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Quantitative ocular tests for myasthenia gravis: a comparative review with detection theory analysis
1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. jbarton@bidmc.harvard.edu
Journal of the Neurological Sciences
|April 30, 1998
Summary
Quantitative eye movement recordings, particularly optokinetic nystagmus, show promise as effective diagnostic tools for myasthenia gravis. Changes in optokinetic quick phase amplitude offer high specificity and sensitivity for identifying the condition.
Area of Science:
- Ophthalmology
- Neurology
- Medical Diagnostics
Background:
- Myasthenia gravis frequently presents with ocular signs.
- Previous studies have explored quantitative measures of eye movements and intraocular pressures for diagnosis.
Purpose of the Study:
- To evaluate the diagnostic utility of laboratory recordings of ocular signs in myasthenia gravis.
- To assess the discriminative power of quantitative eye movement measures.
Main Methods:
- Systematic review of studies measuring eye movements or intraocular pressures in myasthenic and non-myasthenic palsies.
- Application of signal detection theory to evaluate diagnostic variables.
- Analysis of saccades, optokinetic nystagmus, and edrophonium effects.
Main Results:
- Initial saccade and optokinetic nystagmus characteristics were poor discriminators, except in comparison with chronic progressive external ophthalmoplegia.
- Edrophonium-induced changes in saccades and optokinetic quick phases demonstrated high sensitivity and specificity.
- Change in optokinetic quick phase amplitude via infrared oculography showed excellent diagnostic performance (97% specificity and sensitivity).
Conclusions:
- Eye movement recordings, specifically optokinetic nystagmus, are potentially valuable, inexpensive diagnostic tests for myasthenia gravis.
- Further research is warranted to establish these eye movement tests in clinical practice.