High-contrast Acuity Research Articles

Abnormal visual contrast acuity in Parkinson's disease.

Low-contrast vision is thought to be reduced in Parkinson's disease (PD). This may have a direct impact on quality of life such as driving, using tools, finding objects, and mobility in low-light condition. Low-contrast letter acuity testing has been successful in assessing low-contrast vision in multiple sclerosis. We report the use of a new iPad application to measure low-contrast acuity in patients with PD. To evaluate low- and high-contrast letter acuity in PD patients and controls using a variable contrast acuity eye chart developed for the Apple iPad. Thirty-two PD and 71 control subjects were studied. Subjects viewed the Variable Contrast Acuity Chart on an iPad with both eyes open at two distances (40 cm and 2 m) and at high contrast (black and white visual acuity) and 2.5% low contrast. Acuity scores for the two groups were compared. PD patients had significantly lower scores (indicating worse vision) for 2.5% low contrast at both distances and for high contrast at 2 m (p < 0.003) compared to controls. No significant difference was found between the two groups for high contrast at 40 cm (p = 0.12). Parkinson's disease patients have reduced low and high contrast acuity compared to controls. An iPad app, as used in this study, could serve as a quick screening tool to complement more formal testing of patients with PD and other neurologic disorders.

Repeatability of mesopic visual acuity measurements using high- and low-contrast ETDRS letter charts

To determine the repeatability of mesopic high-contrast (HC) and low-contrast (LC) visual acuity (VA) measurements made at distance and near in healthy young individuals. While the repeatability of photopic VA is well-known, there is a lack of information with regard to the repeatability of VA measured under low luminance conditions. In two different sessions 1 week apart, best-corrected monocular VA was determined using HC (96 %) and LC (10 %) ETDRS charts under mesopic luminance conditions (0.75 cd/m(2)) at distance (HCD, LCD) and near (HCN, LCN) in 47 healthy subjects aged 22.9 ± 6.8 years. Repeatability was estimated by the Bland and Altman method, whereby the mean difference (MD) and the 95 % limits of agreement were determined as the coefficient of repeatability (COR). Mean logMAR VA values were HCD = 0.09, LCD = 0.44, HCN = 0.21, and LCN = 0.57. Mean differences in measurements between sessions 1 and 2 were not significant, and low in clinical terms (≤1 letter). Repeatability was better for the distance measurements at both high and lowcontrast (COR HCD ±0.11 and COR LCD ±0.11 logMAR vs COR HCN ±0.15 and COR LCN ±0.16 logMAR), and MDs were also slightly closer to zero for the distance measurements. Similar repeatability was observed between HC and LC VA, both at distance and near. In mesopic conditions, ETDRS charts offer repeatable best-corrected monocular VA measurements. The criterion for a significant change in logMAR VA was 1 line at distance and 1.5 lines at near.

Functional–structural correlations in the afferent visual pathway in pediatric demyelination

We evaluated the relationship of optical coherence tomography (OCT)-measured ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness to other functional measures of afferent visual pathway competence including high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA), visual field sensitivity, and color vision perception in a pediatric population with demyelinating disorders. This was a cross-sectional evaluation of 37 children, aged 8-18 years, with pediatric demyelinating disorders (n = 74 eyes), and 18 healthy controls (n = 36 eyes), who were recruited from the University of Toronto, Hospital for Sick Children and the University of Calgary, Alberta Children's Hospital, Canada. A standardized visual battery, including spectral-domain OCT, visual fields, LCVA, and HCVA, was performed in all subjects. Mean RNFL thickness was 26 µm (25.6%) lower in patients with demyelination (76.2 μm [3.7]) compared to controls (102.4 μm [2.1]) (p < 0.0001). Mean GCL thickness was 20% lower in patients as compared to controls (p < 0.0001). Mean GCL and RNFL thickness were strongly correlated (r = 0.89; p < 0.0001), yet in contrast to RNFL thickness, no differences in GCL thickness were noted between optic neuritis (ON) eyes and non-ON eyes of patients. HCVA and LCVA and visual field mean deviation scores decreased linearly with lower RNFL thickness. GCL thickness was decreased in patients regardless of history of ON. The retina may be a site of primary neuronal injury in pediatric demyelination.

Wavefront-guided scleral lens correction in keratoconus.

To examine the performance of state-of-the-art wavefront-guided scleral contact lenses (wfgSCLs) on a sample of keratoconic eyes, with emphasis on performance quantified with visual quality metrics, and to provide a detailed discussion of the process used to design, manufacture, and evaluate wfgSCLs. Fourteen eyes of seven subjects with keratoconus were enrolled and a wfgSCL was designed for each eye. High-contrast visual acuity and visual quality metrics were used to assess the on-eye performance of the lenses. The wfgSCL provided statistically lower levels of both lower-order root mean square (RMS) (p < 0.001) and higher-order RMS (HORMS) (p < 0.02) than an intermediate spherical equivalent scleral contact lens. The wfgSCL provided lower levels of lower-order RMS than a normal group of well-corrected observers (p << 0.001). However, the wfgSCL does not provide less HORMS than the normal group (p = 0.41). Of the 14 eyes studied, 10 successfully reached the exit criteria, achieving residual HORMS wavefront error less than or within 1 SD of the levels experienced by normal, age-matched subjects. In addition, measures of visual image quality (logVSX, logNS, and logLIB) for the 10 eyes were well distributed within the range of values seen in normal eyes. However, visual performance as measured by high-contrast acuity did not reach normal, age-matched levels, which is in agreement with prior results associated with the acute application of wavefront correction to keratoconic eyes. Wavefront-guided scleral contact lenses are capable of optically compensating for the deleterious effects of higher-order aberration concomitant with the disease and can provide visual image quality equivalent to that seen in normal eyes. Longer-duration studies are needed to assess whether the visual system of the highly aberrated eye wearing a wfgSCL is capable of producing visual performance levels typical of the normal population.

AMILORIDE CLINICAL TRIAL IN OPTIC NEURITIS: TRIAL PARADIGM

Aims To outine the use of Optic Neuritis as a model for neuroprotective trials To present baseline clinical data on the first 14 participants within the ACTION trial. Methods ACTION is a phase II randomised controlled trial of amiloride vs placebo in patients with acute optic neuritis, recruited within 28 days of onset. The primary outcome measure is comparison of 6 month retinal nerve fibre layer thickness between the affected and unaffected eye. Participants undergo OCT and GDx, high and low contrast visual acuity, colour vision, Humphrey visual fields, PERG, VEP, and MRI brain. Results 14 patients have been recruited from 47 referrals. Mean time from onset of symptoms to commencing the study drug is 14.7 days, median 13. Mean visual acuity in the affected eye is 50 letters (6/60), median 64 (6/30). 7 patients had T2 white matter lesions on baseline MRI imaging. One patient had a pre-existing diagnosis of multiple sclerosis. Conclusions Recruiting to clinical trials in acute optic neuritis is challenging but feasible. Ongoing and future neuroprotective trials in optic neuritis require a robust and motivated network of clinicians and researchers recognising the “window of opportunity” to facilitate timely referral.

Relationship between optical coherence tomography and electrophysiology of the visual pathway in non-optic neuritis eyes of multiple sclerosis patients.

PurposeLoss of retinal ganglion cells in in non-optic neuritis eyes of Multiple Sclerosis patients (MS-NON) has recently been demonstrated. However, the pathological basis of this loss at present is not clear. Therefore, the aim of the current study was to investigate associations of clinical (high and low contrast visual acuity) and electrophysiological (electroretinogram and multifocal Visual Evoked Potentials) measures of the visual pathway with neuronal and axonal loss of RGC in order to better understand the nature of this loss.MethodsSixty-two patients with relapsing remitting multiple sclerosis with no previous history of optic neuritis in at least one eye were enrolled. All patients underwent a detailed ophthalmological examination in addition to low contrast visual acuity, Optical Coherence Tomography, full field electroretinogram (ERG) and multifocal visual evoked potentials (mfVEP).ResultsThere was significant reduction of ganglion cell layer thickness, and total and temporal retinal nerve fibre layer (RNFL) thickness (p<0.0001, 0.002 and 0.0002 respectively). Multifocal VEP also demonstrated significant amplitude reduction and latency delay (p<0.0001 for both). Ganglion cell layer thickness, total and temporal RNFL thickness inversely correlated with mfVEP latency (r = −0.48, p<0.0001 respectively; r = −0.53, p<0.0001 and r = −0.59, p<0.0001 respectively). Ganglion cell layer thickness, total and temporal RNFL thickness also inversely correlated with the photopic b-wave latency (r = −0.35, p = 0.01; r = −0.33, p = 0.025; r = −0.36, p = 0.008 respectively). Multivariate linear regression model demonstrated that while both factors were significantly associated with RGC axonal and neuronal loss, the estimated predictive power of the posterior visual pathway damage was considerably larger compare to retinal dysfunction.ConclusionThe results of our study demonstrated significant association of RGC axonal and neuronal loss in NON-eyes of MS patients with both retinal dysfunction and post-chiasmal damage of the visual pathway.

The King–Devick (K–D) test of rapid eye movements: A bedside correlate of disability and quality of life in MS

ObjectiveWe investigated the King–Devick (K–D) test of rapid number naming as a visual performance measure in a cohort of patients with multiple sclerosis (MS). MethodsIn this cross-sectional study, 81 patients with MS and 20 disease-free controls from an ongoing study of visual outcomes underwent K–D testing. A test of rapid number naming, K–D requires saccadic eye movements as well as intact vision, attention and concentration. To perform the K–D test, participants are asked to read numbers aloud as quickly as possible from three test cards; the sum of the three test card times in seconds constitutes the summary score. High-contrast visual acuity (VA), low-contrast letter acuity (1.25% and 2.5% levels), retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT), MS Functional Composite (MSFC) and vision-specific quality of life (QOL) measures (25-Item NEI Visual Functioning Questionnaire [NEI-VFQ-25] and 10-Item Neuro-Ophthalmic Supplement) were also assessed. ResultsK–D time scores in the MS cohort (total time to read the three test cards) were significantly higher (worse) compared to those for disease-free controls (P=0.003, linear regression, accounting for age). Within the MS cohort, higher K–D scores were associated with worse scores for the NEI-VFQ-25 composite (P<0.001), 10-Item Neuro-Ophthalmic Supplement (P<0.001), binocular low-contrast acuity (2.5%, 1.25%, P<0.001, and high-contrast VA (P=0.003). Monocular low-contrast vision scores (P=0.001–0.009) and RNFL thickness (P=0.001) were also reduced in eyes of patients with worse K–D scores (GEE models accounting for age and within-patient, inter-eye correlations). Patients with a history of optic neuritis (ON) had increased (worse) K–D scores. Patients who classified their work disability status as disabled (receiving disability pension) did worse on K–D testing compared to those working full-time (P=0.001, accounting for age). ConclusionsThe K–D test, a <2minute bedside test of rapid number naming, is associated with visual dysfunction, neurologic impairment, and reduced vision-specific QOL in patients with MS. Scores reflect work disability as well as structural changes as measured by OCT imaging. History of ON and abnormal binocular acuities were associated with worse K–D scores, suggesting that abnormalities detected by K–D may go along with afferent dysfunction in MS patients. A brief test that requires saccadic eye movements, K–D should be considered for future MS trials as a rapid visual performance measure.

Assessment of macular function using the SKILL Card in adults with type 2 diabetes mellitus.

To evaluate the impact of reduced contrast and reduced luminance on visual acuity (VA) using the Smith-Kettlewell Institute Low Luminance (SKILL) Card in patients with type 2 diabetes mellitus (T2DM). We studied adults aged 27 to 65 years, 32 with T2DM and no retinopathy (NoRet group), 22 with T2DM and nonproliferative diabetic retinopathy (NPDR group), and 38 healthy control subjects. Monocular high-contrast (SKILL light) and low-contrast, low-luminance (SKILL dark) near visual acuities were tested. The SKILL score was calculated as the difference between dark chart and light chart acuities and was corrected for age. Contrast sensitivity (CS) was also measured. Subject group differences were examined using ANOVA and Tukey honestly significant difference test. Receiver operating characteristic curve analysis was used to assess the ability of the SKILL Card and CS to discriminate the subject groups. The SKILL score and CS were significantly worse in both diabetes groups compared with the controls (P < 0.01). SKILL scores in the NPDR group were poorest (highest) and significantly worse than those in the NoRet group (P < 0.05). SKILL scores discriminated NPDR and NoRet patients from the controls with high accuracy (99% and 88%, respectively), which was significantly (P < 0.03) better than CS (78% and 74%, respectively). The SKILL Card demonstrated vision function changes in diabetes even in the absence of clinically evident retinopathy. Diabetic retinopathy led to a further increase in the SKILL score, while high-contrast VA remained unchanged.

A COMPARATIVE STUDY OF THE EFFECT OF FACE FORM ANGLE ON THE LOW CONTRAST VISUAL ACUITY BEFORE AND AFTER CALCULATION OF ITS POWER

Background and Aim: In wrap around frame wearers, when a lens is tilted due to Face Form angle of spectacle, there is a change in the sphere power, and a cylinder is induced. This power change can be compensated by calculating the effect of face form angle. Although high contrast visual acuity is normal in both with and without compensating the effect of face form angle on the power of lenses, this raises the question of whether low contrast visual acuity is normal. The aim of this study was to examine and compare the effect of face form angle on the lowest contrast visual acuity with/without calculating the effect of face form angle on wraparound frame wearers. Materials and Methods: An experimental study was designed in which two similar wraparound frames ‘with face form angle over 16 degrees’ were selected. 4% contrast visual acuity of 21 participants was tested with/without calculating the effect of face form angle on the best correction power. Results: The results of repeated measured ANOVA indicated that the overall comparison was significant (p < 0.005). The greatest difference was found in non-calculating method (mean difference of VA = 0.02 Log). The difference was less in calculating method (mean difference of VA = 0.01 Log) Conclusion: The results indicated that use of wraparound frames with/without calculating the effect of face form angle in myopia between -3.00 and -6.00 D and with the rule astigmatism less than -1.00 D can decrease visual acuity in 4% contrast visual acuity when the face form angle is over 16 degrees. Key words: Face form angle, visual acuity, the lowest contrast, wrap around frame

Forward light scatter and visual acuity through scratched protective eyewear

BackgroundScratches and other surface abrasions on protective eyewear can shorten their life cycle by scattering light from the image, which will compromise visual performance. Although scratch and abrasion resistance testing is well developed, there is little information available regarding visual acuity through lenses scratched in an actual work environment.MethodsWe collected protective eyewear from mine and smelting operations that had been returned because vision through the lenses was unacceptable due to scratches and abrasions. Forward scattered light was measured on both cleaned and partially cleaned lenses using both haze and light diffusion measurements. Visual acuity through a selection of lenses was determined for both high and low contrast letters under photopic light levels.ResultsLenses with scratches in the central region had haze values ranging from one to 30 per cent. The highest haze values were measured on lenses that were both scratched and covered with dirt, whereas haze values less than 10 per cent were measured on lenses that had the dirt removed and just had scratches in the central region. Light diffusion values were highly correlated with haze. Visual acuity for high and low contrast letters became worse as the percentage haze increased but the linear correlation was only moderate.ConclusionThe appearance of the scratches on the lens surfaces strongly suggests that they were a result of improper lens cleaning. The findings also suggest that haze values less than two per cent or a luminance reduction factor less than 3.0-cd/(m2 lx) are unlikely to affect high and low contrast acuity.

Clinical Performance of a New Hybrid Contact Lens for Keratoconus

To compare the clinical performance of the Clearkone hybrid contact lens for the treatment of keratoconus against the habitual contact lens of the patients. A total of 33 eyes from 18 patients were fitted with the Clearkone. High- and low-contrast visual acuity (HCVA and LCVA), central corneal thickness (CCT), and contrast sensitivity acuity (CSF) were recorded with habitual lenses (prestudy visit) and after 1 week, 15 days, and 1 month of wear of prescribed Clearkone. Subjective vision and comfort were rated using visual analogue scales (VAS). Three patients discontinued the study, one because of diffuse corneal staining after 1 day of use and the other two because of extreme discomfort. The rest of the patients completed the 1-month study. High contrast visual acuity and LCVA (logMAR) improved significantly from 0.16 ± 0.12 and 0.44 ± 0.22, respectively, with the patient's habitual contact lenses to -0.006 ± 0.058 and 0.23 ± 0.13 after 1 day wearing Clearkone, remaining significant during all follow-up visits (P<0.001; repeated measures analysis of variance [RM-ANOVA]). There were no statistically significant differences in the mean CCT. The improvement of CSF was statistically significant with hybrid contact lenses prescribed compared with the patient's habitual contact lenses (P<0.001; RM-ANOVA test). Improvement in VAS score, with prescribed Clearkone, was statistically significant for comfort (P=0.043; RM-ANOVA test), but not for the subjective vision (P=0.759; RM-ANOVA test). Clearkone provides an improvement in visual acuity, contrast sensitivity, and subjective comfort in patients with keratoconus when compared with other contact lens options. However, clinicians must get specific training to fit the lens and be aware of potential adverse events.

Vision related quality of life in patients with keratoconus.

Purpose. The purpose of this study is to evaluate the vision related quality of life in patients with keratoconus by using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Methods. Thirty patients presented with keratoconus (keratoconus group) and 30 healthy patients (control group) were included in this study. Twenty patients were using rigid gas permeable and 10 patients were not using contact lenses in keratoconus group. High and low contrast visual acuity and mean K values of the patients were recorded. Each subject completed the 25-item NEI-VFQ-25. Results. All subscales of NEI-VFQ-25 were lower in the keratoconus patients. The difference was more evident in the subscales of general vision, ocular pain, near vision, vision-specific mental health, vision-specific role difficulties, and peripheral vision (P < 0.05). Overall composite score was 75.2 ± 17.2 in the keratoconus group and 93.2 ± 5.6 in the control group (P = 0.00). Contact lens wearers had higher best corrected visual acuity in comparison with noncontact lens wearers (P = 0.028). Patients with low visual acuity (logMAR > 0.4) in the better eye had lower distance vision, social functioning, mental health, and role difficulties. Meanwhile, patients with low visual acuity (logMAR > 0.4) in the worse eye had lower general health scores (P < 0.05). Conclusions. Vision related quality of life was worse in keratoconus patients. Success in the contact lens usage and maintaining higher visual acuity may improve vision related quality of life.

High Order Aberration Outcomes of Corneal Collagen Crosslinking in Eyes with Keratoconus and Post-LASIK Ectasia

ABSTRACT Purpose To evaluate the effect of riboflavin and ultraviolet- A-induced corneal collagen crosslinking (CXL) on high order aberrations (HOA) up to third-order at 6 months using the iTrace wavefront aberrometer in patients with progressive keratoconus and post-LASIK ectasia. Materials and methods Ongoing retrospective chart review of patients having undergone CXL. The iTrace (Tracey Technologies, Houston, TX) was used to evaluate HOA. Patient data was collected from a single clinical site pre- and 6 months postoperatively. Data collected included logMAR uncorrected distance visual acuity (UDVA), logMAR corrected distance visual acuity (CDVA), manifest refraction, and HOA measurements. Data was analyzed with paired two-tailed student's t-test. Results 18 eyes (9M:4F, mean age 29.2 years, range 16-45) had 6 months of follow-up. Total HOAs, total coma and total trefoil were significantly reduced at 6 months by 16, 33 and 26% respectively (p &lt; 0.05). Nonsignificant trends toward improvement were seen in spherical aberration, secondary astigmatism and UDVA. There were no statistically significant changes in manifest refraction or CDVA. Conclusion Improvement in high order aberration profile is one mechanism by which corneal collagen crosslinking enhances visual function in ectatic corneas. Total HOA and total coma measures are the most commonly reported improvements in HOA measures in previous studies, while total trefoil has only been observed in one other study. The improvements seen in HOAs remain fairly modest which likely accounts for the lack of measureable improvement in high-contrast visual acuity measures, such as Snellen UDVA and CDVA. This study is the first to report HOA outcomes with the iTrace wavefront aberrometer. How to cite this article Muzychuk A, Penner V, Rocha G. High Order Aberration Outcomes of Corneal Collagen Crosslinking in Eyes with Keratoconus and Post-LASIK Ectasia. Int J Kerat Ect Cor Dis 2014;3(3):107-112.

Foveal contour interaction on the edge: Response to ‘Letter-to-the-Editor’ by Drs. Coates and Levi

Recently, we reported that, when considered as a function of the edge-to-edge target-toflanker separation in min arc, the spatial extent of foveal contour interaction is the same for high and low contrast acuity targets. This result resolved an apparent discrepancy in the literature, which suggested that foveal contour interaction was absent or reduced for low contrast targets. In commenting on our results, Drs. Coates and Levi suggest a two-mechanism model for foveal crowding that depends on the center-to-center separation between the acuity target and flanking stimuli, and is based in part on a reanalysis of data from our recent work and a number of other studies. In our reply, we show that the spatial extent of foveal contour interaction for both high and low contrast targets is essentially unchanged by the width of the flanking targets when the target-to-flanker separation is depicted in terms of edge-to-edge separation, but varies systematically when depicted in terms of center-to-center separation. We therefore conclude that for foveal contour interaction in the range of a few min arc, edge-to-edge target-to-flanker separation is the more appropriate metric.

Optic Nerve Diffusion Tensor Imaging after Acute Optic Neuritis Predicts Axonal and Visual Outcomes

BackgroundEarly markers of axonal and clinical outcomes are required for early phase testing of putative neuroprotective therapies for multiple sclerosis (MS). ObjectivesTo assess whether early measurement of diffusion tensor imaging (DTI) parameters (axial and radial diffusivity) within the optic nerve during and after acute demyelinating optic neuritis (ON) could predict axonal (retinal nerve fibre layer thinning and multi-focal visual evoked potential amplitude reduction) or clinical (visual acuity and visual field loss) outcomes at 6 or 12 months. MethodsThirty-seven patients presenting with acute, unilateral ON were studied at baseline, one, three, six and 12 months using optic nerve DTI, clinical and paraclinical markers of axonal injury and clinical visual dysfunction. ResultsAffected nerve axial diffusivity (AD) was reduced at baseline, 1 and 3 months. Reduced 1-month AD correlated with retinal nerve fibre layer (RNFL) thinning at 6 (R=0.38, p=0.04) and 12 months (R=0.437, p=0.008) and VEP amplitude loss at 6 (R=0.414, p=0.019) and 12 months (R=0.484, p=0.003). AD reduction at three months correlated with high contrast visual acuity at 6 (ρ = -0.519, p = 0.001) and 12 months (ρ = -0.414, p=0.011). The time-course for AD reduction for each patient was modelled using a quadratic regression. AD normalised after a median of 18 weeks and longer normalisation times were associated with more pronounced RNFL thinning and mfVEP amplitude loss at 12 months. Affected nerve radial diffusivity (RD) was unchanged until three months, after which time it remained elevated. ConclusionsThese results demonstrate that AD reduces during acute ON. One month AD reduction correlates with the extent of axonal loss and persistent AD reduction at 3 months predicts poorer visual outcomes. This suggests that acute ON therapies that normalise optic nerve AD by 3 months could also promote axon survival and improve visual outcomes.

Evaluating the effect of splitting cylindrical power on improving patient tolerance to toric lens misalignment

Evaluating the impact of splitting toric power on patient tolerance to misorientation such as with intraocular lens rotation. University vision clinic. Healthy, non astigmats had +1.50D astigmatism induced with spectacle lenses at 90°, 135°, 180° and +3.00D at 90°. Two correcting cylindrical lenses of the opposite sign and half the power each were subsequently added to the trial frame misaligned by 0°, 5° or 10° in a random order and misorientated from the initial axis in a clockwise direction by up to 15° in 5° steps. A second group of adapted astigmats with between 1.00 and 3.00DC had their astigmatism corrected with two toric spectacle lenses of half the power separated by 0°, 5° or 10° and misorientated from the initial axis in both directions by up to 15° in 5° steps. Distance, high contrast visual acuity was measured using a computerised test chart at each lens misalignment and misorientation. Misorientation of the split toric lenses caused a statistically significant drop in visual acuity (F=70.341; p<0.001). Comparatively better acuities were observed around 180°, as anticipated (F=3.775; p=0.035). Misaligning the split toric power produced no benefit in visual acuity retention with axis misorientation when subjects had astigmatism induced with a low (F=2.190, p=0.129) or high cylinder (F=0.491, p=0.617) or in the adapted astigmats (F=0.120, p=0.887). Misalignment of toric lens power split across the front and back lens surfaces had no beneficial effect on distance visual acuity, but also no negative effect.

Low contrast visual acuity testing is associated with cognitive performance in multiple sclerosis: a cross-sectional pilot study

BackgroundCognitive impairment and visual deterioration are two key clinical symptoms in MS and affect 50 to 80% of patients. Little is known about the influence of cognitive impairment on visual tests recommended for MS such as low contrast sensitivity testing. Our objective was to investigate whether low contrast sensitivity testing is influenced by cognitive impairment in multiple sclerosis (MS) patients.MethodsCross-sectional study including 89 patients with relapsing-remitting MS. All patients received cognitive evaluation using Rao’s Brief Repeatable Battery of Neuropsychological Testing (BRB-N). Visual assessments included low contrast sensitivity (CS) by functional acuity contrast testing and high contrast visual acuity (VA) using ETDRS charts. Retinal morphology as visual impairment correlate was measured using retinal nerve fiber layer (RNFL) thickness by optical coherence tomography.ResultsIn combined analyses using generalized estimating equation models, Paced Auditory Serial Addition Test (PASAT) and RNFL as well as and the Symbol Digit Modalities Test (SDMT) and RNFL predicted CS. To further control for a potential influence of the anterior visual system we performed partial correlation analyses between visual function and cognitive function test results but controlling for RNFL. Even when controlling for RNFL, CS was associated with PASAT performance and SDMT performance.ConclusionOur data show that: a) cognitive impairment and performance in visual function tests such as low contrast sensitivity testing are associated; b) the main cognitive domains correlating with visual test performance are information processing speed and, to a lesser degree, memory; This preliminary data needs to be substantiated in further studies investigating patients with a higher cognitive burden, healthy controls and in longitudinal settings.

Monocular and binocular low-contrast visual acuity and optical coherence tomography in pediatric multiple sclerosis

BackgroundLow-contrast letter acuity and optical coherence tomography (OCT) capture visual dysfunction and axonal loss in adult-onset multiple sclerosis (MS), and have been proposed as secondary outcome metrics for therapeutic trials. Clinical trials will soon be launched in pediatric MS, but such outcome metrics have not been well-validated in this population. ObjectivesTo determine whether MS onset during childhood and adolescence is associated with measurable loss of visual acuity and thinning of the retinal nerve fiber layer (RNFL), whether such features are noted only in the context of clinical optic nerve inflammation (optic neuritis, ON) or are a feature of MS even in the absence of optic nerve relapses, and to define the optimal methods for such detection. Study designCross-sectional study. MethodsMonocular and binocular high- and low-contrast letter acuity and contrast sensitivity were assessed in a cross-sectional cohort of children (ages 5–17 years) with MS (N=22 patients, 44 eyes; 8 patients with a history of ON) and disease-free controls (N=29 patients; 58 eyes) from three academic centers. Binocular summation was determined by calculating the number of letters correctly identified using the binocular score minus the better eye score for each visual test. RNFL thickness was measured using OCT (Stratus OCT-3). Results were analyzed in terms of “eyes” as: MS ON+, MS ON−, and control eyes. Generalized estimating equation (GEE) regression models were used to compare patients to controls. ResultsTraditional high-contrast visual acuity scores did not differ between MS ON+, MS ON−, and controls eyes. MS ON+ eyes had decreased monocular (p<0.001) and decreased binocular (p=0.007) low-contrast letter acuity (Sloan 1.25% contrast charts) scores. Monocular visual acuity did not differ when comparing MS ON− and control eyes. The magnitude of binocular summation using low-contrast charts was similar for pediatric MS participants and controls and was not diminished in children with a history of ON. While the mean RNFL thickness for all MS eyes (103±17μm) trended lower when compared to corresponding measures in control eyes (109±9μm, p=0.085), we confirmed a highly significant reduction in mean RNFL thickness in MS eyes with a history of ON (86±22μm, p<0.001). RNFL thickness of MS ON− eyes in pediatric MS patients (109±11μm) did not differ from controls (p=0.994). ConclusionsLow-contrast letter acuity detects subtle visual loss in MS patients with prior ON, consistent with incomplete recovery, a finding further supported by RNFL loss in ON affected eyes. In MS patients with prior unilateral ON, binocular acuity is decreased; however, the magnitude of binocular summation is preserved, unlike adult-onset MS who exhibit a reduced capacity for visual compensation in the context of unilateral injury. Also unlike findings in adult-onset MS, we did not demonstrate RNFL thinning in ON− eyes of children and adolescents with MS. Further validation is required to confirm whether neurodegeneration of visual pathways occurs in the absence of relapse, and thus whether OCT will serve as a sensitive metric for such pathology in the pediatric and adolescent MS context.

Long-term changes in straylight induced by corneal refractive therapy: A pilot study

To assess long-term intraocular straylight changes induced by corneal refractive therapy (CRT) and to determine whether these changes persist after cessation of CRT lens wear. A single-center, prospective, longitudinal study was performed in 22 subjects (group 1) undergoing overnight corneal refractive therapy for 1 year. Ten right eyes of 10 subjects (group 2) with emmetropia served as controls. In each subject, high contrast visual acuity (HCVA), manifest refraction and intraocular straylight were determined at several time points during treatment and 1 month after discontinuing treatment. Straylight was measured using the van den Berg straylight meter (third generation). EDTRS charts (logMAR units) were used to assess HCVA. For both groups, only data for the right eyes were analyzed. Straylight (mean ± standard deviation) significantly fell from baseline (0.98 ± 0.13) to values recorded after 1 month (0.88 ± 0.13, p=0.011), 3 months (0.88 ± 0.13, p=0.004), 6 months (0.88 ± 0.13, p=0.000) and 12 months (0.76 ± 0.12, p=0.003) of treatment. One month after discontinuing CRT lens wear, straylight was still significantly lower than baseline (0.89 ± 0.13, p=0.003). No correlations were observed between intraocular straylight and HCVA. Good refractive outcomes and reductions in straylight were observed in response to corneal refractive therapy for myopia. The reduction in straylight observed after discontinuing CRT warrents further investigation.

Differential effects of aging on spatial contrast sensitivity to linear and polar sine-wave gratings

Changes in visual function beyond high-contrast acuity are known to take place during normal aging. We determined whether sensitivity to linear sine-wave gratings and to an elementary stimulus preferentially processed in extrastriate areas could be distinctively affected by aging. We measured spatial contrast sensitivity twice for concentric polar (Bessel) and vertical linear gratings of 0.6, 2.5, 5, and 20 cycles per degree (cpd) in two age groups (20-30 and 60-70 years). All participants were free of identifiable ocular disease and had normal or corrected-to-normal visual acuity. Participants were more sensitive to Cartesian than to polar gratings in all frequencies tested, and the younger adult group was more sensitive to all stimuli tested. Significant differences between sensitivities of the two groups were found for linear (only 20 cpd; P<0.01) and polar gratings (all frequencies tested; P<0.01). The young adult group was significantly more sensitive to linear than to circular gratings in the 20 cpd frequency. The older adult group was significantly more sensitive to linear than to circular gratings in all spatial frequencies, except in the 20 cpd frequency. The results suggest that sensitivity to the two kinds of stimuli is affected differently by aging. We suggest that neural changes in the aging brain are important determinants of this difference and discuss the results according to current models of human aging.