Quantification of Visual Fixation in Multiple Sclerosis

Abstract

PURPOSE. Eye movement abnormalities are common in multiple sclerosis (MS), and infrared oculography is a noninvasive method for quantification. This study aims to describe and classify abnormalities of visual fixation and their clinical relevance in MS. METHODS. A validated standardized infrared oculography protocol, Demonstrate Eye Movement Networks with Saccades, was used for quantifying gaze stability during a fixation task in MS patients and healthy controls. Saccadic intrusions, gaze drift, and stability of fixation around the drift line were used to subclassify MS patients by performing receiver operating characteristic analyses of different parameters. The relationship between the presence of abnormalities of fixation and visual functioning was analyzed using logistic regression models, which was adjusted for possible confounders. RESULTS. This cross-sectional study included 213 subjects with MS and 57 healthy controls. Square wave jerk abnormalities were present in 24% of MS patients. The prevalence was higher in more disabled subjects. The presence of larger square wave jerks (with a higher amplitude) in the MS patients was related to complaints of focusing on stationary objects (odds ratio, 2.2; P ¼ 0.035) and a lower vision-related quality of life (odds ratio, 2.56; P ¼ 0.012). CONCLUSIONS. This study provided a comprehensive overview of the characteristics of problems with visual fixation in subjects with MS. The most important and most common finding was the presence of larger square wave jerks during fixation, which was related to visual functioning in daily life.

A model for interrogating the clinico‐radiological paradox in multiple sclerosis: Internuclear ophthalmoplegia

“…The HC group was only used for the INO detection method [10] and comparison of eye movement values. Eye movement results on saccadic and fixational abnormalities of this cohort were previously reported [10,21]. Participants were at least 18 years of age.…”

Fixational microsaccades: A quantitative and objective measure of disability in multiple sclerosis

“…Nij Bijvank et al 14 utilized pupil-based tracking with the Eyelink1000 Plus to quantify fixational abnormalities in MS, looking at fixational instability dominated by increased amplitude SWJs ( p < 0.001) and saccadic intrusions ( p = 0.021) in 213 MS patients and 57 controls. MS patients showed a larger spread of fixation ( p < 0.011) and the presence of SWJs was increased in individuals with longer MS disease duration ( p = 0.014).…”

“…8–12 Although visual dysfunction is a common symptom in MS patients, deficits in fixation have been the subject of limited studies. 13,14 Fixational eye motion recordings could provide extremely sensitive methods for monitoring MS disease progression. With a primary method of defining disease worsening to be a decrease in ambulation (as defined by increasing Expanded Disability Status Scale (EDSS) scores), we hypothesized that fixational microsaccades, one of the smallest motor movements the body can make, would suffer subclinical deficits in either their magnitude, velocity, acceleration, or quantity due to the large contribution of brainstem/cerebellar atrophy with poor mobility prognoses.…”

Eye Movement Abnormalities in Glaucoma Patients: A Review

“…86 Neurophysiological control of fixation involves cerebral and brainstem structures including the parietal eye field, SEF, middle temporal and medial superior temporal areas, dorsolateral prefrontal cortex, substantia nigra pars reticulata of the basal ganglia, and the rostral pole of the SC. 87 Fixation is impaired in a wide range of conditions including amblyopia, 88 neurological disease, 89 traumatic head injury, 41,90 and macular disease such as age-related macular degeneration. 91 Studies on fixation in glaucoma have evaluated this in a range of viewing conditions, including pure fixation tasks, viewing static images, reading, detecting hazards in video clips, and driving simulator tests (Table 2).…”