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Vujosevic S, Limoli C, Kozak I. Hallmarks of aging in age-related macular degeneration and age-related neurological disorders: novel insights into common mechanisms and clinical relevance. Eye (Lond) 2024:10.1038/s41433-024-03341-5. [PMID: 39289517 DOI: 10.1038/s41433-024-03341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/13/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] Open
Abstract
Age-related macular degeneration (AMD) and age-related neurological diseases (ANDs), such as Alzheimer's and Parkinson's Diseases, are increasingly prevalent conditions that significantly contribute to global morbidity, disability, and mortality. The retina, as an accessible part of the central nervous system (CNS), provides a unique window to study brain aging and neurodegeneration. By examining the associations between AMD and ANDs, this review aims to highlight novel insights into fundamental mechanisms of aging and their role in neurodegenerative disease progression. This review integrates knowledge from the emerging field of aging research, which identifies common denominators of biological aging, specifically loss of proteostasis, impaired macroautophagy, mitochondrial dysfunction, and inflammation. Finally, we emphasize the clinical relevance of these pathways and the potential for cross-disease therapies that target common aging hallmarks. Identifying these shared pathways could open avenues to develop therapeutic strategies targeting mechanisms common to multiple degenerative diseases, potentially attenuating disease progression and promoting the healthspan.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Eye Clinic, IRCCS MultiMedica, Milan, Italy.
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
- University of Milan, Milan, Italy
| | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, UAE
- Ophthalmology and Vision Science, University of Arizona, Tucson, USA
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Devenyi RA, Hamedani AG. Visual dysfunction in dementia with Lewy bodies. Curr Neurol Neurosci Rep 2024; 24:273-284. [PMID: 38907811 PMCID: PMC11258179 DOI: 10.1007/s11910-024-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW To review the literature on visual dysfunction in dementia with Lewy bodies (DLB), including its mechanisms and clinical implications. RECENT FINDINGS Recent studies have explored novel aspects of visual dysfunction in DLB, including visual texture agnosia, mental rotation of 3-dimensional drawn objects, and reading fragmented letters. Recent studies have shown parietal and occipital hypoperfusion correlating with impaired visuoconstruction performance. While visual dysfunction in clinically manifest DLB is well recognized, recent work has focused on prodromal or mild cognitive impairment (MCI) due to Lewy body pathology with mixed results. Advances in retinal imaging have recently led to the identification of abnormalities such as parafoveal thinning in DLB. Patients with DLB experience impairment in color perception, form and object identification, space and motion perception, visuoconstruction tasks, and illusions in association with visual cortex and network dysfunction. These symptoms are associated with visual hallucinations, driving impairment, falls, and other negative outcomes.
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Affiliation(s)
- Ryan A Devenyi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Szmulewicz DJ, Galli R, Tarnutzer AA. Patient-Related Outcome Measures for Oculomotor Symptoms in the Cerebellar Ataxias: Insights from Non-Cerebellar Disorders. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1435-1448. [PMID: 38214833 PMCID: PMC11269357 DOI: 10.1007/s12311-024-01656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
In patients with cerebellar ataxia (CA), symptoms related to oculomotor dysfunction significantly affect quality of life (QoL). This study aimed to analyze the literature on patient-related outcome measures (PROMs) assessing QoL impacts of vestibular and cerebellar oculomotor abnormalities in patients with CA to identify the strengths and limitations of existing scales and highlight any areas of unmet need. A systematic review was conducted (Medline, Embase) of English-language original articles reporting on QoL measures in patients with vertigo, dizziness or CA. Pre-specified parameters were retrieved, including diseases studied, scales applied and conclusions drawn. Our search yielded 3671 articles of which 467 studies (n = 111,606 participants) were deemed relevant. The most frequently studied disease entities were (a) non-specific dizziness/gait imbalance (114 studies; 54,581 participants), (b) vestibular schwannomas (66; 15,360), and (c) vestibular disorders not further specified (66; 10,259). The Dizziness Handicap Inventory (DHI) was the most frequently used PROM to assess QoL (n = 91,851), followed by the Penn Acoustic Neuroma Quality-of-Life Scale (n = 12,027) and the Activities-Specific Balance Confidence Scale (n = 2'471). QoL-scores capturing symptoms related to oculomotor abnormalities in CA were rare, focused on visual impairments (e.g., National-Eye-Institute Visual Function Questionnaire, Oscillopsia Functional Impact, oscillopsia severity score) and were unvalidated. The DHI remains the most widely used and versatile scale for evaluating dizziness. A lack of well-established PROMs for assessing the impact of oculomotor-related symptoms on QoL in CA was noted, emphasizing the need for developing and validating a new QoL-score dedicated to the oculomotor domain for individuals with CA.
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Affiliation(s)
- David J Szmulewicz
- Balance Disorders and Ataxia Service, Royal Victoria Eye and Ear Hospital, Melbourne, VIC, Australia
- The Bionics Institute, Melbourne, VIC, Australia
- University of Melbourne AU, Melbourne, VIC, Australia
| | - Rocco Galli
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Alexander A Tarnutzer
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Department of Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
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Gazanchian M, Jansonius NM. Effect of Nonoverlapping Visual Field Defects on Vision-related Quality of Life in Glaucoma. Ophthalmol Glaucoma 2024; 7:401-409. [PMID: 38311108 DOI: 10.1016/j.ogla.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Glaucoma patients may be considered to have normal vision as long as each point of visual space is perceived by at least 1 eye, that is, with an intact binocular visual field (VF). We aimed to investigate the effect of nonoverlapping VF defects on vision-related quality of life (VR-QoL) in glaucoma. DESIGN Cross-sectional study. SUBJECTS AND CONTROLS Two hundred sixty-nine glaucoma patients and 113 controls. METHODS We evaluated VR-QoL of glaucoma patients (n = 269) and controls (n = 113) using 4 different questionnaires (National Eye Institute visual function questionnaire [NEI-VFQ-25], NEI-VFQ neuro-ophthalmology supplement, Glaucoma Quality of Life-15, and a luminance-specific questionnaire). We defined "differential VF" (DVF) as a measure of location-specific differences in the VFs of both eyes. Within the group of glaucoma patients, we analyzed the relationship between different aspects of VR-QoL and DVF using ordinal multiple regression analysis. Analyses were adjusted for age, sex, integrated VF (IVF; an estimate of the binocular VF from the monocular VFs), and higher visual acuity of both eyes, and corrected for multiple hypothesis testing. MAIN OUTCOME MEASURES Vision-related quality of life. RESULTS Glaucoma patients had lower VR-QoL than controls. Among the glaucoma patients, DVF was significantly associated with general vision (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.54-0.89), peripheral vision (OR, 0.68; 95% CI, 0.54-0.86), walking on uneven ground (OR, 0.73; 95% CI, 0.58-0.93), crossing the street (OR, 0.61; 95% CI, 0.46-0.83), seeing other road users coming from the side (OR, 0.67; 95% CI, 0.52-0.85), cycling during the day (OR, 0.64; 95% CI, 0.46-0.89) and seeing outside on a sunny day (OR, 0.73; 95% CI, 0.57-0.94). In general, IVF was a stronger predictor of VR-QoL than DVF. CONCLUSIONS Nonoverlapping VF defects affect VR-QoL. Although IVF is strongly associated with VR-QoL, basing clinical decisions only on IVF leads to overlooking vision problems that patients may have. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mehrdad Gazanchian
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands.
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Dogra N, Redmond BV, Lilley S, Johnson BA, Lam BL, Tamhankar M, Feldon SE, Fahrenthold B, Yang J, Huxlin KR, Cavanaugh MR. Vision-related quality of life after unilateral occipital stroke. Brain Behav 2024; 14:e3582. [PMID: 38956813 PMCID: PMC11219293 DOI: 10.1002/brb3.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/22/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND/OBJECTIVES Stroke damage to the primary visual cortex induces large, homonymous visual field defects that impair daily living. Here, we asked if vision-related quality of life (VR-QoL) is impacted by time since stroke. SUBJECTS/METHODS We conducted a retrospective meta-analysis of 95 occipital stroke patients (female/male = 26/69, 27-78 years old, 0.5-373.5 months poststroke) in whom VR-QoL was estimated using the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and its 10-item neuro-ophthalmic supplement (Neuro10). Visual deficit severity was represented by the perimetric mean deviation (PMD) calculated from 24-2 Humphrey visual fields. Data were compared with published cohorts of visually intact controls. The relationship between VR-QoL and time poststroke was assessed across participants, adjusting for deficit severity and age with a multiple linear regression analysis. RESULTS Occipital stroke patients had significantly lower NEI-VFQ and Neuro10 composite scores than controls. All subscale scores describing specific aspects of visual ability and functioning were impaired except for ocular pain and general health, which did not differ significantly from controls. Surprisingly, visual deficit severity was not correlated with either composite score, both of which increased with time poststroke, even when adjusting for PMD and age. CONCLUSIONS VR-QoL appears to improve with time postoccipital stroke, irrespective of visual deficit size or patient age at insult. This may reflect the natural development of compensatory strategies and lifestyle adjustments. Thus, future studies examining the impact of rehabilitation on daily living in this patient population should consider the possibility that their VR-QoL may change gradually over time, even without therapeutic intervention.
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Affiliation(s)
- Neil Dogra
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Bryan V. Redmond
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Selena Lilley
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Byron L. Lam
- Bascom Palmer Eye InstituteUniversity of MiamiMiamiFloridaUSA
| | - Madhura Tamhankar
- Scheie Eye InstituteUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Steven E. Feldon
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Berkeley Fahrenthold
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Jingyi Yang
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Krystel R. Huxlin
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
| | - Matthew R. Cavanaugh
- Department of Ophthalmology, Flaum Eye Institute and Center for Visual ScienceUniversity of RochesterRochesterNew YorkUSA
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Nisanova A, Barrios L, Chokshi T, Mannis M, Bloch O, Liu YA. A Feasibility Study on a Portable Vision Device for Patients with Stroke and Brain Tumours. Neuroophthalmology 2024; 48:3-12. [PMID: 38357627 PMCID: PMC10863346 DOI: 10.1080/01658107.2023.2273471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/09/2023] [Indexed: 02/16/2024] Open
Abstract
This prospective, single-centre cohort study aimed to evaluate the impact of a portable vision reading device, OrCam Read, on vision-related quality-of-life and independent functional status in patients with low vision due to stroke or brain tumours. Six patients with poor visual acuity or visual field defects due to a stroke or a brain tumour were enrolled at a U.S. Ophthalmology Department. Participants were trained to use OrCam Read and given a loaner device for the 1 month duration of the study. Various assessments, including daily function tests, the National Eye Institute Visual Function Questionnaire-25, and the 10-item neuro-ophthalmic supplement, were administered at the first and last visits. Patients' experience with the device was evaluated with weekly telephone and end-of-study satisfaction surveys. The main outcome measures were the patient satisfaction with OrCam and the mean assessment scores between enrolment and final visits. The intervention with OrCam significantly improved patients' ability to complete daily tasks and participants reported good satisfaction with the device. The results also show non-significant improvement with distant activities, dependency, and role difficulties. Our findings demonstrate the feasibility of studying vision-related quality-of-life using a portable vision device in this patient population and pave the way for a larger study to validate the results of this study.
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Affiliation(s)
- Arina Nisanova
- School of Medicine, University of California, Davis, California, USA
| | - Laurel Barrios
- School of Medicine, University of California, Davis, California, USA
| | - Tanvi Chokshi
- College of Medicine, California Northstate University, Elk Grove, California, USA
| | - Mark Mannis
- Department of Ophthalmology & Vision Science, University of California, Davis, California, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Yin Allison Liu
- Department of Ophthalmology & Vision Science, University of California, Davis, California, USA
- Department of Neurological Surgery, University of California, Davis, California, USA
- Department of Neurology, University of California, Davis, California, USA
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Howard C, Currie J, Rowe FJ. UK exceptional case driving application outcomes in post-stroke homonymous hemianopia: results from a clinical study. Disabil Rehabil 2023; 45:4065-4073. [PMID: 36377421 DOI: 10.1080/09638288.2022.2144488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE We report results in relation to returning to driving in the UK under the exceptional cases rule for visual field loss. METHODS The Hemianopia Adaptation Study is a prospective clinical study recruiting adult stroke survivors with new onset homonymous hemianopia. The mobility assessment course (MAC) was used to measure navigational scanning. Car drivers were offered a 1-year post-stroke assessment to consider referral for driving assessment. RESULTS Of 144 participants, 51 were eligible for driving assessment, with 13 (25.4%) accepting appointment for UK Driving and Vehicle Licensing Agency (DVLA) referral. A statistically significant difference in gender and baseline Barthel (stroke severity) scores was found between those requesting referral and those declining (p = 0.046; p < 0.001). MAC outcomes were significantly different, with those referred having a lower percentage of target omissions (9.0%) and faster mean course completion time (46.0 s), than those not referred (28.3%/72.5 s) (p = 0.006/p < 0.001). Twelve of the 13 referred were offered a driving assessment by the DVLA. All 12 passed and returned to driving. CONCLUSIONS It is possible for individuals with post-stroke homonymous hemianopia to return to driving, where exceptional cases criteria are met. There is evidence to support use of the MAC as a clinical measurement of adaptation.IMPLICATIONS FOR REHABILITATIONIndividuals with post-stroke homonymous hemianopia should be fully informed regarding driving regulations that can differ between countries and sometimes different states within a country, as well as provided with the support and opportunity to consider a return to driving if appropriate.Professionals providing care within the stroke multi-disciplinary team should be aware that it is possible for patients with homonymous hemianopia to return to driving, when exceptional cases criteria are met.The mobility assessment course (MAC) should be considered as a clinical measurement of adaptation in homonymous hemianopia.A cut-off score of ≤25% omissions on MAC could be employed to determine those likely to adapt to hemianopia long-term and potentially return to driving.
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Affiliation(s)
- Claire Howard
- Manchester Centre for Clinical Neurosciences, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Jim Currie
- Patient and Public Involvement Representative, Sidcup, UK
| | - Fiona J Rowe
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Kelly JT, Wilkes JR, Slobounov SM. An Examination of Visual Quality of Life and Functional Vision Among Collision and Non-Collision Athletes Over a Competitive Season. Arch Clin Neuropsychol 2023; 38:1115-1123. [PMID: 37097732 DOI: 10.1093/arclin/acad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Repetitive head impacts (RHIs) experienced during sports are gaining attention due to potential long-term neurological dysfunction, absent of a diagnosed concussion. One area susceptible to dysfunction is vision. The goal of this study was to evaluate changes in visual quality of life (VQOL) and functional vision scores from pre- to post-season among collision and non-collision athletes. METHODS The Visual Functioning Questionnaire-25 and Neuro-Ophthalmic Supplement (NOS), as well as functional vision testing (Mobile Universal Lexicon Evaluation System - MULES) were completed pre- and post-season by three groups: collision athletes, non-collision athletes, and minimally active controls (MACs). RESULTS There were 42 participants, with 41 (21 male, 20 female) completing both testing sessions, with a mean (standard deviation [SD]) age of 21 (2.46) years (collision group, n = 14; non-collision group, n = 13, MACs, n = 14). Baseline analyses revealed no significant differences between groups for VQOL or MULES scores. However, those with a family history of psychiatric disorder scored significantly worse on NOS. Post-season/follow-up testing revealed no significant differences between groups for VQOL scores. Non-collision athletes significantly improved on the MULES test by 2.46 ± 3.60 (SD) s (35.0 [95% confidence interval, 0.29-4.63]; p = .03). Change score results from pre- to post-season were not significant. CONCLUSION Although the groups were not significantly different from one another, non-collision athletes significantly improved MULES scores, whereas collision athletes performed the worst, suggesting exposure to RHIs may impact functional vision. Thus, further evaluation of RHIs and their impact on vision is warranted.
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Affiliation(s)
- Jon T Kelly
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - James R Wilkes
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Penn State University, University Park, PA, USA
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Panthagani J, O'Donovan C, Aiyegbusi OL, Liu X, Bayliss S, Calvert M, Pesudovs K, Denniston AK, Moore DJ, Braithwaite T. Evaluating patient-reported outcome measures (PROMs) for future clinical trials in adult patients with optic neuritis. Eye (Lond) 2023; 37:3097-3107. [PMID: 36932161 PMCID: PMC10022552 DOI: 10.1038/s41433-023-02478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/09/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To search for and critically appraise the psychometric quality of patient-reported outcome measures (PROMs) developed or validated in optic neuritis, in order to support high-quality research and care. METHODS We systematically searched MEDLINE(Ovid), Embase(Ovid), PsycINFO(Ovid) and CINAHLPlus(EBSCO), and additional grey literature to November 2021, to identify PROM development or validation studies applicable to optic neuritis associated with any systemic or neurologic disease in adults. We included instruments developed using classic test theory or Rasch analysis approaches. We used established quality criteria to assess content development, validity, reliability, and responsiveness, grading multiple domains from A (high quality) to C (low quality). RESULTS From 3142 screened abstracts we identified five PROM instruments potentially applicable to optic neuritis: three differing versions of the National Eye Institute (NEI)-Visual Function Questionnaire (VFQ): the 51-item VFQ; the 25-item VFQ and a 10-item neuro-ophthalmology supplement; and the Impact of Visual Impairment Scale (IVIS), a constituent of the Multiple Sclerosis Quality of Life Inventory (MSQLI) handbook, derived from the Functional Assessment of Multiple Sclerosis (FAMS). Psychometric appraisal revealed the NEI-VFQ-51 and 10-item neuro module had some relevant content development but weak psychometric development, and the FAMS had stronger psychometric development using Rasch Analysis, but was only somewhat relevant to optic neuritis. We identified no content or psychometric development for IVIS. CONCLUSION There is unmet need for a PROM with strong content and psychometric development applicable to optic neuritis for use in virtual care pathways and clinical trials to support drug marketing authorisation.
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Affiliation(s)
| | - Charles O'Donovan
- School of Immunology and Microbiology, King's College London, London, UK.
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, Birmingham Health Partners for Regulatory Science and Innovation, NIHR Birmingham Biomedical Research Centre, NIHR Applied Research Collaboration West Midlands, and NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, University of Birmingham, University Hospitals Birmingham, Health Data Research UK, London, UK
| | - Susan Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, Birmingham Health Partners for Regulatory Science and Innovation, NIHR, Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Centre, NIHR Applied Research Collaboration West Midlands, and NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Alastair K Denniston
- Institute of Inflammation and Ageing, and Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, Birmingham Health Partners for Regulatory Science and Innovation, NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, University Hospitals Birmingham, Health Data Research UK, London, UK
| | - David J Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tasanee Braithwaite
- School of Immunology and Microbiology, King's College London, and The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Mollan SP, Fraser CL, Digre KB, Diener HC, Lipton RB, Juhler M, Miller NR, Pozo-Rosich P, Togha M, Brock K, Dinkin MJ, Chan CKM, Tassorelli C, Sinclair AJ, Terwindt GM, Jensen RH. Guidelines of the International Headache Society for Controlled Clinical Trials in Idiopathic Intracranial Hypertension. Cephalalgia 2023; 43:3331024231197118. [PMID: 37661711 DOI: 10.1177/03331024231197118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The quality of clinical trials is essential to advance treatment, inform regulatory decisions and meta-analysis. With the increased incidence of idiopathic intracranial hypertension and the emergence of clinical trials for novel therapies in this condition, the International Headache Society Guidelines for Controlled Clinical Trials in Idiopathic Intracranial Hypertension aims to establish guidelines for designing state-of-the-art controlled clinical trials for idiopathic intracranial hypertension.
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Affiliation(s)
- Susan P Mollan
- Neuro-ophthalmology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Clare L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Kathleen B Digre
- Neuro-ophthalmology Division, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Hans-Christoph Diener
- Institut für Medizinische Informatik, Biometrie undEpidemiologie (IMIBE), Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neil R Miller
- Wilmer Eye Institute and Departments of Ophthalmology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mansoureh Togha
- Headache Department, Iranian Centre of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kristian Brock
- Cancer Research Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marc J Dinkin
- Department of Ophthalmology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York, USA
- Department of Neurology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York, USA
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Cristina Tassorelli
- Unit of Translational Neurovascular Research, IRCCS Mondino Foundation, 27100, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100, Pavia, Italy
| | - Alex J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Beheshti M, Naeimi T, Hudson TE, Feng C, Mongkolwat P, Riewpaiboon W, Seiple W, Vedanthan R, Rizzo JR. A Smart Service System for Spatial Intelligence and Onboard Navigation for Individuals with Visual Impairment (VIS 4ION Thailand): study protocol of a randomized controlled trial of visually impaired students at the Ratchasuda College, Thailand. Trials 2023; 24:169. [PMID: 36879333 PMCID: PMC9990238 DOI: 10.1186/s13063-023-07173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Blind/low vision (BLV) severely limits information about our three-dimensional world, leading to poor spatial cognition and impaired navigation. BLV engenders mobility losses, debility, illness, and premature mortality. These mobility losses have been associated with unemployment and severe compromises in quality of life. VI not only eviscerates mobility and safety but also, creates barriers to inclusive higher education. Although true in almost every high-income country, these startling facts are even more severe in low- and middle-income countries, such as Thailand. We aim to use VIS4ION (Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation), an advanced wearable technology, to enable real-time access to microservices, providing a potential solution to close this gap and deliver consistent and reliable access to critical spatial information needed for mobility and orientation during navigation. METHODS We are leveraging 3D reconstruction and semantic segmentation techniques to create a digital twin of the campus that houses Mahidol University's disability college. We will do cross-over randomization, and two groups of randomized VI students will deploy this augmented platform in two phases: a passive phase, during which the wearable will only record location, and an active phase, in which end users receive orientation cueing during location recording. A group will perform the active phase first, then the passive, and the other group will experiment reciprocally. We will assess for acceptability, appropriateness, and feasibility, focusing on experiences with VIS4ION. In addition, we will test another cohort of students for navigational, health, and well-being improvements, comparing weeks 1 to 4. We will also conduct a process evaluation according to the Saunders Framework. Finally, we will extend our computer vision and digital twinning technique to a 12-block spatial grid in Bangkok, providing aid in a more complex environment. DISCUSSION Although electronic navigation aids seem like an attractive solution, there are several barriers to their use; chief among them is their dependence on either environmental (sensor-based) infrastructure or WiFi/cell "connectivity" infrastructure or both. These barriers limit their widespread adoption, particularly in low-and-middle-income countries. Here we propose a navigation solution that operates independently of both environmental and Wi-Fi/cell infrastructure. We predict the proposed platform supports spatial cognition in BLV populations, augmenting personal freedom and agency, and promoting health and well-being. TRIAL REGISTRATION ClinicalTrials.gov under the identifier: NCT03174314, Registered 2017.06.02.
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Affiliation(s)
- Mahya Beheshti
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
- Department of Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, New York, NY, USA
| | - Tahereh Naeimi
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | - Todd E Hudson
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
- Department of Neurology, NYU Langone Health, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, NY, USA
| | - Chen Feng
- Department of Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, New York, NY, USA
| | - Pattanasak Mongkolwat
- Department of Information and Communication Technology, Mahidol University, Salaya, Thailand
| | | | - William Seiple
- Lighthouse Guild, New York, NY, USA
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York, NY, USA
| | - John-Ross Rizzo
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA.
- Department of Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, New York, NY, USA.
- Department of Neurology, NYU Langone Health, New York, NY, USA.
- Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, NY, USA.
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12
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Patil SA, Grossman S, Kenney R, Balcer LJ, Galetta S. Where's the Vision? The Importance of Visual Outcomes in Neurologic Disorders: The 2021 H. Houston Merritt Lecture. Neurology 2023; 100:244-253. [PMID: 36522160 PMCID: PMC9931086 DOI: 10.1212/wnl.0000000000201490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
Neurologists have long recognized the importance of the visual system in the diagnosis and monitoring of neurologic disorders. This is particularly true because approximately 50% of the brain's pathways subserve afferent and efferent aspects of vision. During the past 30 years, researchers and clinicians have further refined this concept to include investigation of the visual system for patients with specific neurologic diagnoses, including multiple sclerosis (MS), concussion, Parkinson disease (PD), and conditions along the spectrum of Alzheimer disease (AD, mild cognitive impairment, and subjective cognitive decline). This review highlights the visual "toolbox" that has been developed over the past 3 decades and beyond to capture both structural and functional aspects of vision in neurologic disease. Although the efforts to accelerate the emphasis on structure-function relationships in neurologic disorders began with MS during the early 2000s, such investigations have broadened to recognize the need for outcomes of visual pathway structure, function, and quality of life for clinical trials of therapies across the spectrum of neurologic disorders. This review begins with a patient case study highlighting the importance using the most modern technologies for visual pathway assessment, including optical coherence tomography. We emphasize that both structural and functional tools for vision testing can be used in parallel to detect what might otherwise be subclinical events or markers of visual and, perhaps, more global neurologic decline. Such measures will be critical because clinical trials and therapies become more available across the neurologic disease spectrum.
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Affiliation(s)
- Sachi A Patil
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY.
| | - Scott Grossman
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
| | - Rachel Kenney
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
| | - Laura J Balcer
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
| | - Steven Galetta
- From the Department of Ophthalmology (S.A.P., L.J.B, S.G.), New York University Grossman School of Medicine, NY; Department of Neurology (S.G., L.J.B., S. Galetta), New York University Grossman School of Medicine, NY; Department of Radiology and Radiological Sciences (R.K.), Vanderbilt University School of Medicine, Nashville, TN; Department of Population Health (L.J.B.), New York University Grossman School of Medicine, NY
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13
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Asseyer S, Asgari N, Bennett J, Bialer O, Blanco Y, Bosello F, Camos-Carreras A, Carnero Contentti E, Carta S, Chen J, Chien C, Chomba M, Dale RC, Dalmau J, Feldmann K, Flanagan EP, Froment Tilikete C, Garcia-Alfonso C, Havla J, Hellmann M, Kim HJ, Klyscz P, Konietschke F, La Morgia C, Lana-Peixoto M, Leite MI, Levin N, Levy M, Llufriu S, Lopez P, Lotan I, Lugaresi A, Marignier R, Mariotto S, Mollan SP, Ocampo C, Cosima Oertel F, Olszewska M, Palace J, Pandit L, Peralta Uribe JL, Pittock S, Ramanathan S, Rattanathamsakul N, Saiz A, Samadzadeh S, Sanchez-Dalmau B, Saylor D, Scheel M, Schmitz-Hübsch T, Shifa J, Siritho S, Sperber PS, Subramanian PS, Tiosano A, Vaknin-Dembinsky A, Mejia Vergara AJ, Wilf-Yarkoni A, Zarco LA, Zimmermann HG, Paul F, Stiebel-Kalish H. The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis. Front Neurol 2023; 14:1102353. [PMID: 36908609 PMCID: PMC9998999 DOI: 10.3389/fneur.2023.1102353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Optic neuritis (ON) often occurs at the presentation of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). The recommended treatment of high-dose corticosteroids for ON is based on a North American study population, which did not address treatment timing or antibody serostatus. The Acute Optic Neuritis Network (ACON) presents a global, prospective, observational study protocol primarily designed to investigate the effect of time to high-dose corticosteroid treatment on 6-month visual outcomes in ON. Patients presenting within 30 days of the inaugural ON will be enrolled. For the primary analysis, patients will subsequently be assigned into the MS-ON group, the aquapotin-4-IgG positive ON (AQP4-IgG+ON) group or the MOG-IgG positive ON (MOG-IgG+ON) group and then further sub-stratified according to the number of days from the onset of visual loss to high-dose corticosteroids (days-to-Rx). The primary outcome measure will be high-contrast best-corrected visual acuity (HC-BCVA) at 6 months. In addition, multimodal data will be collected in subjects with any ON (CIS-ON, MS-ON, AQP4-IgG+ON or MOG-IgG+ON, and seronegative non-MS-ON), excluding infectious and granulomatous ON. Secondary outcomes include low-contrast best-corrected visual acuity (LC-BCVA), optical coherence tomography (OCT), magnetic resonance imaging (MRI) measurements, serum and cerebrospinal fluid (CSF) biomarkers (AQP4-IgG and MOG-IgG levels, neurofilament, and glial fibrillary protein), and patient reported outcome measures (headache, visual function in daily routine, depression, and quality of life questionnaires) at presentation at 6-month and 12-month follow-up visits. Data will be collected from 28 academic hospitals from Africa, Asia, the Middle East, Europe, North America, South America, and Australia. Planned recruitment consists of 100 MS-ON, 50 AQP4-IgG+ON, and 50 MOG-IgG+ON. This prospective, multimodal data collection will assess the potential value of early high-dose corticosteroid treatment, investigate the interrelations between functional impairments and structural changes, and evaluate the diagnostic yield of laboratory biomarkers. This analysis has the ability to substantially improve treatment strategies and the accuracy of diagnostic stratification in acute demyelinating ON. Trial registration ClinicalTrials.gov, identifier: NCT05605951.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jeffrey Bennett
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, and Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Francesca Bosello
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Camos-Carreras
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
| | - Claudia Chien
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Sydney, NSW, Australia.,Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Josep Dalmau
- ICREA-IDIBAPS, Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristina Feldmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Eoin P Flanagan
- Laboratory Medicine and Pathology, Departments of Neurology, Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Caroline Froment Tilikete
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | | | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Republic of Korea
| | - Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Chiara La Morgia
- Neurology Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Michael Levy
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Romain Marignier
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Translational Brian Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, United Kingdom
| | | | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacqueline Palace
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | | | - Sean Pittock
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital Westmead, Sydney, NSW, Australia.,Department of Neurology, Concord Hospital, Sydney, NSW, Australia
| | - Natthapon Rattanathamsakul
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Sara Samadzadeh
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Bernardo Sanchez-Dalmau
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Scheel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Pia S Sperber
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Prem S Subramanian
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Adi Wilf-Yarkoni
- Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Unviersitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Reynolds MS, Katz BJ, Digre KB, Brintz BJ, Olson LM, Warner JE. Sharp Edge Eye Syndrome: A Case Report and Survey of Self-Identified Individuals. J Neuroophthalmol 2022; 42:524-529. [PMID: 36166802 PMCID: PMC9675685 DOI: 10.1097/wno.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sharp edge eye syndrome (SEES), sometimes known as visual looming syndrome, is a condition in which the patient experiences ocular pain or discomfort when viewing or mentally picturing sharp objects and edges. Patients may present for medical care because they perceive the condition to represent an ophthalmic problem or a sign of a more serious underlying condition. An individual case report of SEES is included to aid in illustrating syndrome characteristics. Our aim is to describe the syndrome, vision-related quality of life (VRQOL), and psychosocial characteristics in patients with self-identified SEES. METHODS A cross-sectional web-based survey was made available on social media webpages dedicated to SEES. The study included 22 questions developed by the research team, demographic questions, and 4 standardized questionnaires [ID Migraine, the National Eye Institute's Visual Function Questionnaire (NEI-VFQ-25), General Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire (depression) Scale-2]. RESULTS Seventy-seven respondents had an average age of 29 and were 57% male. 92% reported symptoms before age 18. The main site of pain or discomfort was the eyes, with onset resulting from viewing or thinking of sharp objects and edges. Symptoms lasted from seconds to hours and could be prolonged even after closing eyes or avoiding viewing the trigger. The composite and subscale scores on the NEI-VFQ-25 were low, with a mean composite score of 78 and selected subscores of general health (61), general vision (73), ocular pain (68), driving (79), mental health (61), and role difficulties (72). Anxiety was reported in 58% of participants, and depression in 57%. Migraine or headache was reported in 46% of participants. Participants reported Alice in Wonderland syndrome, visual snow, obsessive-compulsive disorder, attention deficit hyperactivity disorder, stripe-induced visual discomfort, and synesthesia. CONCLUSION From this survey, we have the beginnings of an understanding of the characteristics of SEES, as well as VRQOL impacts. These survey responses lead us to postulate that SEES may be a distinct visual phenomenon and to propose SEES criteria. Systematic studies of this condition's clinical features and treatment responses will be additional steps toward improving patient care.
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Affiliation(s)
- Merrick S. Reynolds
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Bradley J. Katz
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Kathleen B. Digre
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Ben J. Brintz
- Department of Pediatrics, Division of Critical Care, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Lenora M. Olson
- Department of Internal Medicine, Division of Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Judith E.A. Warner
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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15
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Pascoal C, Ferreira I, Teixeira C, Almeida E, Slade A, Brasil S, Francisco R, Ligezka AN, Morava E, Plotkin H, Jaeken J, Videira PA, Barros L, dos Reis Ferreira V. Patient reported outcomes for phosphomannomutase 2 congenital disorder of glycosylation (PMM2-CDG): listening to what matters for the patients and health professionals. Orphanet J Rare Dis 2022; 17:398. [PMID: 36309700 PMCID: PMC9618201 DOI: 10.1186/s13023-022-02551-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background Congenital disorders of glycosylation (CDG) are a growing group of rare genetic disorders. The most common CDG is phosphomannomutase 2 (PMM2)-CDG which often has a severe clinical presentation and life-limiting consequences. There are no approved therapies for this condition. Also, there are no validated disease-specific quality of life (QoL) scales to assess the heterogeneous clinical burden of PMM2-CDG which presents a challenge for the assessment of the disease severity and the impact of a certain treatment on the course of the disease. Aim and methods This study aimed to identify the most impactful clinical signs and symptoms of PMM2-CDG, and specific patient and observer reported outcome measures (PROMs and ObsROMs, respectively) that can adequately measure such impact on patients’ QoL. The most burdensome signs and symptoms were identified through input from the CDG community using a survey targeting PMM2-CDG families and experts, followed by family interviews to understand the real burden of these symptoms in daily life. The list of signs and symptoms was then verified and refined by patient representatives and medical experts in the field. Finally, a literature search for PROMs and ObsROMs used in other rare or common diseases with similar signs and symptoms to those of PMM2-CDG was performed. Results Twenty-four signs/symptoms were identified as the most impactful throughout PMM2-CDG patients’ lifetime. We found 239 articles that included tools to measure those community-selected PMM2-CDG symptoms. Among them, we identified 80 QoL scales that address those signs and symptoms and, subsequently, their psychometric quality was analysed. These scales could be applied directly to the PMM2-CDG population or adapted to create the first PMM2-CDG-specific QoL questionnaire. Conclusion Identifying the impactful clinical manifestations of PMM2-CDG, along with the collection of PROMs/ObsROMs assessing QoL using a creative and community-centric methodology are the first step towards the development of a new, tailored, and specific PMM2-CDG QoL questionnaire. These findings can be used to fill a gap in PMM2-CDG clinical development. Importantly, this methodology is transferable to other CDG and rare diseases with multiple signs and symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02551-y.
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Rowe FJ, Hepworth LR, Kirkham JJ. Development of core outcome sets and core outcome measures for central visual impairment, visual field loss and ocular motility disorders due to stroke: a Delphi and consensus study. BMJ Open 2022; 12:e056792. [PMID: 35304397 PMCID: PMC8935181 DOI: 10.1136/bmjopen-2021-056792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Reporting of research for stroke-related visual impairment is inconsistent. The aim of this study was to define three core outcome sets (COS) and related core outcome measurements (COM) for central visual impairment, visual field loss and ocular motility disorders in stroke research. DESIGN The consensus process consisted of an online three-round Delphi survey followed by a consensus meeting of key stakeholders. SETTING UK-wide survey. PARTICIPANTS Stakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers. OUTCOME MEASURES For COS development, a list of potentially relevant visual outcomes was created after review of the literature and further grouped into outcome domains. For COM development, a list of potential instruments was created after review of the literature and quality appraised for reliability and validity. RESULTS COS-119 potential outcomes extracted from published literature. Similar assessment outcomes were grouped into 24 outcome domains. Delphi process included 123 participants in round 1, 65 round 2, 51 round 3. Twelve participants attended the consensus meeting with recommended outcome domains for central visual impairment (visual acuity, functional vision, quality of life), visual field loss (visual fields, functional vision, quality of life) and ocular motility disorders (eye alignment, eye movements, functional vision, quality of life). COM-52 test options extracted from the COS outcomes and grouped into 16 domains. Thirteen participants attended the COM consensus meeting. Recommended instruments for measurement of these outcomes include; Logarithm of the Minimal Angle of Resolution visual acuity, cover test, cardinal position eye movement assessments, peripheral visual field perimetry, Visual Function Questionnaire-25. CONCLUSIONS COS and COM are defined for vision research for stroke survivors. Their use has potential to reduce heterogeneity in routine clinical practice and improve standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and COM.
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Affiliation(s)
- Fiona J Rowe
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester University, Manchester Academic Health Science Centre, Manchester, UK
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17
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Wu SZ, Nolan-Kenney R, Moehringer NJ, Hasanaj LF, Joseph BM, Clayton AM, Rucker JC, Galetta SL, Wisniewski TM, Masurkar AV, Balcer LJ. Exploration of Rapid Automatized Naming and Standard Visual Tests in Prodromal Alzheimer Disease Detection. J Neuroophthalmol 2022; 42:79-87. [PMID: 34029274 PMCID: PMC8595455 DOI: 10.1097/wno.0000000000001228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Visual tests in Alzheimer disease (AD) have been examined over the last several decades to identify a sensitive and noninvasive marker of the disease. Rapid automatized naming (RAN) tasks have shown promise for detecting prodromal AD or mild cognitive impairment (MCI). The purpose of this investigation was to determine the capacity for new rapid image and number naming tests and other measures of visual pathway structure and function to distinguish individuals with MCI due to AD from those with normal aging and cognition. The relation of these tests to vision-specific quality of life scores was also examined in this pilot study. METHODS Participants with MCI due to AD and controls from well-characterized NYU research and clinical cohorts performed high and low-contrast letter acuity (LCLA) testing, as well as RAN using the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number test, and vision-specific quality of life scales, including the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement. Individuals also underwent optical coherence tomography scans to assess peripapillary retinal nerve fiber layer and ganglion cell/inner plexiform layer thicknesses. Hippocampal atrophy on brain MRI was also determined from the participants' Alzheimer disease research center or clinical data. RESULTS Participants with MCI (n = 14) had worse binocular LCLA at 1.25% contrast compared with controls (P = 0.009) and longer (worse) MULES test times (P = 0.006) with more errors in naming images (P = 0.009) compared with controls (n = 16). These were the only significantly different visual tests between groups. MULES test times (area under the receiver operating characteristic curve [AUC] = 0.79), MULES errors (AUC = 0.78), and binocular 1.25% LCLA (AUC = 0.78) showed good diagnostic accuracy for distinguishing MCI from controls. A combination of the MULES score and 1.25% LCLA demonstrated the greatest capacity to distinguish (AUC = 0.87). These visual measures were better predictors of MCI vs control status than the presence of hippocampal atrophy on brain MRI in this cohort. A greater number of MULES test errors (rs = -0.50, P = 0.005) and worse 1.25% LCLA scores (rs = 0.39, P = 0.03) were associated with lower (worse) NEI-VFQ-25 scores. CONCLUSIONS Rapid image naming (MULES) and LCLA are able to distinguish MCI due to AD from normal aging and reflect vision-specific quality of life. Larger studies will determine how these easily administered tests may identify patients at risk for AD and serve as measures in disease-modifying therapy clinical trials.
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Affiliation(s)
- Shirley Z Wu
- Departments of Neurology (SZW, RNK, NM, LH, BJ, AC, JCR, SLG, TMW, AVM, and LJB), Population Health (RNK and LJB), and Ophthalmology (SZW, JCR, SLG, and LJB), New York University Grossman School of Medicine, New York, New York
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18
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Psychometric properties of the Croatian version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Int Ophthalmol 2021; 41:4025-4036. [PMID: 34312780 DOI: 10.1007/s10792-021-01975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study was to translate, adapt and validate the Croatian version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in participants with visual impairment. This study also aims at evaluating the relationship between visual impairment and health-related quality of life (HRQoL). METHODS The prospective observational study was conducted at the University Hospital Centre Zagreb, Department of Ophthalmology. The sample consisted of 175 patients with four chronic ocular diseases: cataract, glaucoma, diabetic retinopathy and age-related macular degeneration. The translation of the NEI VFQ-25 to Croatian was conducted following the standardised procedure. All participants underwent an ophthalmological examination and completed the NEI VFQ-25 and the Medical Outcomes Study Short Form-36 Questionnaire (SF-36). In order to assess the psychometric properties of the NEI VFQ-25, we calculated Cronbach's α coefficient, intraclass correlation coefficient (ICC), convergent and discriminant validity, as well as criterion and concurrent validity. RESULTS Results show high internal consistency (Cronbach α range 0.739-0.932) and high test-retest reliability (ICC 0.876-0.975) for all subscales. None of the items had failed either convergent or discriminant validity. Moderate to high Spearman's rho coefficients of correlations were found between best corrected visual acuity and eight subscales in the NEI VFQ-25 (0.430 < ρ < 0.631). Moderate correlations were found between comparable domains in the NEI VFQ-25 and in the SF-36 questionnaire (p < 0.01). CONCLUSION The Croatian version of the NEI VFQ-25 has very good psychometric properties and can be a useful instrument for assessing vision-related quality of life in Croatian population with chronic ophthalmic diseases.
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Correlation of Visual Quality of Life With Clinical and Visual Status in Friedreich Ataxia. J Neuroophthalmol 2021; 40:213-217. [PMID: 31977662 DOI: 10.1097/wno.0000000000000878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The primary objective was to determine the association of patient-reported vision-specific quality of life to disease status and visual function in patients with Friedreich's ataxia (FRDA). METHODS Patients with FRDA were assessed with the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) along with measures of disease status (ataxia stage) and visual function (low- and high-contrast letter acuity scores). The relations of NEI-VFQ-25 scores to those for disease status and visual function were examined. RESULTS Scores for the NEI-VFQ-25 were lower in patients with FRDA (n = 99) compared with published disease-free controls, particularly reduced in a subgroup of FRDA patients with features of early onset, older age, and abnormal visual function. CONCLUSIONS The NEI-VFQ-25 captures the subjective component of visual function in patients with FRDA.
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20
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Mollan SP, Sinclair AJ. Outcomes measures in idiopathic intracranial hypertension. Expert Rev Neurother 2021; 21:687-700. [PMID: 34047224 DOI: 10.1080/14737175.2021.1931127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Idiopathic intracranial hypertension is a condition characterized by raised intracranial pressure, papilledema, and normal neuroimaging (aside from radiological signs of raised intracranial pressure). Symptoms of idiopathic intracranial hypertension include chronic headaches and for some, visual loss. New treatments are unmet clinical needs.Areas covered: The aim of this review is to present the evidence base and considered opinion on outcome measures to determine successful management of idiopathic intracranial hypertension.Expert opinion: Less invasive measures of disease activity such as optical coherence tomography will continue to grow in this field, both as a measure of papilledema, and potentially as a surrogate for intracranial pressure and visual function. As a highly disabling aspect of the disease is headache, treatment outcomes for headache morbidity need to be appropriately chosen and standardized to allow comparison between trials.
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Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, United Kingdom (UK)
| | - Alexandra J Sinclair
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, United Kingdom (UK).,Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
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21
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Affiliation(s)
- Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, Michigan, USA
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22
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Rizzo JR, Beheshti M, Naeimi T, Feiz F, Fatterpekar G, Balcer LJ, Galetta SL, Shaikh AG, Rucker JC, Hudson TE. The complexity of eye-hand coordination: a perspective on cortico-cerebellar cooperation. CEREBELLUM & ATAXIAS 2020; 7:14. [PMID: 33292609 PMCID: PMC7666466 DOI: 10.1186/s40673-020-00123-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/04/2022]
Abstract
Background Eye–hand coordination (EHC) is a sophisticated act that requires interconnected processes governing synchronization of ocular and manual motor systems. Precise, timely and skillful movements such as reaching for and grasping small objects depend on the acquisition of high-quality visual information about the environment and simultaneous eye and hand control. Multiple areas in the brainstem and cerebellum, as well as some frontal and parietal structures, have critical roles in the control of eye movements and their coordination with the head. Although both cortex and cerebellum contribute critical elements to normal eye-hand function, differences in these contributions suggest that there may be separable deficits following injury. Method As a preliminary assessment for this perspective, we compared eye and hand-movement control in a patient with cortical stroke relative to a patient with cerebellar stroke. Result We found the onset of eye and hand movements to be temporally decoupled, with significant decoupling variance in the patient with cerebellar stroke. In contrast, the patient with cortical stroke displayed increased hand spatial errors and less significant temporal decoupling variance. Increased decoupling variance in the patient with cerebellar stroke was primarily due to unstable timing of rapid eye movements, saccades. Conclusion These findings highlight a perspective in which facets of eye-hand dyscoordination are dependent on lesion location and may or may not cooperate to varying degrees. Broadly speaking, the results corroborate the general notion that the cerebellum is instrumental to the process of temporal prediction for eye and hand movements, while the cortex is instrumental to the process of spatial prediction, both of which are critical aspects of functional movement control.
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Affiliation(s)
- John-Ross Rizzo
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA. .,Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA. .,Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, NY, USA. .,Department of Mechanical & Aerospace Engineering, NYU Tandon School of Engineering, New York, NY, USA.
| | - Mahya Beheshti
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA.,Department of Mechanical & Aerospace Engineering, NYU Tandon School of Engineering, New York, NY, USA
| | - Tahereh Naeimi
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Farnia Feiz
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Girish Fatterpekar
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.,Department. of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.,Department. of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Aasef G Shaikh
- Department of Neurology, University Hospitals Cleveland Medical Center and Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Janet C Rucker
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.,Department. of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Todd E Hudson
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA.,Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.,Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, NY, USA
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23
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Ihl T, Kadas EM, Oberwahrenbrock T, Endres M, Klockgether T, Schroeter J, Brandt AU, Paul F, Minnerop M, Doss S, Schmitz-Hübsch T, Zimmermann HG. Investigation of Visual System Involvement in Spinocerebellar Ataxia Type 14. CEREBELLUM (LONDON, ENGLAND) 2020; 19:469-482. [PMID: 32338350 PMCID: PMC7351844 DOI: 10.1007/s12311-020-01130-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spinocerebellar ataxia type 14 (SCA-PRKCG, formerly SCA14) is a rare, slowly progressive disorder caused by conventional mutations in protein kinase Cγ (PKCγ). The disease usually manifests with ataxia, but previous reports suggested PRKCG variants in retinal pathology. To systematically investigate for the first time visual function and retinal morphology in patients with SCA-PRKCG. Seventeen patients with PRKCG variants and 17 healthy controls were prospectively recruited, of which 12 genetically confirmed SCA-PRKCG patients and 14 matched controls were analyzed. We enquired a structured history for visual symptoms. Vision-related quality of life was obtained with the National Eye Institute Visual Function Questionnaire (NEI-VFQ) including the Neuro-Ophthalmic Supplement (NOS). Participants underwent testing of visual acuity, contrast sensitivity, visual fields, and retinal morphology with optical coherence tomography (OCT). Measurements of the SCA-PRKCG group were analyzed for their association with clinical parameters (ataxia rating and disease duration). SCA-PRKCG patients rate their vision-related quality of life in NEI-VFQ significantly worse than controls. Furthermore, binocular visual acuity and contrast sensitivity were worse in SCA-PRKCG patients compared with controls. Despite this, none of the OCT measurements differed between groups. NEI-VFQ and NOS composite scores were related to ataxia severity. Additionally, we describe one patient with a genetic variant of uncertain significance in the catalytic domain of PKCγ who, unlike all confirmed SCA-PRKCG, presented with a clinically silent epitheliopathy. SCA-PRKCG patients had reduced binocular vision and vision-related quality of life. Since no structural retinal damage was found, the pathomechanism of these findings remains unclear.
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Affiliation(s)
- Thomas Ihl
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ella M Kadas
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Timm Oberwahrenbrock
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias Endres
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site, Berlin, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jan Schroeter
- University Tissue Bank, Cornea Bank Berlin, Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, University of California, Irvine, CA, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Sarah Doss
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurological Sciences, Movement Disorders Section, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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Initial Impairment and Recovery of Vision-Related Functioning in Participants With Acute Optic Neuritis From the RENEW Trial of Opicinumab. J Neuroophthalmol 2020; 39:153-160. [PMID: 30095536 PMCID: PMC6530972 DOI: 10.1097/wno.0000000000000697] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Leucine-rich repeat and immunoglobulin domain-containing Nogo receptor-interacting protein 1 (LINGO-1) is a key suppressor of oligodendrocyte differentiation and axonal remyelination and regeneration. This analysis evaluated the potential benefit of opicinumab, a human monoclonal antibody against LINGO-1, vs placebo on exploratory clinical endpoints of patient-reported vision-related functioning and high-contrast visual acuity (HCVA) in RENEW participants with acute optic neuritis (AON). Methods: Participants were randomized to 100 mg/kg opicinumab intravenous or placebo every 4 weeks (6 infusions). Assessments were conducted in the per-protocol (PP) population and included: 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), 10-item Neuro-Ophthalmic Supplement (NOS-10), and HCVA. Results: The opicinumab group (n = 33) had worse mean (SD) baseline patient-reported vision-related functioning scores vs placebo (n = 36): NEI-VFQ-25 composite, 75.5 (17.6) vs 79.0 (16.6); NOS-10 composite, 63.6 (19.8) vs 69.8 (21.2), respectively. By Week 24, the placebo and opicinumab groups experienced substantial mean improvements from baseline (NEI-VFQ-25 composite, 15.17 vs 13.51 [difference (95% CI): −1.66 (−5.11 to 1.78)]; NOS-10 composite, 17.40 vs 16.04 [difference (95% CI): −1.35 (−7.38 to 4.67)]). Between-treatment differences in mean change from baseline were not significantly different at any time point. Analysis of covariance–adjusted mean recovery from baseline in HCVA at Week 24 for the affected eyes was 11.8 and 8.7 letters for placebo and opicinumab, respectively (P = 0.202). Conclusions: Most participants in the RENEW PP population demonstrated substantial recovery from baseline in patient-reported vision-related functioning and HCVA, regardless of treatment and structural damage. Average scores after recovery remained lower than those of published disease-free control groups. These results provide important information on visual function recovery in patients with AON, as measured by NEI-VFQ-25 and NOS-10.
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Wong SH, Eggenberger E, Cornblath W, Xhepa A, Miranda E, Lee H, Burke A, Barnett C. Preliminary Findings of a Dedicated Ocular Myasthenia Gravis Rating Scale: The OMGRate. Neuroophthalmology 2020; 44:148-156. [PMID: 32395166 DOI: 10.1080/01658107.2019.1660686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022] Open
Abstract
There is a pressing need for a robust rating scale for ocular myasthenia gravis (OMG). Rating scales for myasthenia gravis (MG) research have a predominant focus on generalised disease. We present results of the first dedicated rating scale for OMG: the ocular myasthenia gravis rating scale (OMGRate). The OMGRate was developed through an international collaboration between neuromuscular and neuro-ophthalmology experts in OMG. It comprises two components: a physician- examination (OMGRate-e) and a patient questionnaire (OMGRate-q).. The OMGRate was prospectively validated in patients attending a neuro-ophthalmology clinic from April 2017 to October 2018. External validity and reliability of OMGRate were evaluated using validated MG rating scales: the Myasthenia Gravis Composite (MGC), the Myasthenia Gravis Quality of Life (MG-QOL), and the ocular component from the Myasthenia Gravis Impairment Index questionnaire (MGII). Two hundred and eleven assessments were completed in 104 patients (67 males, mean age 55 y, range 18-86 y). There was very good external validity of the OMGRate: good correlation between OMGRate-e and MGC (r = 0.64, 95% confidence intervals [CI] 0.54-0.74, p < .0001); excellent correlation between OMGRate-q and MGII (r = 0.85, 95% CI 0.78-0.91, p < .0001) and good correlation between OMGRate and MG-QOL (r = 0.68, 95% CI 0.60-0.77, p < .0001). A higher correlation of OMGRate and MG-QOL compared with MGC and MG-QOL (r = 0.47, 95% CI 0.34-0.59, p < .0001) suggests that OMGRate is better able to capture significant QOL information in patients with OMG. It had excellent reliability with an intraclass correlation coefficient of 0.83 (95% CI 0.67-0.92). Feedback from examiners and patients indicated that the OMGRate was easy to use. In conclusion, OMGRate is an easy-to-use, valid and reliable rating scale for monitoring the severity of OMG.
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Affiliation(s)
- Sui Hsien Wong
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, UK
| | - Eric Eggenberger
- Department of Neuro-ophthalmology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | - Wayne Cornblath
- Department of Neuro-ophthalmology, University of Michigan, Ann Arbor, MI, USA
| | - Alba Xhepa
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, UK
| | - Eduardo Miranda
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, UK
| | - Helena Lee
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, UK
| | - Ailbhe Burke
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, UK
| | - Carolina Barnett
- Department of Medicine, Neurology, University Health Network and University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Huizinga F, Heutink J, de Haan GA, van der Lijn I, van der Feen FE, Vrijling ACL, Melis-Dankers BJM, de Vries SM, Tucha O, Koerts J. The development of the Screening of Visual Complaints questionnaire for patients with neurodegenerative disorders: Evaluation of psychometric features in a community sample. PLoS One 2020; 15:e0232232. [PMID: 32348342 PMCID: PMC7190154 DOI: 10.1371/journal.pone.0232232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with neurodegenerative disorders often experience impairments in visual function. In research and clinical care, visual problems are primarily understood as objective visual impairments. Subjective complaints, referring to complaints from a patient's perspective, receive less attention, while they are of utmost clinical importance to guide assessment and rehabilitation. A 21-item Screening of Visual Complaints questionnaire (SVC) was developed for the assessment of subjective visual complaints in patients with neurodegenerative disorders. This prospective study aims to evaluate the psychometric properties of the SVC in a large community sample. METHODS A stratified convenience sample of 1,461 healthy Dutch participants (18-95 years) without severe self-reported neurological, ophthalmological or psychiatric conditions completed the SVC, Cerebral Visual Complaints questionnaire (CVC-q), National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), Behavior Rating Inventory of Executive Function-A (BRIEF-A), Questionnaire for Experiences of Attention Deficits (Fragebogen erlebter Defizite der Aufmerkzamkeit; FEDA), Depression Anxiety Stress Scale-21 (DASS-21) and the Structured Inventory for Malingered Symptomatology (SIMS) online. After two weeks, 66 participants completed the SVC again. We evaluated the factor structure, internal consistency, convergent and divergent validity, and test-retest reliability of the SVC. RESULTS The sample was split in two subsamples to perform exploratory and confirmatory factor analyses. In the first subsample, the exploratory factor analysis extracted three factors from the SVC: diminished visual perception, altered visual perception and ocular discomfort. The confirmatory factor analysis showed this model to be valid in the second subsample. The SVC showed satisfactory convergent validity (NEI-VFQ-25: r = -0.71; CVC-q: r = 0.84) and divergent validity (SIMS: r = 0.26; BRIEF-A: r = 0.29; FEDA: r = 0.40; DASS-21: r = 0.34) and good internal consistency (Cronbach's alpha = 0.85) and test-retest reliability (ICC = 0.82). CONCLUSIONS The SVC is a valid and reliable tool for the assessment of subjective visual complaints in a community sample and appears promising for clinical use in patients with neurodegenerative disorders.
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Affiliation(s)
- Famke Huizinga
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Gera A. de Haan
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Iris van der Lijn
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Fleur E. van der Feen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Anne C. L. Vrijling
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Bart J. M. Melis-Dankers
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Stefanie M. de Vries
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for blind and partially sighted people, Huizen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Braithwaite T, Wiegerinck N, Petzold A, Denniston A. Vision Loss from Atypical Optic Neuritis: Patient and Physician Perspectives. Ophthalmol Ther 2020; 9:215-220. [PMID: 32200476 PMCID: PMC7196107 DOI: 10.1007/s40123-020-00247-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 12/19/2022] Open
Abstract
This article, co-authored by a patient affected by bilateral, recurrent, atypical optic neuritis, and clinicians, discusses the mental burden of living with uncertainty and the possibility of further sight loss, along with the side effects of treatment. The patient shares some of the challenges, coping strategies, and the value they found in creating and participating in a patient support group. The physicians consider whether current clinical measures adequately capture the outcomes that matter to patients and discuss the role for patient-reported outcome measures (PROMs). We identify technological advances that are lowering traditional barriers to the use of PROMs in research and routine clinical care and look towards new PROM instruments enhancing shared patient-physician care in the future. In this patient-physician perspective article, we share the story of a patient affected by an autoimmune disease that attacks the nerves connecting the eyes and the brain and reflect back physicians’ perspectives on the disease and the patient’s experience of it. In a compelling account, we gain some understanding of what it might be like to live with the fear of unpredictable episodes of sudden, recurrent sight loss and the important impacts that this has on a patient’s life and mental wellbeing. We recognize that the outcome metrics that physicians usually focus on, such as measurement of vision and imaging of the optic nerve, do not fully capture the outcomes that most matter to the patient. We explore patient-reported outcome measures that go some way towards bridging this gap. Finally, we consider the technological advances that will make more comprehensive capture of the patient experience a reality in future clinical practice and research, supporting both patients and physicians to optimize shared care.
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Affiliation(s)
- Tasanee Braithwaite
- Neuro Ophthalmology Department, Moorfields Eye Hospital, London, UK.
- Ophthalmology Department, University Hospitals Birmingham, Birmingham, UK.
- Neuro Ophthalmology Department, National Hospital for Neurology & Neurosurgery, London, UK.
| | | | - Axel Petzold
- Neuro Ophthalmology Department, Moorfields Eye Hospital, London, UK
- Neuro Ophthalmology Department, National Hospital for Neurology & Neurosurgery, London, UK
- Institute of Neurology, University College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre Based at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Alastair Denniston
- Ophthalmology Department, University Hospitals Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre Based at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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28
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Hamedani AG, Bardakjian T, Balcer LJ, Gonzalez-Alegre P. Contrast Acuity and the King-Devick Test in Huntington's Disease. Neuroophthalmology 2019; 44:219-225. [PMID: 33012907 DOI: 10.1080/01658107.2019.1669668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Saccadic eye movement abnormalities are among the earliest manifestations of Huntington's disease (HD) but are difficult to quantify at the bedside. Similarly, afferent visual pathway involvement in HD is poorly characterised. The objective was to evaluate afferent and efferent visual function in HD. Participants with manifest HD (n = 19) and healthy controls (n = 20) performed the King-Devick test, a timed test of rapid number naming. Binocular high and low-contrast (2.5% and 1.25%) acuities were measured using low-contrast Sloan letter charts, and pupillometric recordings were made using a handheld NeurOptics PLR-3000 pupillometer. The NEI-VFQ-25 questionnaire with 10-item neuro-ophthalmic supplement were also completed. Unified Huntington's Disease Rating Scale (UHDRS) motor score and other clinical and demographic variables were collected. Comparisons between manifest HD and controls were performed using linear regression adjusted for confounders. Mean King-Devick time scores were 102.9 seconds in patients with manifest HD and 48.2 seconds in controls (p < .01, t-test). In unadjusted analyses, binocular high contrast acuity was seven letters (one Snellen line equivalent) lower in manifest HD than controls (p = .043). This effect was similar for low-contrast acuity, but only low-contrast acuity remained statistically significant after adjusting for covariates. Low-contrast acuity also correlated with UHDRS motor score. There were no differences in pupillary reactivity or self-reported vision-related quality of life. In conclusion, HD is associated with reduced low-contrast acuity and abnormal performance on the King-Devick test of rapid number naming. These tests are easy to administer, providing an objective quantitative measure of visual function which could be incorporated into optimised rating scales.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanya Bardakjian
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura J Balcer
- Departments of Neurology, Ophthalmology and Population Health, New York University School of Medicine, New York, New York, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Raymond G. Perelman Center for Cellular & Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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29
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Ozudogru S, Neufeld A, Katz BJ, Baggaley S, Pippitt K, Zhang Y, Digre KB. Reduced Visual Quality of Life Associated with Migraine is Most Closely Correlated with Symptoms of Dry Eye. Headache 2019; 59:1714-1721. [PMID: 31557326 DOI: 10.1111/head.13662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with migraine frequently report ocular or visual symptoms including aura, photophobia, and eye pain. Using validated instruments, our group previously reported that due to these symptoms, patients have marked reductions in visual quality of life. In chronic migraine, these reductions can be as substantial as those reported for other neuro-ophthalmic diseases such as multiple sclerosis with optic neuritis and idiopathic intracranial hypertension. Because the instruments take several different dimensions into account, we were unable to determine which ocular symptom(s) contributed to reduced visual quality of life. The purpose of this investigation was to attempt to determine which ocular symptom(s) were driving the observed reduction in visual quality of life. METHODS We designed a cross-sectional survey-based study to assess visual quality of life, headache impact, aura, dry eye, and photophobia in migraine patients. Subjects were recruited from the Headache Clinic and General Neurology Clinic at a tertiary teaching hospital. Subjects completed validated questionnaires including: The visual functioning questionnaire-25 (VFQ-25), the headache impact test (HIT-6), the visual aura rating scale (VARS), the ocular surface disease index (OSDI), and the Utah photophobia score (UPSIS-17). Associations between VFQ-25 and OSDI, VFQ-25 and VARS, VFQ-25 and UPSIS-17, HIT-6 and OSDI, HIT-6 and VARS, and HIT-6 and UPSIS-17 were calculated. RESULTS Of the 62 patients who completed all questionnaires, 17 had episodic migraine and 45 had chronic migraine. Twenty-three patients experienced aura and 39 did not report aura. The most striking correlations were observed between the VFQ-25 and the OSDI (-0.678; P < .001), between the HIT-6 and UPSIS-17 (0.489; P < .001), and between the HIT-6 and OSDI (0.453; P < .001). CONCLUSIONS Dry eye seems to be the most important symptom that reduces visual quality of life and worsens headache impact. This symptom may be a form of allodynia, a well-known feature of chronic migraine. Photophobia appears to have modest effects on headache impact. In the future, we hope to determine whether treatment of dry eye symptoms can improve visual quality of life and reduce headache impact.
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Affiliation(s)
- Seniha Ozudogru
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Anastasia Neufeld
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Bradley J Katz
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Susan Baggaley
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Karly Pippitt
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Yue Zhang
- Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Veterans Affairs Medical Center, Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Kathleen B Digre
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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30
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Rowe FJ, Hepworth LR, Conroy EJ, Rainford NEA, Bedson E, Drummond A, García-Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, Johnson S, Noonan C, Sackley C. Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial. Eye (Lond) 2019; 33:1485-1493. [PMID: 30996338 PMCID: PMC7002510 DOI: 10.1038/s41433-019-0441-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We conduct supplementary analyses of the NEI VFQ-25 data to evaluate where changes occurred within subscales of the NEI VFQ-25 leading to change in the composite scores between the three treatment arms, and evaluate the NEI VFQ-25 with and without the Neuro 10 supplement. METHODS A prospective, multicentre, parallel, single-blind, three-arm RCT of fourteen UK acute stroke units was conducted. Stroke survivors with homonymous hemianopia were recruited. Interventions included: Fresnel prisms for minimum 2 h, 5 days/week over 6-weeks (Arm a), Visual search training for minimum 30 min, 5 days/week over 6-weeks (Arm b) and standard care-information only (Arm c). Primary and secondary outcomes (including NEI VFQ-25 data) were measured at baseline, 6, 12 and 26 weeks after randomisation. RESULTS Eighty seven patients were recruited (69% male; mean age (SD) equal to 69 (12) years). At 26 weeks, outcomes for 24, 24 and 22 patients, respectively, were compared to baseline. NEI VFQ-25 (with and without Neuro 10) responses improved from baseline to 26 weeks with visual search training compared to Fresnel prisms and standard care. In subscale analysis, the most impacted across all treatment arms was 'driving' whilst the least impacted were 'colour vision' and 'ocular pain'. CONCLUSIONS Composite scores differed systematically for the NEI VFQ-25 (Neuro 10) versus NEI VFQ-25 at all time points. For subscale scores, descriptive statistics suggest clinically relevant improvement in distance activities and vision-specific dependency subscales for NEI VFQ-25 scores in the visual search treatment arm. TRIAL REGISTRATION Current Controlled Trials ISRCTN05956042.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, L69 3GB, UK.
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, L69 3GB, UK
| | - Elizabeth J Conroy
- Department of Biostatistics, University of Liverpool, Liverpool, L69 3GA, UK
| | - Naomi E A Rainford
- Department of Biostatistics, University of Liverpool, Liverpool, L69 3GA, UK
| | - Emma Bedson
- Clinical Trials Research Unit, University of Liverpool, Liverpool, L69 3GL, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Marta García-Fiñana
- Department of Biostatistics, University of Liverpool, Liverpool, L69 3GA, UK
| | - Claire Howard
- Department of Orthoptics, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - Tracey Shipman
- Department of Orthoptics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - Caroline Dodridge
- Department of Orthoptics, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Stevie Johnson
- Eye Clinic Support Service, Royal National Institute of Blind People, Birmingham, B29 6NA, UK
| | - Carmel Noonan
- Department of Ophthalmology, Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL, UK
| | - Catherine Sackley
- Division of Health and Social Care, King's College, London, WC2B 5RL, UK
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Evolution of Visual Outcomes in Clinical Trials for Multiple Sclerosis Disease-Modifying Therapies. J Neuroophthalmol 2019; 38:202-209. [PMID: 29750734 DOI: 10.1097/wno.0000000000000662] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: BACKGROUND:: The visual pathways are increasingly recognized as an ideal model to study neurodegeneration in multiple sclerosis (MS). Low-contrast letter acuity (LCLA) and optical coherence tomography (OCT) are validated measures of function and structure in MS. In fact, LCLA was the topic of a recent review by the Multiple Sclerosis Outcome Assessments Consortium (MSOAC) to qualify this visual measure as a primary or secondary clinical trial endpoint with the Food and Drug Administration (FDA) and other regulatory agencies. This review focuses on the use of LCLA and OCT measures as outcomes in clinical trials to date of MS disease-modifying therapies. METHODS A Pubmed search using the specific key words "optical coherence tomography," "low-contrast letter acuity," "multiple sclerosis," and "clinical trials" was performed. An additional search on the clinicaltrials.gov website with the same key words was used to find registered clinical trials of MS therapies that included these visual outcome measures. RESULTS As demonstrated by multiple clinical trials, LCLA and OCT measures are sensitive to treatment effects in MS. LCLA has been used in many clinical trials to date, and findings suggest that 7 letters of LCLA at the 2.5% contrast level are meaningful change. Few clinical trials using the benefits of OCT have been performed, although results of observational studies have solidified the ability of OCT to assess change in retinal structure. Continued accrual of clinical trial and observational data is needed to validate the use of OCT in clinical trials, but preliminary work suggests that an intereye difference in retinal nerve fiber layer thickness of 5-6 μm is a clinically meaningful threshold that identifies an optic nerve lesion in MS. CONCLUSIONS Visual impairment represents a significant component of overall disability in MS. LCLA and OCT enhance the detection of visual pathway injury and can be used as measures of axonal and neuronal integrity. Continued investigation is ongoing to further incorporate these vision-based assessments into clinical trials of MS therapies.
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Nolan-Kenney RC, Liu M, Akhand O, Calabresi PA, Paul F, Petzold A, Balk L, Brandt AU, Martínez-Lapiscina EH, Saidha S, Villoslada P, Al-Hassan AA, Behbehani R, Frohman EM, Frohman T, Havla J, Hemmer B, Jiang H, Knier B, Korn T, Leocani L, Papadopoulou A, Pisa M, Zimmermann H, Galetta SL, Balcer LJ. Optimal intereye difference thresholds by optical coherence tomography in multiple sclerosis: An international study. Ann Neurol 2019; 85:618-629. [PMID: 30851125 DOI: 10.1002/ana.25462] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the optimal thresholds for intereye differences in retinal nerve fiber and ganglion cell + inner plexiform layer thicknesses for identifying unilateral optic nerve lesions in multiple sclerosis. Current international diagnostic criteria for multiple sclerosis do not include the optic nerve as a lesion site despite frequent involvement. Optical coherence tomography detects retinal thinning associated with optic nerve lesions. METHODS In this multicenter international study at 11 sites, optical coherence tomography was measured for patients and healthy controls as part of the International Multiple Sclerosis Visual System Consortium. High- and low-contrast acuity were also collected in a subset of participants. Presence of an optic nerve lesion for this study was defined as history of acute unilateral optic neuritis. RESULTS Among patients (n = 1,530), receiver operating characteristic curve analysis demonstrated an optimal peripapillary retinal nerve fiber layer intereye difference threshold of 5μm and ganglion cell + inner plexiform layer threshold of 4μm for identifying unilateral optic neuritis (n = 477). Greater intereye differences in acuities were associated with greater intereye retinal layer thickness differences (p ≤ 0.001). INTERPRETATION Intereye differences of 5μm for retinal nerve fiber layer and 4μm for macular ganglion cell + inner plexiform layer are robust thresholds for identifying unilateral optic nerve lesions. These thresholds may be useful in establishing the presence of asymptomatic and symptomatic optic nerve lesions in multiple sclerosis and could be useful in a new version of the diagnostic criteria. Our findings lend further validation for utilizing the visual system in a multiple sclerosis clinical trial setting. Ann Neurol 2019;85:618-629.
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Affiliation(s)
- Rachel C Nolan-Kenney
- Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY.,Department of Neurology, New York University School of Medicine, New York, NY
| | - Mengling Liu
- Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY
| | - Omar Akhand
- Department of Neurology, New York University School of Medicine, New York, NY
| | | | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Petzold
- Moorfields Eye Hospital, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands
| | - Lisanne Balk
- Moorfields Eye Hospital, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA
| | - Elena H Martínez-Lapiscina
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Pablo Villoslada
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | | | - Elliot M Frohman
- Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX
| | - Teresa Frohman
- Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany.,Data Integration for Future Medicine Consortium, Ludwig Maximilian University, Munich, Germany
| | | | - Hong Jiang
- Bascom Palmer Eye Institute, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | | | - Thomas Korn
- Munich Cluster for Systems Neurology, Munich, Germany.,Technical University of Munich, Munich, Germany
| | - Letizia Leocani
- Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Athina Papadopoulou
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Marco Pisa
- Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY.,Department of Ophthalmology, New York University School of Medicine, New York, NY
| | - Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY.,Department of Ophthalmology, New York University School of Medicine, New York, NY.,Department of Population Health, New York University School of Medicine, New York, NY
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Braithwaite T, Calvert M, Gray A, Pesudovs K, Denniston AK. The use of patient-reported outcome research in modern ophthalmology: impact on clinical trials and routine clinical practice. PATIENT-RELATED OUTCOME MEASURES 2019; 10:9-24. [PMID: 30774489 PMCID: PMC6352858 DOI: 10.2147/prom.s162802] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This review article considers the rising demand for patient-reported outcome measures (PROMs) in modern ophthalmic research and clinical practice. We review what PROMs are, how they are developed and chosen for use, and how their quality can be critically appraised. We outline the progress made to develop PROMs in each clinical subspecialty. We highlight recent examples of the use of PROMs as secondary outcome measures in randomized controlled clinical trials and consider the impact they have had. With increasing interest in using PROMs as primary outcome measures, particularly where interventions have been found to be of equivalent efficacy by traditional outcome metrics, we highlight the importance of instrument precision in permitting smaller sample sizes to be recruited. Our review finds that while there has been considerable progress in PROM development, particularly in cataract, glaucoma, medical retina, and low vision, there is a paucity of useful tools for less common ophthalmic conditions. Development and validation of item banks, administered using computer adaptive testing, has been proposed as a solution to overcome many of the traditional limitations of PROMs, but further work will be needed to examine their acceptability to patients, clinicians, and investigators.
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Affiliation(s)
- Tasanee Braithwaite
- Centre for Patient Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK, .,Moorfields Eye Hospital, London, UK,
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK, .,Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Alastair K Denniston
- Centre for Patient Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK, .,Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Biomedical Research Centre (Moorfields Eye Hospital/UCL), London, UK
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Optimal Intereye Difference Thresholds in Retinal Nerve Fiber Layer Thickness for Predicting a Unilateral Optic Nerve Lesion in Multiple Sclerosis. J Neuroophthalmol 2018; 38:451-458. [DOI: 10.1097/wno.0000000000000629] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Leong D, Morettin C, Messner LV, Steinmetz RJ, Pang Y, Galetta SL, Balcer LJ. Visual Structure and Function in Collision Sport Athletes. J Neuroophthalmol 2018; 38:285-291. [PMID: 28885451 DOI: 10.1097/wno.0000000000000572] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vision-based measures have been shown to be useful markers in multiple sclerosis (MS), Alzheimer and Parkinson disease. Therefore, these testing paradigms may have applications to populations explaining repetitive head trauma that has been associated with long-term neurodegenerative sequelae. We investigated retinal structure and visual function in professional collision sport athletes compared to age- and race-matched control participants. METHODS In this cross-sectional study, participants underwent spectral-domain optical coherence tomography (OCT) measurements of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC = ganglion cell + inner plexiform layers) thickness. High-contrast visual acuity (100% level), low-contrast letter acuity (LCLA) (1.25% and 2.5% levels), and King-Devick Test of rapid number naming performance were administered. Vision-specific quality of life (QOL) measures were assessed. RESULTS Among 46 collision sport athletes (boxing, n = 14; football, n = 29; ice hockey, n = 3) and 104 control participants, average RNFL thickness was a significant predictor of athlete vs control status with athletes demonstrating 4.8-μm of thinning compared to controls (P = 0.01, generalized estimating equation [GEE] models accounting for age and within-subject, intereye correlations). Athlete vs control status was not a predictor of RNFL thickness for the subgroup of football players in this cohort (P = 0.60). Binocular (P = 0.001) and monocular (P = 0.02) LCLA at 2.5% contrast and vision-specific QOL (P = 0.04) were significant predictors of athlete vs control status (GEE models accounting for age and within-subject, intereye correlations). Rapid number naming performance times were not significantly different between the control and athlete groups. CONCLUSIONS This study showed that retinal axonal and neuronal loss is present among collision sport athletes, with most notable differences seen in boxers. These findings are accompanied by reductions in visual function and QOL, similar to patterns observed in multiple sclerosis, Alzheimer and Parkinson diseases. Vision-based changes associated with head trauma exposure that have the potential to be detected in vivo represent a unique opportunity for further study to determine if these changes in collision sport athletes are predictive of future neurodegeneration.
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Affiliation(s)
- Danielle Leong
- Illinois Eye Institute (DL, CM, LVM, RJS, YP), Illinois College of Optometry, Chicago, Illinois; and Departments of Neurology, Ophthalmology, Population Health (SLG, LJB), New York University, New York, New York
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36
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Hanson LL, Ahmed Z, Katz BJ, Warner JE, Crum AV, Zhang Y, Zhang Y, Baggaley S, Pippitt K, Cortez MM, Digre KB. Patients With Migraine Have Substantial Reductions in Measures of Visual Quality of Life. Headache 2018; 58:1007-1013. [DOI: 10.1111/head.13330] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Laura L. Hanson
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; Salt Lake City UT USA
| | - Zubair Ahmed
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - Bradley J. Katz
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; Salt Lake City UT USA
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - Judith E.A. Warner
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; Salt Lake City UT USA
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - Alison V. Crum
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; Salt Lake City UT USA
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - Yingying Zhang
- Division of Epidemiology, Department of Internal Medicine; University of Utah; Salt Lake City UT USA
- Department of Family and Preventive Medicine; University of Utah; Salt Lake City UT USA
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine; University of Utah; Salt Lake City UT USA
- Veterans Affairs Salt Lake City Health Care System; Salt Lake City UT USA
| | - Susan Baggaley
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - Karly Pippitt
- Department of Neurology; University of Utah; Salt Lake City UT USA
- Department of Family and Preventive Medicine; University of Utah; Salt Lake City UT USA
| | - Melissa M Cortez
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - Kathleen B. Digre
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; Salt Lake City UT USA
- Department of Neurology; University of Utah; Salt Lake City UT USA
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Abstract
Migraine has long been associated with disturbances of vision, especially migraine with aura. However, the eye plays an important role in sensory processing as well. We have found that the visual quality of life is reduced in migraine. In this review, we discuss how the migraine and eye pain pathways are similar and affect many of the common complaints which are seen in ophthalmology and neuro-ophthalmology offices, such as dry eye and postoperative eye pain. We also review other related phenomena, including visual snow and photophobia, which also are related to altered sensory processing in migraine.
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Affiliation(s)
- Kathleen B Digre
- Departments of Ophthalmology and Neurology, Moran Eye Center, University of Utah, Salt Lake City,Utah
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Farr J, McGarva E, Nij Bijvank J, van Vliet H, Jellema HM, Crossland MD, Petzold A. The Pulfrich Phenomenon: Practical Implications of the Assessment of Cases and Effectiveness of Treatment. Neuroophthalmology 2018; 42:349-355. [PMID: 30524488 PMCID: PMC6276950 DOI: 10.1080/01658107.2018.1446537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/10/2018] [Accepted: 02/25/2018] [Indexed: 12/02/2022] Open
Abstract
The Pulfrich phenomenon, originally described in normal observers, is a treatable disorder of the perception of movement in depth in cases of unilateral or asymmetric optic neuropathy. Treatment is highly bespoke and factors influencing treatment response and failure remain unclear. We assessed 25 adults with suspected Pulfrich phenomenon due to a range of conditions in two tertiary referral centres. Monocularly tinted spectacles were successful in reducing symptoms of the Pulfrich phenomenon under daylight conditions in nine subjects, eight of whom had optic neuritis. These spectacles were not effective at night and in patients with visual field defects due to ischaemic optic neuropathy, glaucoma, optic disc drusen or severe peripapillary retinal nerve fibre loss on optical coherence tomography.
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Affiliation(s)
- Jane Farr
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Emily McGarva
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Jenny Nij Bijvank
- Departments of Neurology and Ophthalmology, The Dutch Expertise Center for Neuro-ophthalmology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans van Vliet
- Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Michael D Crossland
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Axel Petzold
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom.,Departments of Neurology and Ophthalmology, The Dutch Expertise Center for Neuro-ophthalmology, VU University Medical Center, Amsterdam, The Netherlands
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Sanchez-Dalmau B, Martinez-Lapiscina EH, Pulido-Valdeolivas I, Zubizarreta I, Llufriu S, Blanco Y, Sola-Valls N, Sepulveda M, Guerrero A, Alba S, Andorra M, Camos A, Sanchez-Vela L, Alfonso V, Saiz A, Villoslada P. Predictors of vision impairment in Multiple Sclerosis. PLoS One 2018; 13:e0195856. [PMID: 29664921 PMCID: PMC5903642 DOI: 10.1371/journal.pone.0195856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/31/2018] [Indexed: 01/02/2023] Open
Abstract
Visual impairment significantly alters the quality of life of people with Multiple Sclerosis (MS). The objective of this study was to identify predictors (independent variables) of visual outcomes, and to define their relationship with neurological disability and retinal atrophy when assessed by optical coherence tomography (OCT). We performed a cross-sectional analysis of 119 consecutive patients with MS, assessing vision using high contrast visual acuity (LogMar), 2.5% and 1.25% low contrast visual acuity (Sloan charts), and color vision (Hardy-Rand-Rittler plates). Quality of vision is a patient reported outcome based on an individual's unique perception of his or her vision and was assessed with the Visual Functioning Questionnaire-25 (VFQ-25) with the 10 neuro-ophthalmologic items. MS disability was assessed using the expanded disability status scale (EDSS), the MS functional composite (MSFC) and the brief repetitive battery-neuropsychology (BRB-N). Retinal atrophy was assessed using spectral domain OCT, measuring the thickness of the peripapillar retinal nerve fiber layer (pRNFL) and the volume of the ganglion cell plus inner plexiform layer (GCIPL). The vision of patients with MS was impaired, particularly in eyes with prior optic neuritis. Retinal atrophy (pRNFL and GCIPL) was closely associated with impaired low contrast vision and color vision, whereas the volume of the GCIPL showed a trend (p = 0.092) to be associated with quality of vision. Multiple regression analysis revealed that EDSS was an explanatory variable for high contrast vision after stepwise analysis, GCIPL volume for low contrast vision, and GCIPL volume and EDSS for color vision. The explanatory variables for quality of vision were high contrast vision and color vision. In summary, quality of vision in MS depends on the impairment of high contrast visual acuity and color vision due to the disease.
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Affiliation(s)
| | - Elena H. Martinez-Lapiscina
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Irati Zubizarreta
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Nuria Sola-Valls
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Sepulveda
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ana Guerrero
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salut Alba
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Magi Andorra
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Anna Camos
- Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Laura Sanchez-Vela
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Albert Saiz
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- * E-mail:
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Serra A, Chisari CG, Matta M. Eye Movement Abnormalities in Multiple Sclerosis: Pathogenesis, Modeling, and Treatment. Front Neurol 2018; 9:31. [PMID: 29467711 PMCID: PMC5807658 DOI: 10.3389/fneur.2018.00031] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/15/2018] [Indexed: 01/13/2023] Open
Abstract
Multiple sclerosis (MS) commonly causes eye movement abnormalities that may have a significant impact on patients’ disability. Inflammatory demyelinating lesions, especially occurring in the posterior fossa, result in a wide range of disorders, spanning from acquired pendular nystagmus (APN) to internuclear ophthalmoplegia (INO), among the most common. As the control of eye movements is well understood in terms of anatomical substrate and underlying physiological network, studying ocular motor abnormalities in MS provides a unique opportunity to gain insights into mechanisms of disease. Quantitative measurement and modeling of eye movement disorders, such as INO, may lead to a better understanding of common symptoms encountered in MS, such as Uhthoff’s phenomenon and fatigue. In turn, the pathophysiology of a range of eye movement abnormalities, such as APN, has been clarified based on correlation of experimental model with lesion localization by neuroimaging in MS. Eye movement disorders have the potential of being utilized as structural and functional biomarkers of early cognitive deficit, and possibly help in assessing disease status and progression, and to serve as platform and functional outcome to test novel therapeutic agents for MS. Knowledge of neuropharmacology applied to eye movement dysfunction has guided testing and use of a number of pharmacological agents to treat some eye movement disorders found in MS, such as APN and other forms of central nystagmus.
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Affiliation(s)
- Alessandro Serra
- Neurology, Louis Stokes VA Medical Center, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH, United States
| | | | - Manuela Matta
- Neurology, Ospedale San Luigi Gonzaga, Orbassano, Italy
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Sun H, Cui S, Gao F, You Q, Li Y, Wang J, Zhang X. Eye movement abnormalities in AQP4-IgG positive neuromyelitis optica spectrum disorder. J Neurol Sci 2018; 384:91-95. [PMID: 29249386 DOI: 10.1016/j.jns.2017.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/03/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica spectrum disorder (NMOSD) has been recognized as a disease characterized by severe visual afferent impairment. Abnormal eye movements, as the other important neuro-ophthalmic manifestation of NMOSD, were commonly overlooked. The aim of our study was to describe the ocular motor manifestations of AQP4-IgG positive NMOSD patients, and explore the value of eye movement abnormalities in the evaluation of the disabled disease. METHODS Systemic clinical bedside ocular motor examinations and quantitative horizontal saccadic eye movement assessments were performed in 90 patients with AQP4-IgG positive NMOSD. General disability was evaluated by expanded disability status scale (EDSS). Vision-specific functional status was evaluated by the National Eye Institute-Visual Function Questionnaire (NEI-VFQ 25) and the 10-item neuro-ophthalmic supplement. Brain magnetic resonance imaging (MRI) was acquired in all patients. RESULTS In clinical examination, eye movement abnormalities were found in 38% of NMOSD patients. Abnormalities in the quantitative saccadic test were found in 67% of NMOSD patients, including 48% of patients with clinically normal eye movements. EDSS scores in patients with clinical eye movement abnormality were significantly higher (P<0.001) than those with a normal examination. The 10-item neuro-ophthalmic supplement score was significantly associated with quantitative saccadic eye movement abnormalities (P=0.031). CONCLUSIONS Eye movement abnormalities were common in AQP4-IgG positive NMOSD patients, and were associated with general disability and specific visual handicap. The systemic clinical eye movement examination combined with the quantitative saccade test was easy to perform, and could provide additional useful information in evaluating NMOSD.
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Affiliation(s)
- Houliang Sun
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shilei Cui
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fei Gao
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qisheng You
- Ophthalmology Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaojun Zhang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Abstract
PURPOSE OF REVIEW This article discusses the advantages and pitfalls of testing neuroprotective treatment strategies in patients suffering from optic neuritis. RECENT FINDINGS Spectral domain optical coherence tomography now permits for automated segmentation of individual retinal layers. The peripapillary retinal nerve fibre layer (pRNFL) has been used in 13 of the 15 trials reviewed. Twelve trials also made use of electrophysiology. Overestimation of good visual recovery in the past has recently been recognized. Assessment of low contrast visual acuity and colour vision are now mainstream. SUMMARY The availability of highly accurate and robust trial outcome measures has facilitated research on this topic. A single long-term structural outcome measurement of the pRNFL is sufficient. For shorter term, assessments of the ganglion cell/inner plexiform layer and axonal birefringence are promising. Longitudinal blood levels of neurofilament proteins permit to recognize axonal loss at presentation and monitor changes longitudinally. Inner nuclear layer volume changes relate to inflammatory disease activity.Pitfalls are related to the timing of events. Hyperacute recruitment is needed for future trials. The onset of demyelination is not known, which complicates timing of electrophysiological recordings. Optic disc oedema precludes the use of the pRNFL from the affected eye as a baseline variable. The concomitant use of corticosteroids complicates interpretation of trial data.
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Rowe FJ, Conroy EJ, Bedson E, Cwiklinski E, Drummond A, García-Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, MacIntosh C, Johnson S, Noonan C, Barton G, Sackley C. A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia. Acta Neurol Scand 2017; 136:310-321. [PMID: 28028819 DOI: 10.1111/ane.12725] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). METHODS Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. PARTICIPANTS Stroke survivors with homonymous hemianopia. INTERVENTIONS Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). INCLUSION CRITERIA Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. OUTCOMES Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. RANDOMIZATION Randomization block lists stratified by site and partial/complete hemianopia. BLINDING Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. RESULTS Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). CONCLUSIONS No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation.
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Affiliation(s)
- F. J. Rowe
- Department of Health Services Research; University of Liverpool; Liverpool UK
| | - E. J. Conroy
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - E. Bedson
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - E. Cwiklinski
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - A. Drummond
- School of Health Sciences; University of Nottingham; Nottingham UK
| | - M. García-Fiñana
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - C. Howard
- Department of Orthoptics; Salford Royal NHS Foundation Trust; Manchester UK
| | - A. Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - T. Shipman
- Department of Orthoptics; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - C. Dodridge
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - C. MacIntosh
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - S. Johnson
- Eye Clinic Impact Team; Royal National Institute for the Blind; Birmingham UK
| | - C. Noonan
- Department of Ophthalmology; Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - G. Barton
- Department of Elderly Care; Warrington and Halton Hospitals NHS Foundation Trust; Warrington UK
| | - C. Sackley
- Division of Health and Social Care; King's College; London UK
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Abstract
BACKGROUND Although patients with acute optic neuritis (ON) recover high-contrast visual acuity (HCVA) to 20/40 or better in 95% of affected eyes, patients with a history of ON continue to note subjective abnormalities of vision. Furthermore, substantial and permanent thinning of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) is now known to occur early in the course of ON. We measured vision-specific quality of life (QOL) in patients with a history of acute ON and recovery of VA to 20/40 or better in their affected eyes to determine how these QOL scores relate to RNFL and GCL thickness and low-contrast letter acuity (LCLA) across the spectrum of visual recovery. METHODS Data from an ongoing collaborative study of visual outcomes in multiple sclerosis and ON were analyzed for this cross-sectional observational cohort. Patients and disease-free control participants completed the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement to the NEI-VFQ-25, as well as VA and LCLA testing for each eye separately and binocularly. Optical coherence tomography measures for each eye included peripapillary RNFL thickness and macular GCL + inner plexiform layer (GCL + IPL) thickness. RESULTS Patients with a history of acute ON and recovery to 20/40 or better VA (n = 113) had significantly reduced scores for the NEI-VFQ-25 (83.7 ± 15.4) and 10-Item Neuro-Ophthalmic Supplement (74.6 ± 17.4) compared with disease-free controls (98.2 ± 2.1 and 96.4 ± 5.2, P < 0.001, linear regression models, accounting for age and within-patient, intereye correlations). Most patients with 20/40 or better visual recovery (98/112, 88%) had monocular HCVA in their affected eye of 20/20 or better. Although patients with 20/50 or worse HCVA recovery demonstrated the worst performance on low-contrast acuity, affected eye RNFL and GCL + IPL thickness, and QOL scales, these measures were also significantly reduced among those with 20/40 or better HCVA recovery compared with controls. CONCLUSIONS Patients with a history of ON and "good" visual recovery, defined in the literature as 20/40 or better HCVA, are left with clinically meaningful reductions in vision-specific QOL. Such patient-observed deficits reflect the underlying significant degrees of retinal axonal and neuronal loss and visual dysfunction that are now known to characterize ON even in the setting of maximal HCVA recovery. There remains an unmet therapeutic need for patients with ON.
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Sanchez-Dalmau B, Martinez-Lapiscina EH, Torres-Torres R, Ortiz-Perez S, Zubizarreta I, Pulido-Valdeolivas IV, Alba-Arbalat S, Guerrero-Zamora A, Calbet D, Villoslada P. Early retinal atrophy predicts long-term visual impairment after acute optic neuritis. Mult Scler 2017; 24:1196-1204. [PMID: 28669275 DOI: 10.1177/1352458517718628] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Visual recovery after optic neuritis (ON) used to be defined as good, although patients frequently complain of poor vision. METHODS We carried out a prospective study on 38 consecutive patients with acute ON followed monthly for 6 months and evaluated high- and low-contrast visual acuity (HCVA and LCVA, respectively), quality of vision (National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)), visual fields, and retinal thickness by spectral domain optical coherence tomography (OCT). RESULTS We found significant impaired LCVA and color vision in ON eyes 6 months after acute ON, which impact on quality of life. LCVA and color vision were correlated with the thicknesses of the ganglion cell and inner plexiform layer (GCIPL; 2.5% LCVA r = 0.65 and p = 0.0001; color vision r = 0.75 and p < 0.0001) and that of the peripapillary retinal nerve fiber layer (pRNFL; LCVA r = 0.43 and p = 0.0098; color vision r = 0.62 and p < 0.0001). Linear regression models that included the change in the GCIPL and pRNFL thicknesses from baseline to month 1 after onset explained 47% of the change in 2.5% LCVA and 67% of the change of color vision acuity. When adjusting for the value of visual acuity at baseline, predictors of the change in vision from baseline to month 6 achieved similar performance for all three types of vision (HCVA, LCVA, and color vision). CONCLUSION Monitoring retinal atrophy by OCT within the first month after ON onset allows individuals at a high risk of residual visual impairment to be identified.
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Affiliation(s)
- Bernardo Sanchez-Dalmau
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ruben Torres-Torres
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Santiago Ortiz-Perez
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Irati Zubizarreta
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene V Pulido-Valdeolivas
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salut Alba-Arbalat
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana Guerrero-Zamora
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Pablo Villoslada
- Center of Neuroimmunology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain/University of California San Francisco, San Francisco, CA, USA
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Hainline C, Rizzo JR, Hudson TE, Dai W, Birkemeier J, Raynowska J, Nolan RC, Hasanaj L, Selesnick I, Frohman TC, Frohman EM, Galetta SL, Balcer LJ, Rucker JC. Capturing saccades in multiple sclerosis with a digitized test of rapid number naming. J Neurol 2017; 264:989-998. [PMID: 28389741 DOI: 10.1007/s00415-017-8484-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 01/25/2023]
Abstract
The King-Devick (K-D) test of rapid number naming is a visual performance measure that captures saccadic eye movements. Patients with multiple sclerosis (MS) have slowed K-D test times associated with neurologic disability and reduced quality of life. We assessed eye movements during the K-D test to identify characteristics associated with slowed times. Participants performed a computerized K-D test with video-oculography. The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and its 10-Item Neuro-Ophthalmic Supplement measured vision-specific quality of life (VSQOL). Among 25 participants with MS (age 37 ± 10 years, range 20-59) and 42 controls (age 33 ± 9 years, range 19-54), MS was associated with significantly longer (worse) K-D times (58.2 ± 19.8 vs. 43.8 ± 8.6 s, P = 0.001, linear regression models, accounting for age). In MS, test times were slower among patients with higher (worse) Expanded Disability Status Scale scores (P = 0.01). Average inter-saccadic intervals (ISI) were significantly longer in MS participants compared to controls (362 ± 103 vs. 286 ± 50 ms, P = 0.001), and were highly associated with prolonged K-D times in MS (P = 0.006). MS participants generated greater numbers of saccades (P = 0.007). VSQOL scores were reduced in MS patients with longer (worse) K-D times (P = 0.04-0.001) and longer ISI (P = 0.002-0.001). Patients with MS have slowed K-D times that may be attributable to prolonged ISI and greater numbers of saccades. The K-D test and its requisite eye movements capture VSQOL and make rapid number naming a strong candidate efferent visual performance measure in MS.
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Affiliation(s)
- Clotilde Hainline
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - John-Ross Rizzo
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Todd E Hudson
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Weiwei Dai
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Joel Birkemeier
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Rachel C Nolan
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Lisena Hasanaj
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
| | - Ivan Selesnick
- Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Laura J Balcer
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Janet C Rucker
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY, 10016, USA.
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
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Wall M, Kupersmith MJ, Thurtell MJ, Moss HE, Moss EA, Auinger P. The Longitudinal Idiopathic Intracranial Hypertension Trial: Outcomes From Months 6-12. Am J Ophthalmol 2017; 176:102-107. [PMID: 28104417 DOI: 10.1016/j.ajo.2017.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether the beneficial effects of acetazolamide (ACZ) in improving vision at 6 months continues to month 12 in participants of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). DESIGN Nonrandomized clinical study. METHODS In the IIHTT, subjects were randomly assigned to placebo-plus-diet or maximally tolerated dosage of acetazolamide-plus-diet. At 6 months subjects transitioned from study drug to ACZ. This resulted in the following groups: (1) ACZ to ACZ; n = 34; (2) placebo to ACZ; n = 35; (3) ACZ to no treatment; n = 16; and (4) placebo to no treatment; n = 11. Ninety-six IIHTT subjects had evaluations at 6 and 12 months. Our main outcome measure was change from month 6 to month 12 in visual field mean deviation (MD) with secondary measures being change in papilledema grade, ETDRS scores, and quality-of-life (QoL) measures. RESULTS The ACZ to ACZ group improved 0.35 dB, P = .05; placebo subjects with no ACZ improved 0.81 dB MD, P = .07 at 12 months. The other groups improved 0.35-0.46 dB MD. Mean improvements in papilledema grade occurred most markedly in the group that exchanged placebo for ACZ (0.91 units, P < .001). QoL and headache disability scores showed significant improvements in the placebo group with added ACZ. CONCLUSION Improvements in MD continued from month 6 to month 12 of the IIHTT in all treatment groups, most marked in the placebo group tapered off study drug. Adding ACZ to the placebo group significantly improved papilledema grade, headache, and QoL measures.
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Balcer LJ, Raynowska J, Nolan R, Galetta SL, Kapoor R, Benedict R, Phillips G, LaRocca N, Hudson L, Rudick R. Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:734-747. [PMID: 28206829 PMCID: PMC5407511 DOI: 10.1177/1352458517690822] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.
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Affiliation(s)
- Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Rachel Nolan
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Raju Kapoor
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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Bruce BB, Digre KB, McDermott MP, Schron EB, Wall M. Quality of life at 6 months in the Idiopathic Intracranial Hypertension Treatment Trial. Neurology 2016; 87:1871-1877. [PMID: 27694262 PMCID: PMC5100710 DOI: 10.1212/wnl.0000000000003280] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/18/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the changes in vision-specific and overall health-related quality of life (QOL) at 6 months in participants with idiopathic intracranial hypertension (IIH) and mild visual loss enrolled in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and to determine the signs and symptoms of IIH that mediate the effect of acetazolamide on QOL. METHODS We assessed QOL using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), the 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement, and the 36-Item Short Form Health Survey (SF-36). We examined associations among changes in QOL measures over 6 months, treatment status, and changes in signs and symptoms using linear and structural equation models. RESULTS Among the 165 participants with IIH (86 randomized to acetazolamide, 79 to placebo), beneficial effects of acetazolamide were seen on all QOL scales evaluated, as well as on the Near Activities (5.60 points, p = 0.03), Social Functioning (3.85 points, p = 0.04), and Mental Health (9.82, p = 0.04) subscales of the NEI-VFQ-25. Positive acetazolamide-related effects on QOL appeared to be primarily mediated by improvements in visual field, neck pain, pulsatile tinnitus, and dizziness/vertigo that outweighed the side effects of acetazolamide. CONCLUSIONS The marked reductions in baseline QOL seen among patients with mild visual loss from IIH are improved by treatment with acetazolamide. When combined with acetazolamide-associated improvements in visual field and other aspects of IIH, our findings with respect to QOL provide further support from the IIHTT in favor of acetazolamide to augment a dietary intervention in the treatment of IIH with mild visual loss (clinicaltrials.gov: NCT01003639).
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Affiliation(s)
- Beau B Bruce
- From the Departments of Ophthalmology, Neurology, and Epidemiology (B.B.B.), Emory University, Atlanta, GA; Departments of Neurology and Ophthalmology (K.B.D.), Moran Eye Center, University of Utah, Salt Lake City; Departments of Biostatistics and Computational Biology and Neurology (M.P.M.), University of Rochester Medical Center, NY; Division of Extramural Research (E.B.S.), National Eye Institute, Bethesda, MD; and Department of Ophthalmology and Visual Sciences (M.W.), University of Iowa Carver College of Medicine, Iowa City.
| | - Kathleen B Digre
- From the Departments of Ophthalmology, Neurology, and Epidemiology (B.B.B.), Emory University, Atlanta, GA; Departments of Neurology and Ophthalmology (K.B.D.), Moran Eye Center, University of Utah, Salt Lake City; Departments of Biostatistics and Computational Biology and Neurology (M.P.M.), University of Rochester Medical Center, NY; Division of Extramural Research (E.B.S.), National Eye Institute, Bethesda, MD; and Department of Ophthalmology and Visual Sciences (M.W.), University of Iowa Carver College of Medicine, Iowa City
| | - Michael P McDermott
- From the Departments of Ophthalmology, Neurology, and Epidemiology (B.B.B.), Emory University, Atlanta, GA; Departments of Neurology and Ophthalmology (K.B.D.), Moran Eye Center, University of Utah, Salt Lake City; Departments of Biostatistics and Computational Biology and Neurology (M.P.M.), University of Rochester Medical Center, NY; Division of Extramural Research (E.B.S.), National Eye Institute, Bethesda, MD; and Department of Ophthalmology and Visual Sciences (M.W.), University of Iowa Carver College of Medicine, Iowa City
| | - Eleanor B Schron
- From the Departments of Ophthalmology, Neurology, and Epidemiology (B.B.B.), Emory University, Atlanta, GA; Departments of Neurology and Ophthalmology (K.B.D.), Moran Eye Center, University of Utah, Salt Lake City; Departments of Biostatistics and Computational Biology and Neurology (M.P.M.), University of Rochester Medical Center, NY; Division of Extramural Research (E.B.S.), National Eye Institute, Bethesda, MD; and Department of Ophthalmology and Visual Sciences (M.W.), University of Iowa Carver College of Medicine, Iowa City
| | - Michael Wall
- From the Departments of Ophthalmology, Neurology, and Epidemiology (B.B.B.), Emory University, Atlanta, GA; Departments of Neurology and Ophthalmology (K.B.D.), Moran Eye Center, University of Utah, Salt Lake City; Departments of Biostatistics and Computational Biology and Neurology (M.P.M.), University of Rochester Medical Center, NY; Division of Extramural Research (E.B.S.), National Eye Institute, Bethesda, MD; and Department of Ophthalmology and Visual Sciences (M.W.), University of Iowa Carver College of Medicine, Iowa City
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