Longitudinal Evaluation of Visual Function in Multiple Sclerosis

Abstract

Purpose To evaluate longitudinal changes of visual function in relapsing-remitting multiple sclerosis (RRMS). Methods MfVEP, contrast sensitivity (CS) and Humphrey visual fields (HVF) were obtained at two visits (mean follow-up:1.5±0.9 years) in both eyes of 57 RRMS patients (53 eyes with optic neuritis (ON): 14 ON within 6 months (mo) of first visit (ON<6mo), 39 ON≥6mo, 57 non-ON). Longitudinal changes were assessed using mfVEP amplitude (logSNR), latency, CS and HVF mean deviation based on established 95% tolerance limits of test-retest variability. Results A significant percentage of ON<6mo eyes exceeded 95% tolerance limits for mfVEP logSNR (21%, p<0.05), latency (35%, p<0.01) and CS (31% p<0.001); more improved than worsened over time (14% vs 7% for logSNR, 21% vs 14% for latency and 31% vs 0% for CS). MfVEP latency decreased in 11% non-ON, 10% ON≥6mo, increased in 21%, and 10%, respectively (p<0.01 for all). Latency changes correlated negatively with baseline latency (r=-0.43,-0.45 for non-ON, ON≥6mo;p=0.0008). Although a non-significant percent of non-ON and ON≥6mo eyes exceeded tolerance limits for logSNR, CS or HVF; logSNR and latency changes correlated, and both measures correlated with changes in CS (r=0.47 to 0.79, p<0.01). Conclusions MfVEP, particularly latency, is potentially useful for assessing neuroprotective and remyelinating strategies in RRMS.

Changing Paradigms and Unmet Needs in Multiple Sclerosis: The Role of Clinical Neurophysiology

“…Multifocal visual evoked potentials have demonstrated a significant ability to detect and monitor pathologic changes of the visual system in MS. These advances are excellently reviewed in a number of recent publications 24–28 and extended by the report of Klistorner et al in this issue. 29 My purpose in this section is to explore additional aspects of mfVEP and data regarding mfVEP amplitudes specifically and propose another possible use of mfVEP as a biomarker of progressive MS. To do so, I will first summarize data regarding visual system involvement in MS and characteristic of mfVEP and then review some interesting mfVEP amplitude data obtained from optic neuritis and MS patients in the RENEW and SYNERGY trials of opicinumab.…”

Changing Paradigms and Unmet Needs in Multiple Sclerosis: The Role of Clinical Neurophysiology

“…Multifocal visual evoked potentials have demonstrated a significant ability to detect and monitor pathologic changes of the visual system in MS. These advances are excellently reviewed in a number of recent publications 24–28 and extended by the report of Klistorner et al in this issue. 29 My purpose in this section is to explore additional aspects of mfVEP and data regarding mfVEP amplitudes specifically and propose another possible use of mfVEP as a biomarker of progressive MS. To do so, I will first summarize data regarding visual system involvement in MS and characteristic of mfVEP and then review some interesting mfVEP amplitude data obtained from optic neuritis and MS patients in the RENEW and SYNERGY trials of opicinumab.…”

Early disability in ambulatory patients with multiple sclerosis: optical coherence tomography versus visual evoked potentials, a comparative study

“…As regard VEP, the P100 latency reflects the conductivity of the optic nerve axons which is directly related to the integrity of the myelin sheaths of the nerve; however, the N75/P100 amplitude reflects the functional integrity of the axons itself especially if associated with reduction of the area under the curve [8,13]. The P100 latency was prolonged in patients with MS who suffered previous episodes of ON and usually persist for many years [46].…”

Multifocal visual evoked potentials and contrast sensitivity correlate with ganglion cell-inner plexiform layer thickness in multiple sclerosis

“…MfVEP was recorded and analyzed using methods established by Hood and colleagues (Hood et al, 2003, Fortune et al, 2004, Hood et al, 2004a, Hood et al, 2004b) and has been described in detail in our prior studies (Laron et al, 2009, Narayanan et al, 2015a). Briefly, the stimulus (VERIS 5.1) was a 60 sector cortically-scaled dartboard pattern (mean luminance 66 cd/m 2 , contrast 95%) (Figure 1a).…”

Changing Paradigms and Unmet Needs in Multiple Sclerosis: The Role of Clinical Neurophysiology

“…Multifocal visual evoked potentials have demonstrated a significant ability to detect and monitor pathologic changes of the visual system in MS. These advances are excellently reviewed in a number of recent publications 24–28 and extended by the report of Klistorner et al in this issue. 29 My purpose in this section is to explore additional aspects of mfVEP and data regarding mfVEP amplitudes specifically and propose another possible use of mfVEP as a biomarker of progressive MS. To do so, I will first summarize data regarding visual system involvement in MS and characteristic of mfVEP and then review some interesting mfVEP amplitude data obtained from optic neuritis and MS patients in the RENEW and SYNERGY trials of opicinumab.…”

Early disability in ambulatory patients with multiple sclerosis: optical coherence tomography versus visual evoked potentials, a comparative study

“…As regard VEP, the P100 latency reflects the conductivity of the optic nerve axons which is directly related to the integrity of the myelin sheaths of the nerve; however, the N75/P100 amplitude reflects the functional integrity of the axons itself especially if associated with reduction of the area under the curve [8,13]. The P100 latency was prolonged in patients with MS who suffered previous episodes of ON and usually persist for many years [46].…”

Multifocal visual evoked potentials and contrast sensitivity correlate with ganglion cell-inner plexiform layer thickness in multiple sclerosis

“…MfVEP was recorded and analyzed using methods established by Hood and colleagues (Hood et al, 2003, Fortune et al, 2004, Hood et al, 2004a, Hood et al, 2004b) and has been described in detail in our prior studies (Laron et al, 2009, Narayanan et al, 2015a). Briefly, the stimulus (VERIS 5.1) was a 60 sector cortically-scaled dartboard pattern (mean luminance 66 cd/m 2 , contrast 95%) (Figure 1a).…”

Changing Paradigms and Unmet Needs in Multiple Sclerosis: The Role of Clinical Neurophysiology

“…Multifocal visual evoked potentials have demonstrated a significant ability to detect and monitor pathologic changes of the visual system in MS. These advances are excellently reviewed in a number of recent publications 24–28 and extended by the report of Klistorner et al in this issue. 29 My purpose in this section is to explore additional aspects of mfVEP and data regarding mfVEP amplitudes specifically and propose another possible use of mfVEP as a biomarker of progressive MS. To do so, I will first summarize data regarding visual system involvement in MS and characteristic of mfVEP and then review some interesting mfVEP amplitude data obtained from optic neuritis and MS patients in the RENEW and SYNERGY trials of opicinumab.…”

Early disability in ambulatory patients with multiple sclerosis: optical coherence tomography versus visual evoked potentials, a comparative study

“…As regard VEP, the P100 latency reflects the conductivity of the optic nerve axons which is directly related to the integrity of the myelin sheaths of the nerve; however, the N75/P100 amplitude reflects the functional integrity of the axons itself especially if associated with reduction of the area under the curve [8,13]. The P100 latency was prolonged in patients with MS who suffered previous episodes of ON and usually persist for many years [46].…”

Multifocal visual evoked potentials and contrast sensitivity correlate with ganglion cell-inner plexiform layer thickness in multiple sclerosis

“…MfVEP was recorded and analyzed using methods established by Hood and colleagues (Hood et al, 2003, Fortune et al, 2004, Hood et al, 2004a, Hood et al, 2004b) and has been described in detail in our prior studies (Laron et al, 2009, Narayanan et al, 2015a). Briefly, the stimulus (VERIS 5.1) was a 60 sector cortically-scaled dartboard pattern (mean luminance 66 cd/m 2 , contrast 95%) (Figure 1a).…”