPD Motility Full ROM CVF Full

Exam OD OS External WNL L/L C/S White and clear K Clear AC Deep and quiet Lens Vitreous 1+ cell, aggregates of cell inferiorly Disc C/D=0.3 Macula Flat Flat. V/P

Labs Assessment/Plan Normal CBC, CMP, FTA, and CXR Acute, unilateral intermediate uveitis Referred to uveitis

One month later… Awoke with acute onset facial numbness in the V1 and V2 distribution Noted feeling numbness in hand when anxious. Worsening light dark adaption.

Numerous foci of non-enhancing white matter changes on T2 flair MRI involving multiple lobes of the brain and spinal cord. Diagnosis: Multiple Sclerosis

Methods Retrospective chart review of all uveitis patients diagnosed with MS from 1985 to 2013 113 patients (196 eyes) studied Demographic, ophthalmic, and neurologic data were collected at the patient’s first and last visits at the uveitis clinic A control group of patients was selected with idiopathic intermediate uveitis not suspected to have MS. Messenger W, Hildebrandt L, Mackensen F, Suhler E, Becker M, Rosenbaum JT. Characterisation of uveitis in association with multiple sclerosis. Br J Ophthalmol. 2015 Feb;99(2):205-9.

Result #1: Prevalence Our database search of over 8,300 patients identified 113 patients (196 eyes) with uveitis and MS. The prevalence of MS in American and European populations has been estimated to be 5-8 per 10,000. Multiple sclerosis is 20x more likely in American and European populations with uveitis compared to the general public.

Result #2: Anatomic Location Nearly 25% of patients with uveitis and MS present have anterior segment involvement.

Result #3: Visual Acuity Change in logMAR visual acuity in patients with uveitis and MS On average, logMAR visual acuity improved -0.09 logMAR per year Nine patients lost ≥3 lines and 16 patients gained ≥3 lines. Patients with MS and uveitis have a stable to favorable visual prognosis.

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