Hospital Ramos Mejía
Neurology

Author Of 1 Presentation

Neuro-Ophthalmology Poster Presentation

P0768 - Optical Coherence Tomography and unconventional neuro-ophthalmological evaluation of patients with Multiple Sclerosis (ID 1536)

Speakers
Presentation Number
P0768
Presentation Topic
Neuro-Ophthalmology

Abstract

Background

The afferent visual pathway (AVP) is frequently affected in Multiple Sclerosis (MS) patients and visual quality of life (VQL) is commonly compromised, also with no history of optic neuritis (ON). High contrast visual acuity (HCVA) and confrontation visual field (VF) exam are performed in clinical practice to assess visual impairment. However, this tests may be normal in a high percentage of patients with visual complaints. Therefore, this evaluation methodology has a low sensitivity to detect AVP impairment in MS patients.

Objectives

To conduct an objective and subjective assessment of the AVP in MS patients in order to find a more sensitive parameter that demonstrate its damage.

Methods

A prospective cohort study was conducted. Neuro-ophthalmological assessment was performed: HCVA (Snellen chart), color vision (Ishihara chart), LCLA (Pelli-Robson chart) and confrontation VF exam. VQL questionnaire was performed using the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25I) from which a numerical scale is obtained according to the VFQ25 Score Algorithm. Optical Coherence Tomography (OCT) study was performed using a spectral domain equipment. Statistical analysis was performed using the SPSS package.

Results

We evaluated 117 eyes of 59 patients, 59% were women, mean age 38 years, 91% with relapsing remitting MS. Visual complaints were present in 83%. Of 117 eyes, 30% had history of ON, HCVA was normal in 92% and LCLA was altered in 63%. Color vision and VF exams were normal in 82% and 97% respectively. The VQL was mild affected in 75% of the patients and moderate in 17%, the rest were normal. We found a correlation between NEI-VFQ-25I results and LCLA (r = 0.52 p = 0.013) not found with HCVA or VF exam. OCT was performed in 71 eyes, of which 25.3% had history of ON. The RNFL thinning was found in 50.7% and the temporal quadrant was the most frequently altered (70.4%). The GCL thinning was observed in 58.3%. We found a correlation between RNFL and GCL thickness (r = 0.325, p <0.01) and between decreased RNFL thickness with LCLA deterioration (r = - 0.389, p <0.01), as well as between RNFL thickness and HCVA (r = 0.336, p <0.01).

Conclusions

We detected a high percentage of patients with AVP compromise and normal conventional evaluation. Since we found a correlation between LCLA, NEI-VFQ-25I and OCT we consider the relevance of its use in clinical practice routine to assess visual function. We could demonstrate that those are more sensitive measurable parameters of visual disability in MS patients.

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