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The 20/20 eye in multiple sclerosis.

M J Kupersmith, J I Nelson, W H Seiple

    Neurology
    |August 1, 1983
    PubMed
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    Multiple sclerosis (MS) patients with normal vision often show subclinical visual pathway dysfunction. Advanced tests like visual evoked potentials (VEPs) and contrast sensitivity reveal significant abnormalities, highlighting the need for sensitive diagnostic tools in MS.

    Area of Science:

    • Ophthalmology
    • Neuroscience
    • Clinical Neurology

    Background:

    • Multiple sclerosis (MS) is a demyelinating disease affecting the central nervous system.
    • Visual pathway involvement is common in MS, but subclinical dysfunction can be challenging to detect.
    • Early identification of visual pathway abnormalities is crucial for managing MS progression.

    Purpose of the Study:

    • To evaluate the visual pathway in multiple sclerosis patients with 20/20 Snellen acuity and no history of optic neuritis.
    • To compare the sensitivity of various clinical and electrophysiological measures in detecting visual dysfunction.

    Main Methods:

    • Utilized clinical assessments, transient and contrast visual evoked potentials (VEPs), and psychophysical contrast sensitivity tests.
    • Assessed 20/20 Snellen acuity, dyschromatopsia, afferent pupillary abnormalities, optic nerve pallor, and nerve fiber layer loss.

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  • Compared results from different testing modalities to determine diagnostic superiority.

    • Main Results:

    • Delayed latencies in transient VEPs were observed in 38% of patients; abnormal interocular latency differences were found in 67%.
    • Contrast VEPs were abnormal in 46%, and psychophysical contrast sensitivity was impaired in 78% of patients.
    • Psychophysical contrast evaluations and VEP studies demonstrated superior sensitivity in detecting visual dysfunction compared to other clinical measures.

    Conclusions:

    • A significant proportion of MS patients with clinically normal vision exhibit subclinical visual pathway dysfunction.
    • Visual evoked potentials (VEPs) and psychophysical contrast sensitivity testing are highly effective in revealing early visual impairment in MS.
    • These sensitive methods are valuable for detecting visual pathway abnormalities in MS patients, even without a history of optic neuritis.