Smartphone App Visual Function Tests in Multiple Sclerosis Patients With and Without Optic Neuritis

Abstract

Purpose : In this study, the performance of a suite of rapid smartphone vision tests were evaluated for monitoring visual function in patients with multiple sclerosis with prior optic neuritis (MS+ON), without prior optic neuritis (MS-ON), and normal subjects (N).

Methods : In this pilot study, 56 patients with MS (relapse remitting MS and secondary progressive MS) with prior optic neuritis (MS+ON; n=21) or without prior optic neuritis (MS-ON; n=35) and 34 age-matched controls were tested in the Aalborg, Denmark University Hospital Multilple Sclerosis Clinic using a battery of smartphone visual function tests (Landolt C acuity, Landolt C contrast sensitivity, critical flicker fusion contrast threshold at 7.5 and 15Hz, related to visual conduction speed). Testing was performed with the patient wearing their glasses. One eye was used for statistical comparisons between groups (ANOVA rank test with pairwise multiple comparisons using Dunn’s method).

Results : Each smartphone test took approximately 15 seconds to complete and was intuitive enough that patients were able to immediately perform the visual task. Contrast at which 15 Hz critical flicker fusion occurred provided the greatest separation between MS patients and normal subjects, with or without prior optic neuritis (see Table 1).

Conclusions : Portable and rapid smartphone tests of visual function, specifically visual acuity, contrast sensitivity, and flicker sensitivity, can give valuable information about the function of the afferent visual system, which could help in the triage and monitoring of MS patients and patients with other vision threatening disorders. Interestingly, critical flicker fusion, a test of visual speed of conduction, provided the greatest discrimination between eyes of MS patients with or without a previous diagnosis of optic neuritis compared to normal eyes. This finding motivates the importance of using a behavioral visual test of visual conduction speed, such as critical flicker fusion or flicker sensitivity, which is resistant to optical blur, to monitor various causes of visual dysfunction.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.