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N. Lim, S. Glickman, V. Vora, G. Vafidis; Appreciation of Ophthalmic Problems in Established Multiple Sclerosis (MS) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):162.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To explore the nature and magnitude of ophthalmic impairments in MS and to evaluate the use of a questionnaire to identify MS patients with significant visual problems. Methods: A cross-sectional study of 44 subjects recruited from 440 patients attending a hospital MS rehabilitation unit was performed. All subjects completed a general questionnaire about significant systemic symptoms. Subsequently subjects completed a specially modified Daily Living Task Vision (DLTV) questionnaire. Objective measurements were taken of distance and near visual acuity, contrast sensitivity, binocular function including fusion range, stereo tests, accommodation and convergence, colour vision, visual fields and slit-lamp biomicroscopy was performed too. Results: The demographics of the 31 patients who completed the study (70%) are representative of the cross section of general population of MS patients. There were 20 (65%) females and 11 males – a female:male ratio of 1.8:1. The mean age was 46 years (range 32 –67). The mean time from diagnosis was 13.8 years (range 6 months – 42 years) and from probable first symptoms 16.7 years. On the general questionnaire, only 1/31 (3.2%) rated vision problems amongst their most influential difficulties. On direct questioning with the ophthalmic questionnaire, 20 patients perceived ophthalmic problems, of which 19 were confirmed by ophthalmic assessment. Significant correlations between modified DLTV questionnaire findings with objective findings were found for subjective distance vision vs distance visual acuity (ANOVA, p=0.000), subjective distance vision vs contrast sensitivity (ANOVA, p=0.000), subjective awareness of visual field vs measured visual field defect (ANOVA, p=0.036) and subjective depth perception vs binocular vision (unpaired t-test, p=0.007), There was no significant correlation between subjective near vision vs near visual acuity (ANOVA, p=0.139) or contrast sensitivity (ANOVA, p=0.172). Conclusions: Visual impairment is common in established MS but poorly appreciated by patients. Screening for ophthalmic impairments in MS may reveal important information for patient rehabilitation management. The modified DLTV questionnaire used in this study had good correlation with visual performance on testing, although further modification is needed to identify all subjects with significant eye disease.
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