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Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res 2024; 242:1797-1806. [PMID: 38839617 DOI: 10.1007/s00221-024-06864-1] [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: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
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Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Applied Vestibular Physiology Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, College of Health, University of Montana, Missoula, MT, USA
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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2
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Marcelli V, Giannoni B, Volpe G, Faralli M, Fetoni AR, Pettorossi VE. Downbeat nystagmus: a clinical and pathophysiological review. Front Neurol 2024; 15:1394859. [PMID: 38854962 PMCID: PMC11157062 DOI: 10.3389/fneur.2024.1394859] [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: 03/02/2024] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Downbeat nystagmus (DBN) is a neuro-otological finding frequently encountered by clinicians dealing with patients with vertigo. Since DBN is a finding that should be understood because of central vestibular dysfunction, it is necessary to know how to frame it promptly to suggest the correct diagnostic-therapeutic pathway to the patient. As knowledge of its pathophysiology has progressed, the importance of this clinical sign has been increasingly understood. At the same time, clinical diagnostic knowledge has increased, and it has been recognized that this sign may occur sporadically or in association with others within defined clinical syndromes. Thus, in many cases, different therapeutic solutions have become possible. In our work, we have attempted to systematize current knowledge about the origin of this finding, the clinical presentation and current treatment options, to provide an overview that can be used at different levels, from the general practitioner to the specialist neurologist or neurotologist.
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Affiliation(s)
- Vincenzo Marcelli
- Audiology and Vestibology Unit, Department of ENT, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
- Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples ‘’Federico II’’, Napoli, Italy
| | - Beatrice Giannoni
- Department of Neuroscience, Psychology, Drug’s Area and Child’s Health, University of Florence, Florence, Italy
| | - Giampiero Volpe
- Department of Neurology, Ospedale San Luca di Vallo della Lucania, ASL Salerno, Salerno, Italy
| | - Mario Faralli
- Department of ENT, University of Perugia, Perugia, Italy
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples ‘’Federico II’’, Napoli, Italy
| | - Vito E. Pettorossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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3
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Farabi Maleki S, Yousefi M, Afshar S, Pedrammehr S, Lim CP, Jafarizadeh A, Asadi H. Artificial Intelligence for Multiple Sclerosis Management Using Retinal Images: Pearl, Peaks, and Pitfalls. Semin Ophthalmol 2024; 39:271-288. [PMID: 38088176 DOI: 10.1080/08820538.2023.2293030] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024]
Abstract
Multiple sclerosis (MS) is a complex autoimmune disease characterized by inflammatory processes, demyelination, neurodegeneration, and axonal damage within the central nervous system (CNS). Retinal imaging, particularly Optical coherence tomography (OCT), has emerged as a crucial tool for investigating MS-related retinal injury. The integration of artificial intelligence(AI) has shown promise in enhancing OCT analysis for MS. Researchers are actively utilizing AI algorithms to accurately detect and classify MS-related abnormalities, leading to improved efficiency in diagnosis, monitoring, and personalized treatment planning. The prognostic value of AI in predicting MS disease progression has garnered substantial attention. Machine learning (ML) and deep learning (DL) algorithms can analyze longitudinal OCT data to forecast the course of the disease, providing critical information for personalized treatment planning and improved patient outcomes. Early detection of high-risk patients allows for targeted interventions to mitigate disability progression effectively. As such, AI-driven approaches yielded remarkable abilities in classifying distinct MS subtypes based on retinal features, aiding in disease characterization and guiding tailored therapeutic strategies. Additionally, these algorithms have enhanced the accuracy and efficiency of OCT image segmentation, streamlined diagnostic processes, and reduced human error. This study reviews the current research studies on the integration of AI,including ML and DL algorithms, with OCT in the context of MS. It examines the advancements, challenges, potential prospects, and ethical concerns of AI-powered techniques in enhancing MS diagnosis, monitoring disease progression, revolutionizing patient care, the development of patient screening tools, and supported clinical decision-making based on OCT images.
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Affiliation(s)
| | - Milad Yousefi
- Faculty of Mathematics, Statistics and Computer Sciences, University of Tabriz, Tabriz, Iran
| | - Sayeh Afshar
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Chee Peng Lim
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Burwood, Australia
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Houshyar Asadi
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Burwood, Australia
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4
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Singh A, Mathurkar S. Optic Neuritis in Resolving Phase of COVID-19 Infection and Its Management: A Case Report. Cureus 2024; 16:e58257. [PMID: 38752088 PMCID: PMC11094531 DOI: 10.7759/cureus.58257] [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: 10/08/2022] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
Optic neuritis is assumed to be immune-mediated, although the specific antigens that cause demyelination are uncertain. Systemic T-cell activation is detected at the onset of symptoms, which occurs before alterations in cerebrospinal fluid (CSF). The optic nerve disease is a rare disease and can occur in one or both eyes, especially in those with no established inflammatory or autoimmune illnesses. Adult ophthalmic neuritis is usually unilateral and is frequently associated with multiple sclerosis (MS). Generally, it starts as a rapid loss of vision and pain in eye movement. It progresses and achieves the maximal deficiency over a week. The objectives of this paper were to determine the association between coronavirus disease 2019 (COVID-19) and optic neuritis and to study the management of optic neuritis in the resolving phase of COVID-19. A case study was done on a 38-year-old female complaining of sudden diminution of vision in her right eye for one week. She tested positive on the reverse transcriptase-polymerase chain reaction (RT-PCR) test for COVID-19 for which she was managed symptomatically and was started on antiretrovirals. This case report is based on an infrequent COVID-19 complication. It has been proposed that this virus has the probability of manifesting various neurological complications. In our case, optic neuritis occurs mainly three weeks after COVID-19 infection. Our patient was managed by intravenous methylprednisolone injection followed by oral prednisone for 14 days. So, further case studies will be required to support the above treatment plan for optic neuritis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unilateral or bilateral optic neuritis can occur as a neurological complication in the resolving stage of COVID-19 infection. Early detection and treatment with steroids can result in the best visual outcome.
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Affiliation(s)
- Aanchal Singh
- Ophthalmology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapneel Mathurkar
- Ophthalmology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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5
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van der Feen FE, de Haan GA, van der Lijn I, Stellingwerf C, Vrijling ACL, Heersema DJ, Meilof JF, Heutink J. The complex relation between visual complaints and decline in visual, visuoperceptual and cognitive functions in people with multiple sclerosis. Neuropsychol Rehabil 2024; 34:220-243. [PMID: 36871257 DOI: 10.1080/09602011.2023.2179075] [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: 07/05/2022] [Accepted: 02/05/2023] [Indexed: 03/06/2023]
Abstract
People with multiple sclerosis (pwMS) report many different visual complaints, but not all of them are well understood. Decline in visual, visuoperceptual and cognitive functions do occur in pwMS, but it is unclear to what extend those help us understand visual complaints. The purpose of this cross-sectional study was to explore the relation between visual complaints and decline in visual, visuoperceptual and cognitive functions, to optimize care for pwMS. Visual, visuoperceptual and cognitive functions of 68 pwMS with visual complaints and 37 pwMS with no or minimal visual complaints were assessed. The frequency of functional decline was compared between the two groups and correlations were calculated between visual complaints and the assessed functions. Decline in several functions occurred more frequently in pwMS with visual complaints. Visual complaints may be an indication of declined visual or cognitive functioning. However, as most correlations were not significant or weak, we cannot infer that visual complaints are directly related to functions. The relationship may be indirect and more complex. Future research could focus on the overarching cognitive capacity that may contribute to visual complaints. Further research into these and other explanations for visual complaints could help us to provide appropriate care for pwMS.
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Affiliation(s)
- F E van der Feen
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Centre of Expertise for blind and partially sighted people, Royal Dutch Visio, Huizen, Netherlands
| | - G A de Haan
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Centre of Expertise for blind and partially sighted people, Royal Dutch Visio, Huizen, Netherlands
| | - I van der Lijn
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Centre of Expertise for blind and partially sighted people, Royal Dutch Visio, Huizen, Netherlands
| | - C Stellingwerf
- Centre of Expertise for blind and partially sighted people, Royal Dutch Visio, Huizen, Netherlands
| | - A C L Vrijling
- Centre of Expertise for blind and partially sighted people, Royal Dutch Visio, Huizen, Netherlands
| | - D J Heersema
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- MS Centrum Noord Nederland, Groningen, Netherlands
| | - J F Meilof
- Department of Neurology, Martini Hospital Groningen, Groningen, Netherlands
- MS Centrum Noord Nederland, Groningen, Netherlands
| | - J Heutink
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Centre of Expertise for blind and partially sighted people, Royal Dutch Visio, Huizen, Netherlands
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6
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Mey GM, DeSilva TM. Utility of the visual system to monitor neurodegeneration in multiple sclerosis. Front Mol Neurosci 2023; 16:1125115. [PMID: 37063369 PMCID: PMC10090562 DOI: 10.3389/fnmol.2023.1125115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Neurodegeneration occurs early in the multiple sclerosis (MS) disease course and is an important driver of permanent disability. Current immunomodulatory therapies do not directly target neuronal health; thus, there is a critical need to develop neuroprotective strategies in MS. Outcome measures in clinical trials primarily evaluate disease activity and clinical disability scores rather than measures of neurodegeneration. The visual system provides a noninvasive correlate of brain atrophy and neuronal function through structural and functional exams. Furthermore, optic nerve axons and their respective neuronal cell bodies in the retina, in addition to their synaptic input to the thalamus, provide a distinct anatomy to investigate neurodegenerative processes. This review discusses the utility of the visual system as an early output measure of neurodegeneration in MS as well as an important platform to evaluate neuroprotective strategies in preclinical models.
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Affiliation(s)
| | - Tara M. DeSilva
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH, United States
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Grove CR, Wagner A, Yang VB, Loyd BJ, Dibble LE, Schubert MC. Greater Disability Is Associated with Worse Vestibular and Compensatory Oculomotor Functions in People Living with Multiple Sclerosis. Brain Sci 2022; 12:1519. [PMID: 36358444 PMCID: PMC9688247 DOI: 10.3390/brainsci12111519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 08/15/2023] Open
Abstract
Globally, there are nearly three million people living with multiple sclerosis (PLW-MS). Many PLW-MS experience vertigo and have signs of vestibular dysfunction, e.g., low vestibulo-ocular reflex (VOR) gains or the presence of compensatory saccades (CSs), on video head impulse testing (vHIT). We examined whether the vestibular function and compensatory oculomotor behaviors in PLW-MS differed based on the level of MS-related disability. The VOR gain, CS frequency and latency, and gaze position error (GPE) were calculated from the individual traces obtained during six-canal vHIT for 37 PLW-MS (mean age 53.4 ± 12.4 years-old, 28 females) with vertigo and/or an imbalance. The subjects were grouped by their Expanded Disability Status Scale (EDSS) scores: PLW-min-MS (EDSS = 1.0-2.5, n = 8), PLW-mild-MS (EDSS = 3.0-4.5, n = 23), and PLW-moderate-MS (EDSS = 5.0-6.0, n = 6). The between-group differences were assessed with Kruskal-Wallis tests. The VOR gains for most of the canals were higher for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. CS occurred less often in PLW-min-MS versus PLW-mild- and mod-MS, respectively. No clear trend in CS latency was found. The GPE was often lower for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. Thus, our data demonstrate that worse VOR and compensatory oculomotor functions are associated with a greater MS-related disability. PLW-MS may benefit from personalized vestibular physical therapy.
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Affiliation(s)
- Colin R. Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Andrew Wagner
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH 43212, USA
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43212, USA
| | - Victor B. Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Brian J. Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT 59812, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD 21287, USA
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8
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Babazadeh A, Barary M, Ebrahimpour S, Sio TT, Mohseni Afshar Z. Non-arteritic anterior ischemic optic neuropathy as an atypical feature of COVID-19: A case report. J Fr Ophtalmol 2022; 45:e171-e173. [PMID: 35031149 PMCID: PMC8733217 DOI: 10.1016/j.jfo.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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9
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Singh R, Pandey S. Movement Disorder in Demyelinating Disease: Tracing the Charcot's Foot Print. Ann Indian Acad Neurol 2022; 25:821-831. [PMID: 36561038 PMCID: PMC9764914 DOI: 10.4103/aian.aian_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 12/25/2022] Open
Abstract
Movement disorders may be one of the neurological manifestations of demyelinating disorders. They can manifest in Parkinsonism or a wide spectrum of hyperkinetic movement disorders including tremor, paroxysmal dyskinesia, dystonia, chorea, and ballism. Some of these disorders occur during an acute episode of demyelination, whereas others can develop later or even may precede the onset of the demyelinating disorders. The pathophysiology of movement disorders in demyelination is complex and the current evidence indicates a wide involvement of different brain networks and spinal cord. Treatment is mainly symptomatic and oral pharmacological agents are the mainstay of the management. Botulinum toxin and neurosurgical interventions may be required in selected patients.
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Affiliation(s)
- Rashmi Singh
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India,Address for correspondence: Dr. Sanjay Pandey, Department of Neurology, Academic Block, Room No 503, Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi - 110 002, India. E-mail:
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10
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Graves JS, Oertel FC, Van der Walt A, Collorone S, Sotirchos ES, Pihl-Jensen G, Albrecht P, Yeh EA, Saidha S, Frederiksen J, Newsome SD, Paul F. Leveraging Visual Outcome Measures to Advance Therapy Development in Neuroimmunologic Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 9:9/2/e1126. [PMID: 34955459 PMCID: PMC8711076 DOI: 10.1212/nxi.0000000000001126] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022]
Abstract
The visual system offers unparalleled precision in the assessment of neuroaxonal damage. With the majority of patients with multiple sclerosis (MS) experiencing afferent and efferent visual dysfunction, outcome measures capturing these deficits provide insight into neuroaxonal injury, even in those with minimal disability. Ideal for use in clinical trials, visual measures are generally inexpensive, accessible, and reproducible. Quantification of visual acuity, visual fields, visual quality of life, and electrophysiologic parameters allows assessment of function, whereas optical coherence tomography (OCT) provides reliable measures of the structural integrity of the anterior afferent visual pathway. The technology of oculomotor biometrics continues to advance, and discrete measures of fixation, smooth pursuit, and saccadic eye movement abnormalities are ready for inclusion in future trials of MS progression. Visual outcomes allow tracking of neuroaxonal injury and aid in distinguishing MS from diseases such as neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody-associated diseases (MOGAD). OCT has also provided unique insights into pathophysiology, including the identification of foveal pitting in NMOSD, possibly from damage to Müller cells, which carry an abundance of aquaporin-4 channels. For some study designs, the cost-benefit ratio favors visual outcomes over more expensive MRI outcomes. With the next frontier of therapeutics focused on remyelination and neuroprotection, visual outcomes are likely to take center stage. As an international community of collaborative, committed, vision scientists, this review by the International MS Visual System Consortium (IMSVISUAL) outlines the quality standards, informatics, and framework needed to routinely incorporate vision outcomes into MS and NMOSD trials.
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Affiliation(s)
- Jennifer S Graves
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada.
| | - Frederike Cosima Oertel
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Anneke Van der Walt
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Sara Collorone
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Elias S Sotirchos
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Gorm Pihl-Jensen
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Philipp Albrecht
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - E Ann Yeh
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Shiv Saidha
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Jette Frederiksen
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Scott Douglas Newsome
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
| | - Friedemann Paul
- Department of Neurosciences (J.S.G.), University of California, San Diego; Experimental and Clinical Research Center (F.C.O., F.P.), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin & 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 neuroscience (A.V.D.W.), Central Clinical School, Monash University, Melbourne, Australia; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation (S.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology (E.S.S., S.S., S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Rigshospitalet (J.F.), Denmark; Department of Neurology (P.A.), Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany; Division of Neurology, Department of Pediatrics (E.A.Y.), Division of Neuroscience and Mental Health, Hospital for Sick Children, Hospital for Sick Children Research Institute, and University of Toronto, Toronto, Canada
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11
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Gil-Casas A, Piñero DP, Molina-Martin A. Are near visual signs and symptoms in multiple sclerosis compatible with convergence insufficiency? Clin Exp Optom 2021; 105:631-636. [PMID: 34406109 DOI: 10.1080/08164622.2021.1961566] [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] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Optometric management of neurodegenerative diseases is essential since visual signs, such as double vision, visual acuity reduction, or oculomotricity dysfunctions, are usually present in these subjects over the course of the disease. The present paper can guide clinicians in better managing their patients with multiple sclerosis. BACKGROUND Patients with multiple sclerosis present near vision symptoms that may be related to binocular anomalies, but these symptoms have not been investigated and related to specific signs. The aim of the present study was to evaluate the binocular vision in subjects with multiple sclerosis, and to analyse if the near visual signs and symptoms observed are compatible with those found in convergence insufficiency, as occurs in other neurodegenerative diseases. METHODS A total of 57 multiple sclerosis patients and 26 healthy controls were examined and classified as potentially compatible with convergence insufficiency according to the signs and symptoms. Clinical diagnosis of convergence insufficiency was established when subjects met the following criteria: NPC breakpoint more than 6 cm, PFV ≤ than 15Δ (base-out), and exophoria greater at near than at distance at least 4Δ. Convergence Insufficiency Symptom Survey (CISS) was administered to assess the symptomatology considering a score ≥16 as positive. RESULTS According to the CISS score, 54,4% of the multiple sclerosis subjects revised showed a suspect of convergence insufficiency, with a median score of 27 (IQR 9), whereas only one subject from control group (3.8%) showed this suspect. According to the diagnostic criteria based on signs, only 15.8% of multiple sclerosis patients had a real diagnosis of convergence insufficiency. CONCLUSION Multiple sclerosis patients showed symptomatology compatible with convergence insufficiency, but this was not supported by the signs which showed a more esophoric tendency. The discrepancies between the signs and symptoms could be due to the questionnaire used including items that are also related to the cognitive function and other ocular abnormalities.
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Affiliation(s)
- Amparo Gil-Casas
- Optometry Clinic, Fundació Lluís Alcanyís, University of Valencia, Valencia, Spain
| | - David P Piñero
- Optics and Visual Perception Group, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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12
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Uribe-Reina P, Muñoz-Ortiz J, Cifuentes-González C, Reyes-Guanes J, Terreros-Dorado JP, Zambrano-Romero W, López-Rojas C, Mantilla-Sylvain F, Mantilla-Hernández RD, de-la-Torre A. Ocular Manifestations in Colombian Patients with Systemic Rheumatologic Diseases. Clin Ophthalmol 2021; 15:2787-2802. [PMID: 34234401 PMCID: PMC8254180 DOI: 10.2147/opth.s306621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To establish the prevalence of ocular involvement in a Colombian population with rheumatologic diseases. DESIGN Observational cross-sectional study. METHODS We included a probabilistic sample size of 797 patients who attended a rheumatologic disease center in Bogotá, Colombia. Statistical analysis with descriptive measures and Chi-square independence test between rheumatologic diseases and ophthalmological symptoms and diseases was performed. RESULTS Eighty-four percent of the population were women, and the mean age was 54.61± 15.64 years. The most common condition was rheumatoid arthritis (33.37%), followed by fibromyalgia (22.71%), Sjögren Syndrome (19.72%), and systemic lupus erythematosus (9.91%). Almost 7% of the patients presented polyautoimmunity. Thirty-five percent of the patients reported one or more ophthalmological symptoms, being dry eye sensation the most common (30.86%), followed by ocular pain (2.76%), red-eye, and decreased visual acuity (both 2.63%). Similarly, 21.45% of the patients presented one or more ophthalmological diagnoses, being keratoconjunctivitis sicca the most common (15.93%), followed by cataract, uveitis (1.38% each), and scleritis (1.25%). CONCLUSION Almost a third of the patients reported any ocular involvement. It is crucial to be aware of the most common ophthalmic manifestations among the different rheumatologic diseases in our population, to offer early specialist referral and timely treatment.
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Affiliation(s)
- Pilar Uribe-Reina
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Juan Pablo Terreros-Dorado
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Zambrano-Romero
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Fundación Para la Investigación en Dermatología y Reumatología (FUNINDERMA), Bogotá, Colombia
| | - Carolina López-Rojas
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Fabien Mantilla-Sylvain
- Fundación Para la Investigación en Dermatología y Reumatología (FUNINDERMA), Bogotá, Colombia
| | | | - Alejandra de-la-Torre
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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13
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Gil-Casas A, Piñero-Llorens DP, Molina-Martin A. Binocular Vision in Patients with Multiple Sclerosis. CLINICAL OPTOMETRY 2021; 13:39-49. [PMID: 33603529 PMCID: PMC7886387 DOI: 10.2147/opto.s286862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Oculomotor disorders have been reported in multiple sclerosis (MS) in up to 80% of cases. There have been studies evaluating binocular vision in several neurological diseases, but not in MS. Considering that a high percentage of eye-movement anomalies have been reported, the aim of this study was to analyze binocular vision in these subjects. METHODS A total of 59 participants with MS - 21 with monocular optic neuritis, eleven with binocular optic neuritis, and 27 without optic neuritis - and 26 age-matched controls were enrolled. Binocular vision was analyzed using near point of convergence (NPC), positive and negative fusional vergence for far and near distance, measurement of heterophoria at both distances with cover and modified Thorington tests, and random-dot stereoscopy. RESULTS The percentage of subjects with abnormal NPC values was highest in the MS group, followed by the MSONm (MS with optic neuritis in one eye), MSONb (MS with optic neuritis in both eyes), and control groups. MS patients showed an esophoric trend at near distance. Positive fusional vergence showed no significant differences between control and MS groups, but higher variability in recovery was found in MS groups. Negative fusional vergence at near distance showed significant differences between the control group and the two MS groups, with optic neuritis for both break-point and recovery values. A high percentage of patients with MS had alterations on stereopsis. CONCLUSION Alterations in binocular vision were present in MS, with divergence at near distance and stereopsis the most affected parameters. Likewise, MS patients with optic neuritis showed worse binocular vision.
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Affiliation(s)
- Amparo Gil-Casas
- Clínica Optométrica, Fundació Lluís Alcanyís, University of Valencia, Valencia, Spain
- Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology, and Anatomy, University of Alicante, Alicante, Spain
| | - David P Piñero-Llorens
- Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology, and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology, and Anatomy, University of Alicante, Alicante, Spain
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14
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Grillini A, Renken RJ, Vrijling ACL, Heutink J, Cornelissen FW. Eye Movement Evaluation in Multiple Sclerosis and Parkinson's Disease Using a Standardized Oculomotor and Neuro-Ophthalmic Disorder Assessment (SONDA). Front Neurol 2020; 11:971. [PMID: 33013643 PMCID: PMC7506055 DOI: 10.3389/fneur.2020.00971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Evaluating the state of the oculomotor system of a patient is one of the fundamental tests done in neuro-ophthalmology. However, up to date, very few quantitative standardized tests of eye movements' quality exist, limiting this assessment to confrontational tests reliant on subjective interpretation. Furthermore, quantitative tests relying on eye movement properties, such as pursuit gain and saccade dynamics are often insufficient to capture the complexity of the underlying disorders and are often (too) long and tiring. In this study, we present SONDA (Standardized Oculomotor and Neurological Disorder Assessment): this test is based on analyzing eye tracking recorded during a short and intuitive continuous tracking task. We tested patients affected by Multiple Sclerosis (MS) and Parkinson's Disease (PD) and find that: (1) the saccadic dynamics of the main sequence alone are not sufficient to separate patients from healthy controls; (2) the combination of spatio-temporal and statistical properties of saccades and saccadic dynamics enables an identification of oculomotor abnormalities in both MS and PD patients. We conclude that SONDA constitutes a powerful screening tool that allows an in-depth evaluation of (deviant) oculomotor behavior in a few minutes of non-invasive testing.
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Affiliation(s)
- Alessandro Grillini
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Remco J Renken
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anne C L Vrijling
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, Netherlands
| | - Joost Heutink
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Frans W Cornelissen
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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15
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Gil-Casas A, Piñero DP, Molina-Martin A. Binocular, Accommodative and Oculomotor Alterations In Multiple Sclerosis: A Review. Semin Ophthalmol 2020; 35:103-115. [PMID: 32228341 DOI: 10.1080/08820538.2020.1744671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Amparo Gil-Casas
- Clínica Optométrica, Foundation Lluís Alcanyís, University of Valencia, Valencia, Spain
| | - David P Piñero
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martin
- Optics and Visual Perception Group (GOPV). Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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16
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Klatt BN, Sparto PJ, Terhorst L, Winser S, Heyman R, Whitney SL. Relationship between subjective visual vertical and balance in individuals with multiple sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1757. [PMID: 30403321 DOI: 10.1002/pri.1757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/06/2018] [Accepted: 09/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Subjective visual vertical (SVV) deviations have been correlated to abnormal cerebellar function in individuals diagnosed with multiple sclerosis (MS). It has been shown that individuals with MS have increased incidence of SVV abnormalities, yet this is not routinely tested in this population during physical therapy evaluation. OBJECTIVE This study aims to determine if there is a relationship between SVV and balance performance in people with MS who have cerebellar involvement. We hypothesize that individuals with greater SVV deviations will have worse balance performance. METHODS Fifteen females and five males (mean age 54.5 years [±7.03 SD]) with the diagnosis of MS and cerebellar involvement participated. Computerized SVV testing included rod and rod-and-frame conditions. None of the balance outcomes were correlated with the rod-only condition. Because there was a difference in magnitude of results within the rod-and-frame condition, based on whether the frame was rotated clockwise (CW) or counterclockwise (CCW), they were analysed independently. RESULTS For all six of the balance outcomes, there was a statistically significant moderate correlation with SVV deviations when the frame was tilted CCW: Barthel Index (r = -0.47, p = 0.018), Berg Balance Score (r = -0.59, p = 0.003), gait velocity (r = -0.52, p = 0.010), International Cooperative Ataxia Rating Scale (r = 0.56, p = 0.006), Scale for the Assessment and Rating of Ataxia (r = 0.62, p = 0.002), and Timed Up and Go (r = 0.58, p = 0.003). Interestingly, the Barthel Index was the only outcome that had statistical significance with a moderate correlation (r = -0.66, p = 0.001) when the frame was rotated CW. In this cohort, greater deviations during the rod-and-frame condition of SVV testing correlated with worse functional outcomes, especially when the frame was tilted CCW. CONCLUSION Individuals with MS who demonstrate decreased balance performance may rely more heavily on visual backgrounds. Implementation of SVV assessment for individuals with MS may provide clinicians with valuable information to identify clinical interventions.
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Affiliation(s)
- Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stanley Winser
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rock Heyman
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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17
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Schönfeldt-Lecuona C, Kregel T, Schmidt A, Pinkhardt EH, Lauda F, Kassubek J, Connemann BJ, Freudenmann RW, Gahr M. From Imaging the Brain to Imaging the Retina: Optical Coherence Tomography (OCT) in Schizophrenia. Schizophr Bull 2016; 42:9-14. [PMID: 26048298 PMCID: PMC4681543 DOI: 10.1093/schbul/sbv073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Optical Coherence Tomography (OCT) is a noninvasive imaging method, which provides an in vivo image of the retina. It allows for quantitative measurements of retinal and macular thickness, including single-layer analysis. Because the retinal nerve fibre layer comprises the first axons of the visual pathway and is unmyelinated, it can be considered a unique anatomical model, which may provide insight into the pathophysiological processes of diseases with a neurodegenerative character. In fact, past OCT studies have emphasized the role of the visual pathway as an ideal structure for exploring neurodegeneration and have demonstrated the potential of the method as an instrument for longitudinally monitoring structural changes in neurological disorders such as multiple sclerosis. Progress in signal processing and advancements to the OCT technique enables the illustration of structural changes in the retinal layers in a quick, reproducible, and objective manner with a spatial resolution comparable to those of histological slices.Findings from computer-based magnetic resonance imaging analyses and neuropathological studies support the hypothesis of a degenerative component of certain psychiatric disorders such as schizophrenia. Studies in schizophrenia incorporating OCT are currently rare and have yielded further heterogeneous results. This article elucidates the method of OCT and the retina's role as a "window to the brain". Furthermore, in delineating the degenerative components of schizophrenia, we discuss the possible applications of OCT in the schizophrenia population.
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Affiliation(s)
- Carlos Schönfeldt-Lecuona
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12-14, Ulm, Germany;
| | - Thomas Kregel
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany;,These authors contributed equally to this article
| | - Arno Schmidt
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
| | - Elmar H. Pinkhardt
- Department of Neurology, University Clinic Ulm, Oberer Eselsberg 45, Ulm, Germany
| | - Florian Lauda
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany;,Department of Neurology, University Clinic Ulm, Oberer Eselsberg 45, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University Clinic Ulm, Oberer Eselsberg 45, Ulm, Germany
| | - Bernhard J. Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
| | - Roland W. Freudenmann
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
| | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
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18
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Kinyas Ş, Esgin H. Peripheral Vasculitis, Intermediate Uveitis and Interferon Use in Multiple Sclerosis. Turk J Ophthalmol 2016; 46:41-43. [PMID: 27800257 PMCID: PMC5076309 DOI: 10.4274/tjo.35555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/07/2014] [Indexed: 12/01/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. A 40-year-old female patient with a 12-year history of MS was admitted to our clinic with blurred vision and floaters in her right eye for about 1 month. Here, we share the findings and the management of intermediate uveitis and retinal periphlebitis in an MS case being treated with interferon beta-1a for 7 years.
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Affiliation(s)
- Şeref Kinyas
- Trakya University Faculty of Medicine, Department of Ophthalmology, Edirne, Turkey
| | - Haluk Esgin
- Trakya University Faculty of Medicine, Department of Ophthalmology, Edirne, Turkey
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Voitenkov V, Skripchenko N, Klimkin A. Visual pathways involvement in clinically isolated syndrome in children. Int J Ophthalmol 2015; 8:382-4. [PMID: 25938060 DOI: 10.3980/j.issn.2222-3959.2015.02.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/06/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate extent and nature of visual pathways involvement in children with clinically isolated syndrome (CIS). METHODS Forty-seven patients (age 11-17y) with CIS, which later proved to be multiple sclerosis (MS) onset, and 30 controls underwent visual evoked potentials (VEP) investigation within 12d from the appearance of the first signs of disease. Latency and amplitude of P100 peak were compared with normative data and between groups. RESULTS In 58% patients, including those without signs of retrobulbar neuritis, significant slowing of conduction along the central visual pathways (P100 latency lengthening) is seen. P100 amplitudes drop (signs of axonal damage) are registered less frequently (29% cases). CONCLUSION The results indicate that visual pathways are often affected in the MS onset; mostly demyelination signs are seen. Despite MRI significance for MS diagnostic, VEPs proved to be still effective in early diagnosis of MS in children.
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Affiliation(s)
- Vladislav Voitenkov
- Scientific Research Institute of Children's Infections, Professora Popova 9, Saint-Petersburg 197122, Russia
| | - Natalia Skripchenko
- Scientific Research Institute of Children's Infections, Professora Popova 9, Saint-Petersburg 197122, Russia
| | - Andrey Klimkin
- Scientific Research Institute of Children's Infections, Professora Popova 9, Saint-Petersburg 197122, Russia
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Balcer LJ, Miller DH, Reingold SC, Cohen JA. Vision and vision-related outcome measures in multiple sclerosis. Brain 2015; 138:11-27. [PMID: 25433914 PMCID: PMC4285195 DOI: 10.1093/brain/awu335] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/14/2014] [Accepted: 10/29/2014] [Indexed: 12/22/2022] Open
Abstract
Visual impairment is a key manifestation of multiple sclerosis. Acute optic neuritis is a common, often presenting manifestation, but visual deficits and structural loss of retinal axonal and neuronal integrity can occur even without a history of optic neuritis. Interest in vision in multiple sclerosis is growing, partially in response to the development of sensitive visual function tests, structural markers such as optical coherence tomography and magnetic resonance imaging, and quality of life measures that give clinical meaning to the structure-function correlations that are unique to the afferent visual pathway. Abnormal eye movements also are common in multiple sclerosis, but quantitative assessment methods that can be applied in practice and clinical trials are not readily available. We summarize here a comprehensive literature search and the discussion at a recent international meeting of investigators involved in the development and study of visual outcomes in multiple sclerosis, which had, as its overriding goals, to review the state of the field and identify areas for future research. We review data and principles to help us understand the importance of vision as a model for outcomes assessment in clinical practice and therapeutic trials in multiple sclerosis.
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Affiliation(s)
- Laura J Balcer
- 1 Departments of Neurology, Ophthalmology and Population Health, New York University School of Medicine, NY 10016, USA
| | - David H Miller
- 2 Queen Square MS Centre, UCL Institute of Neurology, London, WC1N 3BG, UK
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Roberg BL, Bruce JM, Feaster HT, O’Bryan SR, Westervelt HJ, Glusman M. Speedy eye movements in multiple sclerosis: Association with performance on visual and nonvisual cognitive tests. J Clin Exp Neuropsychol 2014; 37:1-15. [DOI: 10.1080/13803395.2014.983465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Torres-Torres R, Sanchez-Dalmau BF. Treatment of acute optic neuritis and vision complaints in multiple sclerosis. Curr Treat Options Neurol 2014; 17:328. [PMID: 25399875 DOI: 10.1007/s11940-014-0328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OPINION STATEMENT Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost all patients develop some degree of visual impairment during the disease. Optic neuritis is the most common and known visual affection and may be the initial clinical disease manifestation, but visual complaints can have a wide variety of presentations and some of them can lead to clinical confusion. Most symptoms are the result of acute injury and subsequent axonal loss in the afferent and efferent visual pathway, but others may be consequences of treatments. Currently, we can tell the functional and anatomical damage caused by multiple sclerosis by visual function test, measurement of eye movements, electrophysiological testing, optical coherence tomography, and magnetic resonance imaging. The purpose of this review is to describe the afferent and efferent visual symptoms associated with multiple sclerosis or multiple sclerosis treatment, and review the current and future therapeutic options available for them.
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Affiliation(s)
- Ruben Torres-Torres
- Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic. Seu Maternitat, Sabino d'Arana (s/n), 08028, Barcelona, Spain
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Infectious and noninfectious granulomatosis in patient with multiple sclerosis: diagnostic dilemmas and followup. Case Reports Immunol 2014; 2014:876525. [PMID: 25379311 PMCID: PMC4207459 DOI: 10.1155/2014/876525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/05/2014] [Indexed: 11/17/2022] Open
Abstract
Patient was followed up over the course of 30 years. In 1978, after severe systemic infection followed by fever, pulmonary edema, and numerous neurological manifestations, patient was differentially diagnosed with apoplectic form of multiple sclerosis (MS), which was confirmed a year later via neurological and MRI findings. Approximately 20 years following the initial attack, sarcoidosis was diagnosed during the regular preoperative procedures required for cataract surgery. As consequence of lower immune system, infectious granulomatosis in form of pulmonary tuberculosis developed. Ophthalmological findings revealed bilateral retrobulbar neuritis (RBN) approximately six years after initial attack. This developed into total uveitis with retinal periphlebitis and anterior granulomatous uveitis—all of which are clinically similar in both MS and sarcoidosis.
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Multiple sclerosis and optic nerve: an analysis of retinal nerve fiber layer thickness and color Doppler imaging parameters. Eye (Lond) 2014; 28:1206-11. [PMID: 25081285 DOI: 10.1038/eye.2014.178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/25/2014] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To compare both retinal nerve fiber layer thickness and orbital color Doppler ultrasonography parameters in patients with multiple sclerosis (MS) versus healthy controls. METHODS This is an observational case-control study. Forty eyes from MS patients and twenty eyes from healthy volunteers were examined. Eyes were classified into three groups as group 1, eyes from MS patients with previous optic neuritis (n=20); group 2, eyes from MS patients without previous optic neuritis (n=20); and group 3, eyes from healthy controls (n=20). Following complete ophthalmologic examination and retinal nerve fiber layer thickness measurement for each group, blood flow velocities of posterior ciliary arteries, central retinal artery, ophthalmic artery, and superior ophthalmic vein were measured. Pourcelot index (resistive index), an indicator of peripheral vascular resistance, was also calculated. The statistical assessment was performed with the assistance of Pearson's Chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Spearman's correlation test. RESULTS The studied eyes exposed similar values in terms of intraocular pressure and central corneal thickness, implying no evidence in favor of glaucoma. All nerve fiber layer thickness values, except superior nasal quadrants, in group 1 were found to be significantly thinner than groups 2 and 3. Blood flow velocity and mean resistivity index parameters were similar in all the groups. CONCLUSIONS In MS patients, especially with previous optic neuritis, diminished retinal nerve fiber layer thickness was observed. Contrary to several studies in the current literature, no evidence supporting potential vascular origin of ocular involvement in MS was found.
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Gender and uveitis in patients with multiple sclerosis. J Ophthalmol 2014; 2014:565262. [PMID: 24891944 PMCID: PMC4033526 DOI: 10.1155/2014/565262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/30/2014] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS), a demyelinating disease of the central nervous system, is more commonly seen in women. It has been associated with both anterior and intermediate uveitis as well as retinal vasculitis. Ocular inflammation may develop concurrent with, prior to, or after the development of neurologic signs and symptoms. Patients with MS have an approximately 1% chance of developing intraocular inflammation. Patients with intermediate uveitis have an 8–12% risk of being diagnosed with MS. This risk is higher in females and in those with bilateral disease. This should be kept in mind when evaluating patients with uveitis, particularly in those patients for whom TNF inhibitor therapy is being considered, as these agents may worsen demyelinating disease.
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Abstract
The aim of this article is to report the findings of ocular examinations in a group of patients diagnosed with multiple sclerosis who were referred to the eye department of the Nationaal Multiple Sclerosis Centrum of Melsbroek, Belgium, from 2007 to 2010. Patients were evaluated by a single examiner, who noted visual acuity for distance, the state of the optic disks, oculomotor balance, and the presence of nystagmus, uveitis, trigeminal neuralgia, and facial palsy. The sample consisted of 284 adults born between 1920 and 1989: 111 males and 173 females. There were 51 patients with a corrected visual acuity in the better-seeing eye of less than 6/20. The optic nerve head was found to be normal in 245 eyes. Nystagmus was noted in 104 patients. Diplopia at distance was found to be present in 20 males, of whom 12 also had nystagmus, and in 31 females, of whom 13 also had nystagmus. Oscillopsia was present in 6 males and 11 females. In summary, most of the patients evaluated had sufficient visual function to allow performance of activities of daily living without help. A small number of patients had visual failure due to dysfunction of the visual sensory pathway and/or disturbances of oculomotor balance, often of a supranuclear origin, resulting in considerable disability.
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Affiliation(s)
- Jan M Roodhooft
- Department of Ophthalmology, Nationaal Multiple Sclerosis Centrum, 1820 Melsbroek, Belgium
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Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported. J Neurol 2013; 261:17-26. [PMID: 23700317 DOI: 10.1007/s00415-013-6957-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
Chronic relapsing inflammatory optic neuropathy (CRION) is an entity that was described in 2003. Early recognition of patients suffering from CRION is relevant because of the associated risk for blindness if treated inappropriately. It seems timely to have a clinical review on this recently defined entity. A systematic literature review, irrespective of language, retrieved 22 case series and single reports describing 122 patients with CRION between 2003 and 2013. We review the epidemiology, diagnostic workup, differential diagnosis, and treatment (acute, intermediate, and long term) in view of the collective data. These data suggest that CRION is a distinct nosological entity, which is seronegative for anti-aquaporin four auto-antibodies and recognized by and managed through its dependency on immuno-suppression. Revised diagnostic criteria are proposed in light of the data compromising a critical discussion of relevant limitations.
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Vision in multiple sclerosis: the story, structure-function correlations, and models for neuroprotection. J Neuroophthalmol 2012; 31:362-73. [PMID: 22089500 DOI: 10.1097/wno.0b013e318238937f] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Visual dysfunction is one of the most common clinical manifestations of multiple sclerosis (MS). Just over a decade ago, MS clinical trials did not include visual outcomes, but experts recognized the need for more sensitive measures of visual function. Low-contrast letter acuity emerged as the leading candidate to measure visual disability in MS, and subsequent studies found low-contrast acuity testing to correlate well with brain MRI lesion burden, visual-evoked potentials, quality of life (QOL), and retinal nerve fiber layer (RNFL) loss, as measured by optical coherence tomography (OCT). OCT in MS has allowed for assessment of structure-function correlations that make the anterior visual pathway and acute optic neuritis (ON) ideal models for testing novel agents for neuroprotection and repair. New therapies that reduce axonal loss by neuroprotective or myelin repair mechanisms can now be assessed noninvasively by OCT and coupled with visual function data. Based on OCT studies in MS, RNFL thickness is reduced significantly among patients (92 μm) vs controls (105 μm) and is particularly reduced in MS eyes with a history of ON (85 μm). Worsening of visual function by a clinically significant ≥ 7 letters or approximately 1.5 lines for low-contrast acuity is associated with approximately 4.5 μm reductions in RNFL thickness in MS eyes. Longitudinal studies of OCT have also shown RNFL axonal loss over time that occurs even in the absence of acute ON and that correlates with clinically meaningful worsening of vision and QOL, even in patients with benign MS. The latest OCT investigations involve high-resolution spectral-domain (SD) OCT with segmentation and measurement of specific retinal layers using computerized algorithms. These methods allow quantitation of ganglion cell (neuronal) layer loss and axonal degeneration in MS in vivo. In this review, we examine the data from these studies and ongoing trials that highlight the entity of ON as a model to investigate neuroprotection and neurorepair. In doing so, we also present representative group data from studies that have examined visual function, OCT measures, and QOL scales in patients with MS and ON and disease-free controls. These data, and those from recent meta-analyses, may be used to provide reference values for the development of clinical trial protocols.
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