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Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability
Laurence Jasse1, Sandra Vukusic, Françoise Durand-Dubief
1INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France.
Objective:
The objective of this article is to evaluate in multiple sclerosis (MS) patients the prevalence of persistent complaints of visual disturbances and the mechanisms and resulting functional disability of persistent visual complaints (PVCs).
Methods:
Firstly, the prevalence of PVCs was calculated in 303 MS patients. MS-related data of patients with or without PVCs were compared. Secondly, 70 patients with PVCs performed an extensive neuro-ophthalmologic assessment and a vision-related quality of life questionnaire, the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25).
Results:
PVCs were reported in 105 MS patients (34.6%). Patients with PVCs had more frequently primary progressive MS (30.5% vs 13.6%) and more neuro-ophthalmologic relapses (1.97 vs 1.36) than patients without PVCs. In the mechanisms/disability study, an afferent visual and an ocular-motor pathways dysfunction were respectively diagnosed in 41 and 59 patients, mostly related to bilateral optic neuropathy and bilateral internuclear ophthalmoplegia. The NEI-VFQ 25 score was poor and significantly correlated with the number of impaired neuro-ophthalmologic tests.
Conclusion:
Our study emphasizes the high prevalence of PVC in MS patients. Regarding the nature of neuro-ophthalmologic deficit, our results suggest that persistent optic neuropathy, as part of the progressive evolution of the disease, is not rare. We also demonstrate that isolated ocular motor dysfunctions induce visual disability in daily life.
Insights
Persistent visual complaints (PVCs) affect over a third of multiple sclerosis (MS) patients, often stemming from optic nerve damage or eye movement issues, impacting daily life quality.
Area of Science:
- Neuro-ophthalmology
- Clinical Neurology
Background:
- Multiple sclerosis (MS) is a chronic neurological disease.
- Visual disturbances are common symptoms in MS patients.
- Persistent visual complaints (PVCs) can significantly impact quality of life.
Purpose of the Study:
- To determine the prevalence of PVCs in MS patients.
- To investigate the underlying mechanisms of PVCs.
- To assess the functional disability resulting from PVCs.
Main Methods:
- Prevalence of PVCs assessed in 303 MS patients.
- Comparison of MS-related data between patients with and without PVCs.
- Neuro-ophthalmologic assessment and quality of life questionnaire (NEI-VFQ-25) administered to 70 PVC patients.
Main Results:
- PVCs reported in 34.6% of MS patients.
- PVC patients more frequently had primary progressive MS and neuro-ophthalmologic relapses.
- Afferent visual and ocular-motor pathway dysfunctions were common, linked to optic neuropathy and internuclear ophthalmoplegia; poor NEI-VFQ-25 scores correlated with test impairments.
Conclusions:
- High prevalence of PVCs in MS patients confirmed.
- Persistent optic neuropathy is a notable cause of PVCs in progressive MS.
- Ocular motor dysfunctions contribute to visual disability in daily life for MS patients.
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