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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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Eye movement disorders have been reported in patients with multiple sclerosis (MS) as saccadic disturbances. Several methods have been described for the assessment of saccades, including the K-D and DEM tests. The performance of these tests also involves attention, language, and other brain areas which have been reported to be altered in MS patients. The aim of the study was to determine how developmental eye movement (DEM) and King-Devick (K-D) tests are affected in MS-patients. It was also to analyze whether a resolved episode of optic neuritis (ON) has a negative influence. Subjects with MS showed worse outcomes (higher times) in DEM test (72 (26) s and a K-D test (56 (22) s compared to healthy subjects (64 (7) s and 55 (11) s, respectively). However, a previous ON episode did not worsen the MS-times of DEM (80 (33) s or of K-D (62 (33) s. Horizontal saccades with the DEM showed differences between subjects with MS (with and without ON) and healthy ones (p < 0.05), whereas no such differences were found in the vertical saccades. According to the DEM instructions, MS patients would present heterogeneous oculomotor and non-visual disturbances. Regarding the K-D test, only the third card (the most complex one) showed differences (p < 0.05) between groups. These tests can capture impairment of attention, language, and other areas that correlate with suboptimal brain function in addition to the oculomotor dysfunctions present in subjects with MS.

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. Among them, oculomotor, accommodative and binocular alterations have been reported in MS. Our research group has conducted a complete analysis of the visual and oculomotor function in several researches with MS patients conducted in the last 4 years, obtaining a characterization of some visual aspects of the patient with MS. Concerning the binocular function, several alterations have been detected in MS patients, with divergence at near distance and stereopsis the most affected parameters. Likewise, MS patients with previous optic neuritis present worse binocular vision. Symptomatology compatible with convergence insufficiency measured with the CISS (Convergence Insufficiency Symptom Survey) is frequently reported by MS patients, but not supported by signs that show clear trend to esophoria at near. This discrepancy between the signs and symptoms could be due to the peculiarities of the CISS questionnaire, including items that are also related to the cognitive function and other ocular abnormalities. Oculomotor alterations have been reported also in patients with multiple sclerosis (MS), especially saccadic dysfunctions. The indirect analysis of horizontal saccades with the Developmental Eye Movement (DEM) and King‐Devick tests shows that are affected by MS, with more level of alteration if there has been a previous episode of optic neuritis. Similar findings have been also reported by other authors using objective eye tracking or video‐oculographic systems. Specifically, the most reported saccadic alterations in advanced MS and clinically isolated syndrome (CIS) are saccadic dysmetry (41.7%) and impaired smooth pursuit (42.3%), which relates to prolonged saccadic latency, no matter if they have suffered or not optic neuritis or internuclear ophthalmoplegia (INO). An increase in saccadic latency has been even found in children with MS. Saccadic initiation time (SI time) and average inter‐saccadic intervals (ISI) are also higher in patients with MS. Furthermore, the first cause of acquired pendular nystagmus is MS. Finally, macular sensitivity measured by microperimetry has been found to be altered in MS patients, especially in eyes with previous optic neuritis. Likewise, a fixational instability characterized also my microperimetry is present in MS patients with optic neuritis, with more increase of the vertical axis of the fixation area than of the horizontal. The ratio of the disease also affects the patient fixation pattern.