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    You are here : Home » MS Research News » New Discoveries » Vision and MS

    Vision and MS

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    MS patients' stumbles tied to vision loss

    MS and Vision Vision loss, especially in low light, may contribute to problems with walking in multiple sclerosis (MS) patients, a researcher said here.

    Lower visual acuity in low-contrast situations among MS patients was significantly associated with poorer performance on a gait test in a controlled trial, said Rachel Tripoli, a medical student at Florida State University in Tallahassee, Fla.

    Moreover, many of the MS patients showed improvements when they wore contrast-enhancing yellow lenses, she said -- a simple and practical solution to a problem that diminishes quality of life and can cause physical injury.

    Tripoli reported the findings at the joint meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

    Previous studies had indicated that reduced vision in low light was common in MS with or without overt optical neuropathy, Tripoli said.

    She and colleagues recruited 22 MS patients and 22 age-matched healthy controls for their study, in which participants underwent visual and gait testing under a variety of lighting conditions.

    The vision testing involved low-contrast Sloan charts, which display letters that appear increasingly faded as one reads down.

    Participants also underwent optic coherence tomography scans to evaluate optic nerve morphology.

    Finally, walking ability was measured on a "gait pad," a 22-foot carpet embedded with sensors that capture footfall pressure and duration, as well as gait speed and total time to traverse the pad. The data were used to calculate a functional ambulation performance (FAP) score.

    Walking was evaluated under low light (less than 4 candelas) and four brightly lit (more than 80 candelas) conditions. Participants were tested four times under each lighting condition -- with and without obstacles (cones placed on the pad) and with and without contrast-enhancing yellow lenses.

    The optic coherence tomography testing showed that, as expected, the MS patients had significantly decreased optic nerve thickness relative to controls, Tripoli said.

    Sloan chart scores also were lower in the MS patients than in controls, she reported.

    Under three different contrast conditions, MS patients were able to read about five fewer letters than controls.

    On the gait tests, MS patients' FAP scores were negatively associated with EDSS disability scores, indicating that increased disability was correlated with poorer walking performance.

    Differences in gait measurements in MS patients versus controls were apparent only under low light. In bright light, no significant deficiency for patients was apparent, Tripoli said.

    With obstacles, the mean FAP score for patients was about 75, compared with more than 90 in controls. The difference in the obstacle-free test was smaller, about 10 points, but still significant, Tripoli said.

    Use of yellow lenses improved FAP scores in patients to the point that they no longer differed significantly from controls, both with and without obstacles.

    She said it was reasonable to conclude that the lenses "increase obstacle discrimination" and could be useful for injury prevention.

    The study had no commercial funding.

    Tripoli and other investigators said they had no relevant financial interests.

    Primary source: Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis
    Source reference:
    Tripoli R, et al "Deficient contrast visual acuity in patients with multiple sclerosis degrades gait performance under conditions of low illumination" CMSC-ACTRIMS 2012.

    Source: Medpage Today © 2012 Everyday Health, Inc. (07/06/12)

    Retinal scans eyed for tracking MS

    Retinal ScansA common retinal imaging technology could eventually supplement or even replace MRI for tracking multiple sclerosis severity and progression, researchers suggested here.

    In analyses presented at the annual meeting of the Consortium of Multiple Sclerosis Centers, distinctive changes to the optic nerve were seen in MS patients imaged with optical coherence tomography (OCT) that correlated with MRI-based markers of disease activity.

    With additional studies, OCT may prove to be a better tool than MRI for directly measuring the effects of MS in the nervous system, several researchers said.

    OCT is commonly used to diagnose and monitor retinopathy and macular edema in patients with vision problems. It captures high-resolution images of the retina and tissues beneath it, including nerve cell ganglia, based on scattering of light at near-infrared wavelengths.

    The method is best known for its application to macular degeneration, retinal vein occlusion, and diabetic retinopathy, but it is also used to evaluate patients with optic neuritis and neuromyelitis optical (NMO), both of which are related to MS.

    Based on that experience, researchers have been exploring OCT's potential in MS patients without ocular problems, insofar as the disease may induce subclinical changes in the optic nerve detectable with the technology.

    Two studies reported here by researchers in the lab of Peter Calabresi, MD, at Johns Hopkins University, suggested that the idea has good potential.

    At a poster session, medical student Stephanie Syc reported on OCT findings in 98 MS patients and 22 patients with NMO, all with a history of optic neuritis, as well as 72 healthy controls age-matched to the two patient groups.

    The study focused particularly on the retinal ganglion cell and inner plexiform layers.

    In both patient groups relative to controls, these layers were significantly thinner, especially in the eyes that previously had optic neuritis, but also in the unaffected eyes (P<0.001), Syc said.

    Also, greater thinning was seen in the NMO versus MS patients, she said.

    Based on results from the second study, Aleksandra Stankiewicz told CMSC attendees in a platform presentation that OCT findings in 29 MS patients correlated with changes in certain brain regions detected with MRI.

    Specifically, she said, thickness of the axonal retinal nerve fiber layer measured with OCT was associated with occipital lobe cortical thickness, but not with frontal lobe cortical thickness.

    Stankiewicz said the overall pattern suggested that degeneration in the anterior and posterior visual pathways were related.

    She noted, however, that the study had excluded patients with other ocular disease such as macular degeneration, diabetic retinopathy, and glaucoma. In response to questions from audience members, she agreed that OCT findings could be harder to interpret in MS patients with these comorbidities.

    On the other hand, Syc pointed out that most such conditions are age-related and therefore not especially common in MS patients.

    "Most MS patients are diagnosed in their 20s and 30s, at which point the rate of glaucoma is very, very low," she told MedPage Today.

    "I think [OCT] has great promise for clinicians," she said.

    Another neurologist not associated with the studies agreed. Pilar Prieto, MD, of the University of Houston, said it made sense to perform OCT in MS patients even if they had no vision complaints. She told MedPage Today that she likes her patients to have them just to establish a baseline in case optic neuritis does develop later.

    Prieto added that she had been impressed with the research on the relationship between OCT findings and other, nonophthalmologic manifestations of MS and said it seemed likely that OCT could be used clinically.

    Stankiewicz had pointed out in her presentation that OCT scans can be completed in 10 minutes with results available almost instantly, in contrast to MRI.

    Prieto said that such a tool, "which may be easier and cheaper" than MRI, would be a great help to clinicians.

    A more direct evaluation of OCT-based monitoring of MS patients is now under way as part of an industry-sponsored trial of a pegylated interferon-beta-1a product.

    The trial, called ADVANCE, is a randomized, placebo-controlled, phase III study lasting 24 months and involving some 1,500 patients.

    It includes OCT-based measurement of the retinal neuron fiber layer thickness in about 120 patients as one of the evaluations performed in the trial. The primary endpoint in the OCT substudy will be a decrease of 5 microns or more from baseline to study months 12 and 24.

    In addition, the substudy will examine the reproducibility of OCT findings at different clinical sites in the multicenter trial.

    The study, sponsored by Biogen Idec, is expected to finish in August 2013.

    The study by Syc and colleagues was funded by the National Multiple Sclerosis Society (NMSS), the National Eye Institute, and a foundation grant.

    The study by Stankiewicz and colleagues was funded by the NMSS and the National Institute of Neurological Disorders and Stroke.

    Syc, Stankiewicz, and Prieto declared they had no relevant financial interests.

    Source: MedPage Today © 2011 Everyday Health, Inc. (08/06/11)

    Gabapentin and Memantine effective in nystagmus
    Visual Disturbance in MSAcquired forms of nystagmus (rapid involuntary movements of the eyes) often produce disabling visual symptoms in Mutliple Sclerosis.

    The authors used a blinded crossover trial design to study 10 people with a variety of neurological conditions, 3 of whom had MS.

    Study participants were randomly assigned to first take gabapentin of memantine. They found that all people improved with one or both drugs and concluded that both drugs should be considered as treatment for acquired forms of nystagmus.

    Researchers  conducted a masked, crossover, therapeutic trial of gabapentin (1,200mg/day) versus memantine (40 mg/day) for acquired nystagmus in 10 patients (aged 28-61 years; 7 female; 3 multiple sclerosis [MS]; 6 post-stroke; 1 post-traumatic).

    Nystagmus was pendular in 6 patients (4 oculopalatal tremor; 2 MS) and jerk upbeat, hemi-seesaw, torsional, or upbeat-diagonal in each of the others.

    For the group, both drugs reduced median eye speed (p < 0.001), gabapentin by 32.8% and memantine by 27.8%, and improved visual acuity (p < 0.05).

    Each patient improved with 1 or both drugs.

    Side effects included unsteadiness with gabapentin and lethargy with memantine. 

    The investigators conclude that both drugs should be considered as treatment for acquired forms of nystagmus.

    Source: Ann Neurol. 2010 May;67(5):676-80 (20/05/10)

    Vision compromised in Multiple Sclerosis even without symptoms
    Visual Disturbance in MS

    Researchers here suggested that deterioration of vision occurs in multiple sclerosis patients even without clinical manifestations such as optic neuritis.

    University of Pennsylvania physicians told colleagues to consider having MS patients undergo regular testing for vision loss, with specific concentration on advanced tests for low-contrast acuity.

    "Our findings suggest there is subclinical axonal loss in the anterior vision pathways of patients with multiple sclerosis that occurs without symptoms," said Esther Bisker, M.D., a resident in neurology.

    In fact, she said, researchers found worsening of low-contrast acuity in 29% of the eyes with a history of optic neuritis and a statistically comparable 35% of eyes with no such history. Hence, the need for advance testing.

    "The emergence of optical coherence tomography has allowed us to capture the unique structure-function correlations provided by the anterior visual pathway in multiple sclerosis," Dr. Bisker said in a presentation at the Association for Research in Vision and Ophthalmology.

    "Our study indicates that these tests should be performed among all patients diagnosed with multiple sclerosis, not just those with a history of vision complications," she said.

    Dr. Bisker and colleagues followed 1,011 patients in the multiple sclerosis treatment programs at the University of Pennsylvania, Johns Hopkins, and The University of Texas Southwestern Medical School in Dallas.

    They checked the patients' high-contrast and low-contrast visual acuity at six and 12-month intervals, and used optical coherence tomography to determine differences in retinal nerve fiber layer thickness.

    The patients were separated into two study groups -- one involving 428 eyes that did not experience optic neuritis and the other involving 220 eyes that did.

    The patients were 43 to 45 years old, and 85% were diagnosed with the relapsing-remitting form of multiple sclerosis.

    The eyes of MS patients were separated into two groups, those that lost vision and those that did not. Of the eyes that lost vision, 29% had a past history of optic neuritis, while 35% of the eyes that did not lose vision had a past history of optic neuritis.

    Dr. Bisker said that difference did not rise to statistical significance but instead underscored that clinicians need to be aware that visual deterioration is ongoing in multiple sclerosis.

    "It makes sense that these patients would have continuing damage that could cause vision loss -- even without outright multiple sclerosis symptoms," said Charles G. Conner, Ph.D., O.D., professor of optometry at the Southern College of Optometry, Memphis, Tenn.

    "The underlying disease is continually wearing away the nerve 'wiring,' and that is going to cause problems anywhere in the body," said Dr. Connor, who is director of research at the college.

    Association for Research in Vision and Ophthalmology
    Source reference: Bisker, E, et al "Clinical and ocular imaging characteristics of eyes with visual loss over time in multiple sclerosis" ARVO 2009; Abstract 927.

    Source: Medpage Today © 2004-2009 MedPage Today, LLC (11/05/09)

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