Amplitude of Accommodation in Patients with Multiple Sclerosis

BCLA CLEAR Presbyopia: Epidemiology and impact

The global all-ages prevalence of epidemiologically-measured 'functional' presbyopia was estimated at 24.9% in 2015, affecting 1.8 billion people. This prevalence was projected to stabilise at 24.1% in 2030 due to increasing myopia, but to affect more people (2.1 billion) due to population dynamics. Factors affecting the prevalence of presbyopia include age, geographic location, urban versus rural location, sex, and, to a lesser extent, socioeconomic status, literacy and education, health literacy and inequality. Risk factors for early onset of presbyopia included environmental factors, nutrition, near demands, refractive error, accommodative dysfunction, medications, certain health conditions and sleep. Presbyopia was found to impact on quality-of-life, in particular quality of vision, labour force participation, work productivity and financial burden, mental health, social wellbeing and physical health. Current understanding makes it clear that presbyopia is a very common age-related condition that has significant impacts on both patient-reported outcome measures and economics. However, there are complexities in defining presbyopia for epidemiological and impact studies. Standardisation of definitions will assist future synthesis, pattern analysis and sense-making between studies.

Static and dynamic pupillary characteristics in multiple sclerosis

PURPOSE

To examine the static and dynamic pupillary functions with automated pupillography in multiple sclerosis (MS) patients with preserved visual acuity.

METHODS

Forty-seven MS patients with preserved visual acuity were included in the study group and 43 healthy volunteers in the control group. The visual evoked potential of the patients was obtained. After routine ophthalmologic examination contrast sensitivity and the retinal nerve fiber layer (RNFL) thickness were measured. Finally scotopic, mesopic, and photopic pupillographies followed by dynamic pupillography were undertaken, and the pupillary dilatation speed was calculated.

RESULTS

The contrast sensitivity and RNFL thickness of the MS group were significantly lower than those of the control group (p < 0.05; for both). In the MS and control groups, the scotopic pupil diameters were 5.48 ± 1.03 and 5.28 ± 0.78 mm, mesopic pupil diameters were 4.82 ± 0.83 and 4.48 ± 0.70 mm, and photopic pupil diameters were 3.84 ± 0.79 and 3.42 ± 0.49 mm, respectively (p = 0.315, p = 0.044, and p = 0.004, respectively). In dynamic pupillography, the pupil in the MS group was more dilated than control group at all time sections examined except the sixth second (p < 0.05; for all). Although the mean pupillary dilation speed in the first second was higher in the MS group (p = 0.044), there was no significant difference between the groups for the other time intervals examined (p > 0.05; for all). There was no correlation between pupillary parameters and P100-wave latency, RNFL thickness, or contrast sensitivity (p > 0.05; for all).

CONCLUSIONS

Static and dynamic pupillary functions may be affected in MS patients with preserved visual acuity. Although scotopic pupillary functions are preserved, mesopic, and photopic pupil functions are weakened.

Binocular, Accommodative and Oculomotor Alterations In Multiple Sclerosis: A Review

Multiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. The objective of this narrative review was to collect and summarize the available scientific information on oculomotor, accommodative and binocular alterations that have been reported in MS. A systematic search strategy with the following descriptors was carried out: multiple sclerosis, ocular motility disorders, internuclear ophthalmoplegia, nystagmus, vergences, fixation, pupil reflex, accommodation and stereopsis. According to the search, some oculomotor alterations were found to be commonly reported in MS, such as alterations in saccades and nystagmus. In contrast, accommodative, vergence and stereopsis alterations have not been comprehensively studied despite their relevance, with only minimal evidence showing a potential negative impact of the disease on these aspects. In conclusion, oculomotor impairment is a common component of disability in MS patients and should be considered when managing this type of patients. More research is still needed to know the real impact of this disease on binocular vision and accommodation.

The Influence of Type 1 Diabetes Mellitus on Amplitude of Accommodation

PURPOSE

The aim of the study was to assess the amplitude of accommodation (AA) in patients with type 1 diabetes mellitus (DM) and without diabetic retinopathy.

MATERIALS AND METHODS

In two age- and sex-matched groups - one with twenty-nine eyes of 29 patients with type 1 DM, the other with twenty-nine eyes of 29 healthy individuals - retinal nerve fibre layer thickness and macular volume were determined by using optic coherence tomography in all quadrants, whereas AA was measured with the minus lens technique. The mean values of all three measurements were compared between the groups, and the effect of age, disease duration, (HbA1c and fasting blood glucose on AA were analysed using multiple regression analysis.

RESULTS

On average, participants were 25.0 ± 3.3 years old (range 19-30) in both groups (P = 1.000), and patients had type 1 DM for an average of 13.0 ± 3.3 years. Mean AA in the right eye was 7.3 ± 1.1 D among patients and 8.1 ± 1.1 D among controls (P = .005), as well as significantly negatively correlated with age in both groups (r = -0.735, P <.001 and r = -0.819, P < .001, respectively) and disease duration among patients (r = -0.434, P = .019). In multivariable regression, age and disease duration significantly affected AA in patients, with an R ² value of 0.623 (P < .001 and P = .025, respectively). Average RNFL thickness was significantly different between the groups (P = .014). Mean macular volumes for areas 1, 3 or 5 mm in diameter were similar between the groups.

CONCLUSIONS

AA was significantly lower among patients with type 1 DM than among healthy individuals, which suggests that the former might experience presbyopia earlier in life than the general population.