Visual Fixation Instability in Multiple Sclerosis Measured Using SLO-OCT

Mallery, Robert M.; Poolman, Pieter; Thurtell, Matthew J.; Full, Jan M; Ledolter, Johannes; Kimbrough, Dorlan; Frohman, Elliot M.; Frohman, Teresa C.; Kardon, Randy H.

doi:10.1167/iovs.17-22391

Cited by 19 publications

(10 citation statements)

References 26 publications

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“…In this study of 16 MS patients, an increased fixation instability compared to healthy controls was measured with scanning laser ophthalmoscopybased eye tracking during optical coherence tomography scanning. 19 This lends support to further quantify and classify fixation abnormalities and investigate prevalence and clinical correlates in a larger cohort. For visualization and quantification of eye movements, a noninvasive and accurate eye tracking method is available, namely, infrared oculography.…”

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confidence: 72%

Quantification of Visual Fixation in Multiple Sclerosis

Bijvank

Petzold

Coric

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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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.

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confidence: 72%

Quantification of Visual Fixation in Multiple Sclerosis

Bijvank

Petzold

Coric

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: Objective tools for prognosis and disease progression monitoring in multiple sclerosis (MS) are lacking. The visuomotor system could be used to track motor dysfunction at the micron scale through the monitoring of fixational microsaccades. Aims: The aim of this study was to evaluate whether microsaccades are correlated with standard MS disability metrics and to assess whether these methods play a predictive role in MS disability. Method: We used a custom-built retinal eye tracker, the tracking scanning laser ophthalmoscope (TSLO), to record fixation in 111 participants with MS and 100 unaffected controls. Results: In MS participants, a greater number of microsaccades showed significant association with higher Expanded Disability Status Scale score (EDSS, p < 0.001), nine-hole peg test (non-dominant: p = 0.006), Symbol Digit Modalities Test (SMDT, p = 0.014), and Functional Systems Scores (FSS) including brainstem ( p = 0.005), cerebellar ( p = 0.011), and pyramidal ( p = 0.009). Both brainstem FSS and patient-reported fatigue showed significant associations with microsaccade number, amplitude, and peak acceleration. Participants with MS showed a statistically different average number ( p = 0.020), peak vertical acceleration ( p = 0.003), and vertical amplitude ( p < 0.001) versus controls. Logistic regression models for MS disability were created using TSLO microsaccade metrics and paraclinical tests with ⩾80% accuracy. Conclusion: Microsaccades provide objective measurements of MS disability level and disease worsening.

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“…In MS, inflammatory demyelinating lesions in different brain areas result in a wide range of oculomotor disorders: most commonly, static and dynamic ocular misalignment (Serra et al, 2018) coupled with dysmetric saccadic behavior (Serra et al, 2003). Furthermore, fixation (Mallery et al, 2018), smooth pursuit (Lizak et al, 2016), and vestibulo-ocular responses (Huygen et al, 1986) are also often impaired. Most of these disorders are accentuated by the presence of internuclear ophthalmoplegia (INO).…”

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confidence: 99%

Eye movement evaluation in Multiple Sclerosis and Parkinson’s Disease using a Standardized Oculomotor and Neuro-ophthalmic Disorder Assessment (SONDA)

Grillini

Renken

Vrijling

et al. 2020

Preprint

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Evaluating the state of the oculomotor system of a patient is one of the fundamental tests done in neuro-ophthalmology. However, up to date, very few quantitative standardized tests of eye movements quality exist, limiting this assessment to confrontational tests reliant on subjective interpretation. Furthermore, quantitative tests relying on eye movement properties such as pursuit gain and saccade dynamics are often insufficient to capture the complexity of the underlying disorders and are often (too) long and tiring. In this study, we present SONDA (Standardised Oculomotor and Neurological Disorder Assessment): this test is based on analyzing eye tracking recorded during a short and intuitive continuous tracking task. We tested patients affected by Multiple Sclerosis (MS) and Parkinson's Disease (PD) and find that: (1) the saccadic dynamics of the main sequence alone are not sufficient to separate patients from healthy controls; (2) the combination of spatio-temporal and statistical properties of saccades and saccadic dynamics enables an identification of oculomotor abnormalities in both MS and PD patients. We conclude that SONDA constitutes a powerful screening tool that allows an in-depth evaluation of (deviant) oculomotor behavior in a few minutes of non-invasive testing.

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Visual Fixation Instability in Multiple Sclerosis Measured Using SLO-OCT

Cited by 19 publications

References 26 publications

Quantification of Visual Fixation in Multiple Sclerosis

Quantification of Visual Fixation in Multiple Sclerosis

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

Eye movement evaluation in Multiple Sclerosis and Parkinson’s Disease using a Standardized Oculomotor and Neuro-ophthalmic Disorder Assessment (SONDA)

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