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MS research update - Longer lasting sight problems in MS: How common are they? - 13 March 2013

Summary

Problems with eyesight are common in MS but often improve or go away completely after an attack. This research paper looked at how often eyesight problems persist in MS, who is more likely to experience them and how much they affect day to day life.

Background

Problems with eyesight are common in MS and are often one of the first symptoms people experience. They include optic neuritis, double vision (diplopia) and nystagmus (where the eyes move in a more or less rhythmical manner). Attacks of optic neuritis can include complete loss of sight, partial blind spots (called scotomas), blurred or foggy vision, or colour vision disturbances.

Some people find that an increase in temperature affects their vision in some way. This effect is known as Uhthoff's phenomenon or Uhthoff's sign.

Problems with vision often improve or may disappear after a relapse but they can persist.

How this study was carried out

This study examined if longstanding problems with vision were common in people with MS, what caused them and what difficulties they brought.

303 people with MS, who were either in-patients or out-patients at a clinic in France, were asked about any eyesight problems that persisted despite wearing glasses. People who had experienced a relapse in the last three months were not included in the study.

Those people who had persistent visual symptoms then undertook a series of neuro- ophthalmologic tests. These are tests which detect problems due to damage to the nerves supplying the eye or the parts of the brain concerned with vision rather than problems in the eye itself.

The group also completed questionnaires, called the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25) and the 10-Item Neuro-Ophthalmic Supplement, to assess how much impact their sight problems had on everyday life. Questions included:

  • How much difficulty do you have reading ordinary print in newspapers?
  • How much difficulty do you have reading street signs or the names of stores?
  • Because of your eyesight, how much difficulty do you have going down steps, stairs, or curbs in dim light or at night?

What was found

They found that, out of 303 people with MS, just over a quarter (26%) had optic neuritis as their first symptom and one in eight (12%) had oculomotor symptoms (abnormal movements of the eyeball) from the beginning of their MS.

During the whole course of their MS, just over half (53%) had experienced at least one episode of optic neuritis and almost a third (31%) had experienced at least one episode of ocular motor symptoms.

Just over a third of the group reported continuing problems with their vision. Out of this sub-group, the most common symptoms were visual fatigue (59%), diplopia (35%) and visual instability (28%). These symptoms were not related to age or how long someone had MS. These symptoms were more common in men, those who had progressive MS from the beginning and those with a higher level of disability.

People with continuing problems with their sight were more likely (than other people with MS) to have had problems with vision at the beginning of their MS, at least one relapse with these symptoms and to have experienced significantly more relapses where visual symptoms occurred.

70 people from this study continued into the second phase. A variety of problems were detected using the neuro-ophthalmologic tests including optic neuropathy (57%), impaired visual acuity (53%), disc pallor (49%), visual field impairment (59%), contrast sensitivity (58%) and colour discrimination (63%). These problems often affected both eyes. Oculomotor symptoms (abnormal movements of the eyeball) were seen in 85% of the group.

Those with persistent sight problems were more likely to report a lower quality of life.

What does it mean?

This study provides additional evidence on how common problems with eyesight are for people with MS, how they can persist and how they impact on everyday tasks like reading and going up and down stairs.

Jasse L, Vukusic S, Durand-Dubief F, et al.
Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability.
Mult Scler. 2013 Mar 5. [Epub ahead of print]
abstract

More about sight problems in MS

You can read more about problems with eyesight in the A to Z of MS including optic neuritis, double vision, nystagmus (the eyes move in a more or less rhythmical manner) and Uhthoff's phenomenon.

Not all problems with eyesight are due to MS so it is important to have any difficulties properly assessed and any aids, like glasses or contact lenses, updated when required. It has been suggested that people should:

  • Have regular eye tests and have any new problems treated. Opticians recommend that everyone should have their eyes tested at least every two years, whether they have MS or not
  • Double vision can sometimes be managed with the short-term use of an eye patch
  • If double vision persists, prisms can be fitted to glasses. The prism compensates for the double vision by altering the way light reaches the eye
  • If there is a problem with the messages from the eyes arriving at the brain at different speeds, a tinted lens in front of the good eye can help. An orthoptist can design the lens so that it matches the delay on the affected side
  • Be careful of sudden changes in light. If you go from light to dark, or dark to light, stop and give your eyes time to adjust
  • If heat affects your symptoms, try to avoid hot environments and keep cool in warmer weather
  • Seek medical attention if you think you have an infection as this can raise your body temperature and make visual symptoms worse

Problems with eyesight can make someone more likely to fall. Advice on preventing falls is available in Falls: managing the ups and downs of MS.

Difficulties with reading may be helped by using a magnifying glass or printing on different coloured paper. If reading from a computer screen is difficult, most browsers have accessibility features which allow you to change the size of the text, the screen colours and other features to improve readability. You can read more on the Microsoft and Firefox web sites. The BBC also offers an excellent guide on making the web easier to use if you have difficulties with sight, using a mouse or keyboard or have other computer accessibility questions.

Charities like AbilityNet may also be able to help with computer accessibility issues.

Research by topic areas...

MS relapses

Steinvorth SM, Röver C, Schneider S, et al.
Explaining temporal trends in annualised relapse rates in placebo groups of randomised controlled trials in relapsing multiple sclerosis: systematic review and meta-regression.
Mult Scler. 2013 Mar 7. [Epub ahead of print]
abstract

Disease modifying treatments

Olsson T, Achiron A, Alfredsson L, et al.
Anti-JC virus antibody prevalence in a multinational multiple sclerosis cohort.
Mult Scler. 2013 Mar 4. [Epub ahead of print]
abstract

Graves J, Galetta SL, Palmer J, et al.
Alemtuzumab improves contrast sensitivity in patients with relapsing-remitting multiple sclerosis.
Mult Scler. 2013 Mar 4. [Epub ahead of print]
abstract

Thöne J, Ellrichmann G.
Oral available agents in the treatment of relapsing remitting multiple sclerosis: an overview of merits and culprits.
Drug Healthc Patient Saf. 2013;5:37-47. doi: 10.2147/DHPS.S28822.
abstract
Read the full text of this paper

Radue EW, O'Connor P, Polman CH, et al.
Impact of fingolimod therapy on magnetic resonance imaging outcomes in patients with multiple sclerosis.
Arch Neurol. 2012 Oct;69(10):1259-69. PubMed PMID:
abstract

Assessment tools

Lee P, Plavina T, Castro A, et al.
A second-generation ELISA (STRATIFY JCV(™) DxSelect™) for detection of JC virus antibodies in human serum and plasma to support progressive multifocal leukoencephalopathy risk stratification.
J Clin Virol. 2013 Mar 2. doi:pii: S1386-6532(13)00042-5. 10.1016/j.jcv.2013.02.002. [Epub ahead of print]
abstract

Quality of life

Tepavcevic DK, Pekmezovic T, Stojsavljevic N, et al.
Predictive value of health-related quality of life in progression of disability and depression in persons with multiple sclerosis: a 3-year study.
Acta Neurol Belg. 2013 Mar 5. [Epub ahead of print]
abstract

Causes of MS

Nielsen NM, Bager P, Stenager E, et al.
Cesarean section and offspring's risk of multiple sclerosis: a Danish nationwide cohort study.
Mult Scler. 2013 Mar 6. [Epub ahead of print]
abstract

Psychological aspects

Bragazzi NL.
The gap in the current research on the link between health locus of control and multiple sclerosis: lessons and insights from a systematic review.
Mult Scler Int. 2013;2013:972471. doi: 10.1155/2013/972471. Epub 2013 Feb 14.
abstract
Read the full text of this paper

Ishigami Y, Fisk JD, Wojtowicz M, et al.
Repeated measurement of the attention components of patients with multiple sclerosis using the Attention Network Test-Interaction (ANT-I): Stability, isolability, robustness, and reliability.
J Neurosci Methods. 2013 Mar 6. doi:pii: S0165-0270(13)00087-3. 10.1016/j.jneumeth.2013.02.013. [Epub ahead of print]
abstract

Dennison L, Moss-Morris R, Yardley L, et al.
Change and processes of change within interventions to promote adjustment to multiple sclerosis: Learning from patient experiences.
Psychol Health. 2013 Mar 6. [Epub ahead of print]
abstract

Ruet A, Deloire MS, Charré-Morin J, et al.
A new computerised cognitive test for the detection of information processing speed impairment in multiple sclerosis.
Mult Scler. 2013 Mar 4. [Epub ahead of print]
abstract

das Nair R, Lincoln NB.
Evaluation of rehabilitation of memory in neurological disabilities (ReMiND): a randomized controlled trial.
Clin Rehabil. 2012 Oct;26(10):894-903.
abstract

Physical activity

Franceschini M, Rampello A, Agosti M, et al.
Walking performance: correlation between energy cost of walking and walking participation. new statistical approach concerning outcome measurement.
PLoS One. 2013;8(2):e56669.
abstract
Read the full text of this paper

 

Prognosis

Keyhanian K, Davoudi V, Etemadifar M, et al.
Better prognosis of multiple sclerosis in patients who experienced a full-term pregnancy.
Eur Neurol. 2012;68(3):150-5.
abstract

Pathophysiology

Papadopoulou A, Müller-Lenke N, Naegelin Y, et al.
Contribution of cortical and white matter lesions to cognitive impairment in multiple sclerosis.
Mult Scler. 2013 Mar 4. [Epub ahead of print]
abstract

Review

Derfuss T.
Personalized medicine in multiple sclerosis: hope or reality?
BMC Med. 2012 Oct 4;10:116. doi: 10.1186/1741-7015-10-116. Review. PubMed PMID:
abstract
Read the full text of this paper

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