Relations of low contrast visual acuity, quality of life and multiple sclerosis functional composite: a cross-sectional analysisReport as inadecuate

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BMC Neurology

, 14:31

Demyelinating diseases


BackgroundAlthough common and often disabling in multiple sclerosis MS, visual dysfunction is currently not adequately accounted for in both clinical routine and MS trials. Sloan low contrast letter acuity SLCLA is a standardised chart-based measure of visual function particular at low contrast and has been suggested as additional visual component to the Multiple Sclerosis Functional Composite MSFC. Here, we evaluate the relations between SLCLA, retinal integrity, MSFC, and quality of life QoL in MS patients.

MethodsCross-sectional analysis of retinal nerve fibre layer RNFL thickness, MSFC, SLCLA 2.5% and 1.25% contrast levels, visual evoked potentials, and QoL Short Form SF 36, National Eye Institute Visual Functioning Questionnaire NEIVFQ using baseline data of 92 MS patients from an ongoing prospective longitudinal trial. Relations between RNFL thickness or P100 latency and SLCLA were analysed using generalised estimating equations GEE accounting for intra-individual inter-eye dependencies and corrected for age, gender, and history of optic neuritis. Pearson’s correlations were used to assess relations between SLCLA, MSFC, and QoL.

ResultsSLCLA reflected RNFL thickness p = 0.021 and P100 latency p = 0.004 and predicted vision-related QoL, reflected by the NEIVFQ39 subscores -general vision- and -near activities- p < 0.008 for both. SLCLA did not predict general QoL reflected by SF36. Implementing SLCLA into MSFC, thus creating a four-dimensional MSFC4, captured aspects of disability reflected by the NEIVFQ39 subscores -general vision- r = 0.42, p < 0.0001 and -near activity- r = 0.3, p = 0.014 which were not captured by standard MSFC3.

ConclusionsSLCLA at 2.5% and 1.25% contrast levels correlates with retinal morphology and P100 latency and predicts some aspects of vision-related QoL in MS. More importantly, using a prospective cross-sectional approach we provide evidence that extending the MSFC by SLCLA as an additional visual component increases the performance of MSFC to capture MS-related disability. Longitudinal data on the relation between SLCLA, MSFC, and QoL will be available in the near future.

KeywordsMultiple sclerosis Low contrast visual acuity Sloan low contrast letter acuity Multiple sclerosis functional composite Quality of life Retinal nerve fibre layer thickness Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-14-31 contains supplementary material, which is available to authorized users.

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Author: Johann Schinzel - Hanna Zimmermann - Friedemann Paul - Klemens Ruprecht - Katrin Hahn - Alexander U Brandt - Jan Dörr


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