Article – Ocular MG – A Prism Solution

Source: from article by Gary Nelsen, Springfield Support Group Leader and Dr. Shaun Hill, Optometrist

Double vision is often the the first sign to appear for those of us who have been diagnosed with myasthenia gravis. For some, like me,. that continues to be the primary symptom. I was diagnosed in 2006 and struggled with double vision, even after having tried Mestinon, Imuran, Predisone and Cellcept, and found little help.

Two years ago my opthalmologist recommended that
we try prisms in my eye glasses. I was not enthused becaused we had tried temporary prisms which can be stuck on the lenses and they had not helped at all. But my opthalmologist wanted to have my optometrist perform the eye exam late in the morning when my symptoms were less severe.

The new glasses were amazing almost totally relieving me of the double vision. When my eyes were checked a year later the optometrist made an additional adjustment . The result ­ no double vision at all, tired or not. It is a WOW !

I asked my optometrist to explain what he did, in the hope that relaying this information might help someone else, as we all know about the ‘snowflake’ aspect of MG and how different symptoms be can from one person to another.

Here is his reponse:

“Myasthenia gravis is an unpredictable disease in which the muscles and nerves innervating the muscles seem randomly disconnected from patient’s perspective. Myasthenia gravis is known to cause ptosis (drooping) of the eyelid, diplopia (double vision) and tumors of the thymus gland, as well as muscle weakness including difficulties swallowing and breathing.”

“My patient has experienced ocular difficulties due to having myasthenia graves for over six years.  He began having double vertical double vision.  The difficulty was that the amount of vertical prism necessary would change from one visit to the next.  Every four or five months the amount of prism kept changing. With some patients this can change hourly or even after a few minutes. After approximately four years, the vertical prism stabilized and with a slight horizontal prism included, his diplopia has stabi­ lized for the last ten months.”

“The hidden pearl is that the patient’s best visual acuity (clearness and sharpness of vision) should be maximised and expect fluctuation.  Cataract surgery could improve the overall quality of vision.”

We thank the MGF of Illinois – Conquer, September 2013 and Gary Nelsen for this article.