Low-contrast letter acuity testing captures visual dysfunction in patients with multiple sclerosis

Baier, Monika; Cutter, Gary; Rudick, RA; Miller, Daniel M.; Cohen, J. A.; Weinstock‐Guttman, B.; Mass, Michele; Balcer, Laura J.

doi:10.1212/01.wnl.0000154521.40686.63

Cited by 151 publications

(129 citation statements)

References 12 publications

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“…The development of validated measures of visual functioning has greatly facilitated the exploration for a structural marker for neurodegeneration in MS. Balcer et al [62] and Baier et al [63] have utilized performance on low-contrast letter acuity charts to compare retinal structure with visual function in patients with MS who have MS pathology in the anterior visual system. Patients with MS and a history of ON will have lower thickness measures of the RNFL than patients with MS but no prior history of ON, or than individuals without a history of either condition.…”

Section: Role For Oct In Modeling Axonal and Neuronal Loss In Msmentioning

confidence: 99%

Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

et al. 2011

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Summary: Axonal and neuronal degeneration are important features of multiple sclerosis (MS) and other neurologic disorders that affect the anterior visual pathway. Optical coherence tomography (OCT) is a non-invasive technique that allows imaging of the retinal nerve fiber layer (RNFL), a structure which is principally composed of ganglion cell axons that form the optic nerves, chiasm, and optic tracts. Since retinal axons are nonmyelinated until they penetrate the lamina cribrosa, the RNFL is an ideal structure (no other central nervous system tract has this unique arrangement) for visualizing the processes of neurodegeneration, neuroprotection and, potentially, even neuro-repair. OCT is capable of providing high-resolution reconstructions of retinal anatomy in a rapid and reproducible fashion and permits objective analysis of the RNFL (axons) as well as ganglion cells and other neurons in the macula. In a systematic OCT examination of multiple sclerosis (MS) patients, RNFL thickness and macular volumes are reduced when compared to disease-free controls.Conspicuously, these changes, which signify disorganization of retinal structural architecture, occur over time even in the absence of a history of acute demyelinating optic neuritis. RNFL axonal loss in MS is most severe in those eyes with a corresponding reduction in low-contrast letter acuity (a sensitive vision test involving the perception of gray letters on a white background) and in those patients who exhibit the greatest magnitude of brain atrophy, as measured by validated magnetic resonance imaging techniques. These unique structure-function correlations make the anterior visual pathway an ideal model for investigating the effects of standard and novel therapies that target axonal and neuronal degeneration. We provide an overview of the physics of OCT, its unique properties as a non-invasive imaging technique, and its potential applications toward understanding mechanisms of brain tissue injury in MS, other optic neuropathies, and neurologic disorders.

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Section: Role For Oct In Modeling Axonal and Neuronal Loss In Msmentioning

confidence: 99%

Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

et al. 2011

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“…In addition, although the most sensitive clinical measurement of ON is low contrast visual acuity, we did not routinely measure this parameter. 32 Nevertheless, it is meaningful, in that this is the first study to analyze risk factors related to pRNFL and GCIPL thinning after ON.…”

Section: Discussionmentioning

confidence: 99%

Retinal ganglion cell and axonal loss in optic neuritis: risk factors and visual functions

Lee

Park

et al. 2016

Eye

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Purpose The peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cellinner plexiform layer (GCIPL) are important predictive factors for the prognosis of optic neuritis (ON). We investigated the risk factors for pRNFL and GCIPL thinning in ON and its relationship with visual function. Patients and methods We analyzed 33 eyes of 33 patients with a first attack of unilateral ON. Patients were divided into two groups according to pRNFL and GCIPL thinning, using spectral-domain optical coherence tomography. We evaluated patients' age, sex, color vision, visual acuity (VA), optic nerve findings on MRI, elapsed period from onset of visual symptoms to steroid treatment, visual field (VF) mean deviation (MD), average pRNFL thickness, and GCIPL thickness. Results There was no patient with residual VF defect in the groups without pRNFL or GCIPL thinning. Significant correlations were found between pRNFL (some sectors) and GCIPL (all sectors) thickness and BCVA and VF MD (Po0.03 for all). Multivariate logistic regression analysis revealed that only worse initial VF MD was a significant risk factor of pRFNL and GCIPL thinning after ON (OR, 0.841; 95% CI, P = 0.017 and OR, 0.871; 95% CI, P = 0.046, respectively). Conclusion Retinal ganglion cell and axonal losses occurred in ON cases showing severe initial VF loss. Therefore, it is necessary to pay more attention to the degree of initial VF loss in ON while considering the possibility of residual VF loss accompanying pRNFL and GCIPL thinning.

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“…5) Other tests, such as low contrast letter acuity (LCLA) and visual quality of life (QOL) could have added valuable information. Generally, testing of low contrast vision has been shown to be sensitive in detecting visual dysfunction in patients with MS (Baier et al., 2005). However, both LCLA measured with Sloan charts and contrast sensitivity measured with Pelli Robson charts, are sensitive tests (Balcer et al., 2003).…”

Section: Discussionmentioning

confidence: 99%

Time to steroid treatment in severe acute optic neuritis

et al. 2018

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ObjectivesSteroid treatment can accelerate visual recovery in patients with optic neuritis (ON), but it is unknown whether the timing of the start of treatment influences the outcome. The main purpose of this observational study was to assess the effect of early onset steroid treatment of ON on visual prognosis and retinal morphology.MethodsForty‐nine patients with acute mild/moderate (n = 21) or severe (n = 28) ON, and an equal number of healthy controls were enrolled. Patients with severe ON either received early onset steroid treatment (initiated within 1 week of presentation with visual loss) (n = 9), late‐onset treatment (initiated after 1 week) (n = 13), or no treatment (n = 6). Visual function and retinal morphology was studied after 6 and 12 months.ResultsAll measures of visual function had improved after 6 months (p ≤ 0.03) in the three groups with severe ON. This was not the case for Rayleigh match setting range (SR) in the nontreated group (p = 0.24), or for SR (p = 0.08) and latency to P100 of visual evoked potential (p = 0.08) in the late‐onset treated group. After 12 months, further improvement occurred in the nontreated and late‐treated groups, but not in the early treated group. Macular retinal nerve fiber layer (mRNFL) and ganglion cell plus inner plexiform layer had decreased significantly (p ≤ 0.001) in all three groups with severe ON after 6 months. After 12 months, only mRNFL had further significantly decreased and only in the late‐onset treated group (p = 0.02).ConclusionThe beneficial effects of early onset steroid treatment of ON is limited to a few months whereas the long‐term prognosis is independent of the timing of treatment.

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Low-contrast letter acuity testing captures visual dysfunction in patients with multiple sclerosis

Cited by 151 publications

References 12 publications

Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

Retinal ganglion cell and axonal loss in optic neuritis: risk factors and visual functions

Time to steroid treatment in severe acute optic neuritis

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