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

2. 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.

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

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

5. 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

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

7. 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.

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

9. 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 Feb;99(2):205-9.

10. 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.

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

12. Result #3: Visual Acuity
Change in logMAR visual acuity in patients with uveitis and MS
On average, logMAR visual acuity improved 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.

13. Thank You!
Dog Mountain, Columbia River Gorge