Ocular Involvement Occurs Frequently at All Stages of Amyotrophic Lateral Sclerosis: Preliminary Experience in a Large Italian Cohort

Abstract

Background and Purpose The study aimed to obtain optometric findings of amyotrophic lateral sclerosis (ALS) patients in different stages of the disease, and to determine the relation between ocular data and ALS-related features; that is, functional and cognitive impairment and staging. Methods The optometric protocol included tests of the ocular motility [broad-H test and Northeastern State University College of Optometry (NSUCO) test], near point of convergence (NPC), error refraction, best-corrected visual acuity, and binocular visual alignment, and an ocular symptoms questionnaire. The functional measures included the Amyotrophic Lateral Sclerosis Functional Rating Scale–revised (ALSFRS-r) and Milano-Torino staging (MiToS), and cognitive impairment was assessed using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Demographic and clinical features were also collected, including whether the patients used an eye-tracking communication device (ETCD). Results Two-hundred consecutive ALS patients (median age of 64 years, 118 males and 82 females) in different stages of disease were recruited. Nearly 70% of patients reported at least one ocular symptom, and the use of an ETCD was found to be significantly related to the presence of most symptoms. Moreover, the severely symptomatic group was characterized by significantly lower ALSFRS-r total and subscale scores, and higher MiToS. Abnormal NPC values were significantly related to lower ALSFRS-r total and bulbar-subscale scores. Patients with acceptable NSUCO test values exhibited significantly higher ECAS scores. Conclusions The presence of ocular alteration in patients in different stages of ALS supports the idea that this is a multisystem disorder and emphasizes the importance of optometric evaluations in multidisciplinary assessments to address ocular impairment early in the disease process.

Body Fat Percentage and Availability of Oral Food Intake: Prognostic Factors and Implications for Nutrition in Amyotrophic Lateral Sclerosis

“…ALS is a neurodegenerative disorder characterized by progressive motor neuron degeneration, resulting in progressive weakness with muscle mass loss and eventual death [1][2][3][4]. However, the etiology and prognostic factors of ALS are poorly understood, and the treatment options are limited [5].…”

Binocular vision parameters in handloom silk weavers

“…In the sensory evaluation, stereopsis testing (Titmus fly test, Stereo Optical Co., Inc., Chicago, IL, USA) [15] and the Worth's Four Dot test [16] were performed. In motor evaluation, ocular motility was assessed using the broad-H test [17], and a modified Thorington test using the Bernell Muscle Imbalance Measure card [18] was performed to determine the presence of heterophoria for distance and near; the near point of convergence was assessed using red and green filters [19]. Negative (divergence) and positive (convergence) fusional vergence were measured using a hand-held prism bar for both distance and near [20], and vergence facility was measured using the flipper prism with 12 prism base-out and 3 prism base-in [21].…”

Gaming for Training Voluntary Control of Pupil Size

“…The option of considering autonomic pathways is particularly appealing because they appear to be relatively preserved in ALS. In particular, no ALS-related deficit in pupil function has been described [11,12] while no difference in basal pupil size and quantitative pupillometry was reported in ALS patients compared to matched controls [13]. We recently devised a simple and effective strategy to voluntarily reduce the pupil size [14], which exploits the pupil accommodative response (PAR) [15,16].…”