AOA 2026: Detecting and managing MS-related vision changes

Jacqueline Theis, OD, FAAO, a neuro-optometrist in Richmond, Virginia, discussed key takeaways from her AOA Optometry’s Meeting 2026 presentation “Multiple Sclerosis: Visual Manifestations and Neuro-Optometric Strategies.” She characterizes multiple sclerosis (MS) as a heterogeneous autoimmune, neuroinflammatory, and neurodegenerative condition, noting that the visual system can be affected at multiple points along the disease course.

A major theme is the variable presentation of optic neuritis, which is frequently an initial manifestation of MS. Theis explained that while many patients recover visual acuity, subtle but functionally significant deficits often remain, including reduced contrast sensitivity, ocular motor abnormalities, and persistent scotomas. She highlighted that optic neuritis is often unilateral, can be bilateral, and typically evolves as subacute vision loss; posterior optic neuritis may present with a normal-appearing fundus despite measurable visual dysfunction, complicating diagnosis.

She also underscored cases where MS presents less “typically,” such as double vision or abnormal eye movements in demographics not classically associated with MS (for example, older males). These presentations may initially suggest an alternative diagnosis until neuroimaging reveals MS, which she describes as some of the “harder” cases.

Another key focus is visual fatigue linked to ocular motor instability, such as nystagmus, oscillopsia, and saccadic intrusions. Theis differentiates visual fatigue from broader cognitive fatigue and notes that interventions that stabilize fixation or improve visual input—such as low vision strategies, magnification, tints, and managing photophobia—can have a meaningful impact on patients’ perceived fatigue and function.

She stressed the importance of individualizing care based on where the patient is in their MS journey—newly diagnosed, undergoing treatment, or experiencing progressive disability. Practical considerations include avoiding progressive lenses in patients with mobility challenges and adjusting working distances for those in wheelchairs or gurneys so they can continue valued activities like reading and writing.

Finally, Theis emphasizes interprofessional collaboration. She routinely asks patients what they struggle with visually and, when the issues appear more cognitive or environmental, refers them to occupational therapy, cognitive OT, social work, or neuropsychology. She closed by noting the robust therapeutic pipeline in MS, including disease-modifying agents and potential remyelination strategies, and anticipates a growing role for optometry in long-term MS management.