Predictors of vision impairment in Multiple Sclerosis

Abstract

Visual impairment significantly alters the quality of life of people with Multiple Sclerosis (MS). The objective of this study was to identify predictors (independent variables) of visual outcomes, and to define their relationship with neurological disability and retinal atrophy when assessed by optical coherence tomography (OCT). We performed a cross-sectional analysis of 119 consecutive patients with MS, assessing vision using high contrast visual acuity (LogMar), 2.5% and 1.25% low contrast visual acuity (Sloan charts), and color vision (Hardy-Rand-Rittler plates). Quality of vision is a patient reported outcome based on an individual's unique perception of his or her vision and was assessed with the Visual Functioning Questionnaire-25 (VFQ-25) with the 10 neuro-ophthalmologic items. MS disability was assessed using the expanded disability status scale (EDSS), the MS functional composite (MSFC) and the brief repetitive battery-neuropsychology (BRB-N). Retinal atrophy was assessed using spectral domain OCT, measuring the thickness of the peripapillar retinal nerve fiber layer (pRNFL) and the volume of the ganglion cell plus inner plexiform layer (GCIPL). The vision of patients with MS was impaired, particularly in eyes with prior optic neuritis. Retinal atrophy (pRNFL and GCIPL) was closely associated with impaired low contrast vision and color vision, whereas the volume of the GCIPL showed a trend (p = 0.092) to be associated with quality of vision. Multiple regression analysis revealed that EDSS was an explanatory variable for high contrast vision after stepwise analysis, GCIPL volume for low contrast vision, and GCIPL volume and EDSS for color vision. The explanatory variables for quality of vision were high contrast vision and color vision. In summary, quality of vision in MS depends on the impairment of high contrast visual acuity and color vision due to the disease.

Immune tolerance in multiple sclerosis and neuromyelitis optica with peptide-loaded tolerogenic dendritic cells in a phase 1b trial

“…OCT was performed using a spectral domain device (Spectralis; Heidelberg Engineering), as previously described (14), and performed before therapy initiation and by week 12 follow-up. We calculated the thickness of the peripapillary retinal nerve fiber layer thickness and MV from each eye at baseline and week 12 following criteria as previously described (25).…”

Longitudinal cortical thinning progression differs across multiple sclerosis phenotypes and is clinically relevant: A multicentre study

“…Indeed, lateral orbitofrontal cortices and the left inferior parietal lobule showed also associations with concomitantly worse EDSS scores, mirroring the sensitivity of the EDSS for the detection of sensorimotor 32 and visual impairment. 33 It is worth noting that atrophy within cortical areas not correlated with T1-hypointense LV was associated with more severe concurrent and subsequent clinical disability, suggesting that MS-related direct cortical damage (e.g. inflammation-mediated cortical demyelination) may be crucial for worsening of clinical disability.…”

Case for a new corticosteroid treatment trial in optic neuritis: review of updated evidence

“…Despite the current challenge facing the inclusion of a QoL endpoint that captures the impacts of vision function in a clinical trial, the importance of finding a way forward is clear 44 45. Multiple studies, including our own large cohort (n=267), report a statistical association between instruments measuring QoL (54-item Multiple Sclerosis Quality of Life Scale score, 39-item NEI-VFQ, NEI-VFQ-25 and the 10-item Neuro-Ophthalmic supplement) and OCT atrophy measures 45–49. Many studies also report an association between vision-related QoL and other measures of vision function.…”