Title:
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Persistent visual impairment in people with multiple sclerosis : prevalence and functional consequences
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Impaired visual function is a concern for up to 80% of people who have received a
diagnosis of multiple sclerosis (Balcer 2015). Visual symptoms may represent the
most prominent symptoms in pwMS. In this project, the prevalence and impact of
persistent visual impairment in people with Multiple Sclerosis (pwMS) was assessed
in three stages.
Stage One gathered information on self-reported general function and visual function
from pwMS. Overall, pwMS reported MS to have a significant impact on daily
living using the MSIS-29 questionnaire, however the participants felt that vision
impacted less overall on quality of life using the VFQ-25+10 questionnaire. This
may be due, in part, to deficits we normally associate with vision being intact as the
results from Stage Two conclude, i.e. high contrast visual acuity (HCVA), visual
fields, ocular motility and colour vision.
Stage two provided a comprehensive clinical assessment of visual and general
function in pwMS including the measurement of Contrast Sensitivity Function (CSF)
using of the quick CSF (qCSF) computerized paradigm. The results concluded that
while HCVA was well preserved in the study population (97.3%), pwMS were found
to have significantly reduced CSF in both spatial (88.2%) and temporal domains
(90.9%).
Moreover, further investigation of the visual system including extra-cortical visual
processing areas in Stage Three suggested that the more severe the MS, the greater
the functional deficit not only in CSF but also in global motion and postural stability
assessment.
In addition to clinical measures of visual performance, the findings from Stage Three
suggest that structural measures using Optical Coherence Tomography (OCT) may
provide a biomarker for subclinical disease.
The study findings conclude that MS has a global effect on the visual system
affecting the afferent visual pathway (AVP), striate and extra-striate cortex.
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