Highlights
- •Visual problems are common in MS and have a variety of causes.
- •Initial assessment of the patient should be by an optometrist.
- •Neuro-ophthalmology assessment should follow, if necessary.
- •Drug treatment should be tried for oscillopsia due to acquired pendular nystagmus.
- •If sight remains poor, registration with a visual impairment should occur.
Abstract
Multiple sclerosis can affect vision in many ways, including optic neuritis, chronic
optic neuropathy, retrochiasmal visual field defects, higher order cortical processing,
double vision, nystagmus and also by related ocular conditions such as uveitis. There
are also side effects from recently introduced multiple sclerosis treatments that
can affect vision. This review will discuss all these aspects and how they come together
to cause visual symptoms. It will then focus on practical aspects of how to recognise
when there is a vision problem in a multiple sclerosis patient and on what treatments
are available to improve vision.
Abbreviations:
EDSS (expanded disability status scale), EQ-5D (EuroQuol questionnaire), ETDRS (early treatment diabetic retinopathy study), MRI (magnetic resonance imaging), MS (multiple sclerosis), MSVQ-7 (MS-specific vision questionnaire), NARCOMS (North American Research Committee on Multiple Sclerosis), NEI-VFQ 25 (25-Item National Eye Institute visual function questionnaire), NICE (National Institute of Health and Clinical Excellence), ONTT (Optic Neuritis Treatment Trial), OCT (optical coherence tomography), PML (progressive multifocal leucoencephalopathy), RNFL (retinal nerve fibre layer), UFOV (useful field of vision), UK (United Kingdom), VEP (visual evoked potentials)Keywords
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References
- Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis.Journal of the American Association for Pediatric Ophthalmology and Strabismus. 2009; 13: 13-15
- A double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus.Annals of Neurology. 1997; 41: 818-825
- Contrast letter acuity as a visual component for the Multiple Sclerosis Functional Composite.Neurology. 2003; 61: 1367-1373
- Gabapentin but not vigabatrin is effective in the treatment of acquired nystagmus in multiple sclerosis: how valid is the GABAergic hypothesis?.Journal of Neurology, Neurosurgery and Psychiatry. 2001; 71: 107-110
- The ocular manifestations of multiple sclerosis. 2. Abnormalities of eye movements.Journal of Neurology, Neurosurgery and Psychiatry. 1992; 55: 863-868
- Acquired pendular nystagmus in multiple sclerosis: clinical observations and the role of optic neuropathy.Journal of Neurology, Neurosurgery and Psychiatry. 1993; 56: 262-267
- Interferon as a treatment for uveitis associated with multiple sclerosis.British Journal of Ophthalmology. 2005; 89: 1254-1257
- Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS).Journal of the International Neuropsychological Society. 2006; 12: 549-558
- Multiple sclerosis associated with uveitis in two large clinic-based series.Neurology. 1999; 52: 179-181
- Mild visual acuity disturbances are associated with performance on tests of complex visual attention in MS.Journal of the International Neuropsychological Society. 2007; 13: 544-548
- Leading causes of certification for blindness and partial sight in England & Wales.BioMed Central Public Health. 2006; 6: 58
- Bilateral and recurrent optic neuritis in multiple sclerosis.Acta Neurologica Scandinavica. 2011; 123: 207-210
- Provocative test for early diagnosis of multiple sclerosis.Documenta Ophthalmologica. 1985; 61: 113-118
- Cognitive impairment in multiple sclerosis.The Lancet Neurology. 2008; 7: 1139-1151
- Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: Lessons from 28 cases.Lancet Neurology. 2010; 9: 438-446
- Natural history of multiple sclerosis: a unifying concept.Brain. 2006; 129: 606-616
- Should optical coherence tomography be used to manage patients with multiple sclerosis?.Journal of Neuro-Ophthalmology. 2012; 32: 363-371
- MRI of optic nerve and postchiasmal visual pathways and visual evoked potentials in secondary progressive multiple sclerosis.Neuroradiology. 1998; 40: 765-770
- Abnormal eye movements predict disability in MS: two-year follow-up.Annals of the New York Academy of Science. 2005; 1039: 521-523
- Pars planitis: a 20-year study of incidence, clinical features, and outcomes.American Journal of Ophthalmology. 2007; 144: 812-817
- A model of Alexander's law of vestibular nystagmus.Biological Cybernetics. 1979; 34: 181-186
- Saccadic and vestibular abnormalities in multiple sclerosis: sensitive clinical signs of brainstem and cerebellar involvement.Annals of the New York Academy of Science. 2002; 956: 438-440
- Neurological disease activity in multiple sclerosis patients with periphlebitis retinae.Acta Neurologica Scandinavica. 1986; 73: 168-172
- Visual resolution in a patient exhibiting a visual fatigue or saturation-like effect: probable multiple sclerosis.Archives of Ophthalmology. 1979; 97: 76-78
- Memantine for axonal loss of optic neuritis.Graefes Archive of Clinical and Experimental Ophthalmology. 2012; 250: 863-869
- Unsteady gaze fixation enhances the severity of MS intention tremor.Neurology. 2008; 70: 106-113
- Dementia in two histologically confirmed cases of multiple sclerosis: one case with isolated dementia and one case associated with psychiatric symptoms.Journal of Neurology Neurosurgery and Psychiatry. 1994; 57: 353-359
- Evaluation of the visual system in multiple sclerosis. II. Colour vision.Acta Neurologica Scandinavica. 1986; 74: 203-209
- Insidious atrophy of retinal nerve fibers in multiple sclerosis: funduscopic identification in patients with and without visual complaints.Archives of Ophthalmology. 1974; 92: 91-97
- Visual acuity in optic atrophy: a quantitative clinicopathological analysis.Graefes Archive of Clinical and Experimental Ophthalmology. 1984; 222: 71-74
- The neuro-ophthalmology of multiple sclerosis.Lancet Neurology. 2005; 4: 111-121
- Measures of visual pathway structure and function in MS: clinical usefulness and role for MS trials.Multiple Sclerosis and Related Disorders. 2013; 2: 172-182
- Visual evoked response in diagnosis of multiple sclerosis.British Medical Journal. 1973; 4: 661-664
- Occurrence of a multiple sclerosis-like illness in women who have a Leber's hereditary optic neuropathy mitochondrial DNA mutation.Brain. 1992; 115: 979-989
- Colour vision abnormalities in multiple sclerosis.Canadian Journal of Neurological Sciences. 1987; 14: 279-285
- Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable.Multiple Sclerosis Journal. 2008; 14: 988-991
- An investigation of the retinal nerve fibre layer in progressive multiple sclerosis using optical coherence tomography.Brain. 2008; 131: 277-287
- Neurological visual field defects.Neuro-Ophthalmology. 2011; 35: 242-250
- Optic nerve imaging in multiple sclerosis.Journal of Neuroimaging. 2007; 17: 42S-45S
- Management of acute optic neuritis.The Lancet. 2002; 360: 1953-1962
- Optic neuritis: an update typical and atypical optic neuritis.Neuro-Ophthalmology. 2008; 32: 237-248
- Frequent involvement of the optic radiations in patients with acute isolated optic neuritis.Neurology. 1992; 42: 77-79
- Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy.Neurology. 2013; 80: 1-5
- Fingolimod-associated macular edema: incidence, detection, and management.Neurology. 2012; 78: 672-680
- Combined pharmacologic and surgical approach to acquired nystagmus due to multiple sclerosis.American Journal of Ophthalmology. 2002; 134: 780-782
- The multiple facets of multiple sclerosis.The American Orthoptic Journal. 2007; 57: 69-78
- Baseline visual field profile of optic neuritis. The experience of the Optic Neuritis Treatment Trial.Archives of Ophthalmology. 1993; 111: 231-234
- Clinical manifestations of multiple sclerosis.in: Handbook of clinical neurology. vol. 9. North Holland Publishing Company, Amsterdam1970 (p. 161–216)
- Visual object recognition in multiple sclerosis.Journal of the Neurological Sciences. 2001; 185: 77-88
- Impact of visual impairment on quality of life: a comparison with quality of life in the general population and with other chronic conditions.Ophthalmic Epidemiology. 2007; 14: 119-126
- What is low vision? A re-evaluation of definitions.Optometry and Vision Science. 1999; 76: 198-211
- Uveitis associated with multiple sclerosis.Multiple Sclerosis Journal. 2008; 14: 415-417
- Memantine for cognitive impairment in multiple sclerosis: a randomized placebo-controlled trial.Multiple Sclerosis Journal. 2010; 16: 715-723
- Self-reported visual dysfunction in multiple sclerosis: new data from the VFQ-25 and development of an MS- specific vision questionnaire.American Journal of Ophthalmology. 2002; 133: 686-692
- Alexia without agraphia in multiple sclerosis: case report with magnetic resonance imaging localization.Multiple Sclerosis Journal. 2004; 10: 705-707
- Helping blind and partially sighted people to read: the effectiveness of low vision aids.British Journal of Ophthalmology. 2000; 84: 919-921
- Substantial adverse association of visual and vascular comorbidities on visual disability in multiple sclerosis.Multiple Sclerosis Journal. 2011; 17: 1464-1471
- The pharmacological treatment of acquired nystagmus.Practical Neurology. 2012; 12: 147-153
- A randomized trial of memantine as treatment for spasticity in multiple sclerosis.Multiple Sclerosis Journal. 2010; 16: 248-251
- Advanced lightweight cooling-garment technology: functional improvements in thermosensitive patients with multiple sclerosis.Multiple Sclerosis Journal. 2007; 13: 232-237
- Chromatic discrimination losses in multiple sclerosis patients with and without optic neuritis using the Cambridge Colour Test.Visual Neuroscience. 2008; 25: 463-468
- Botulinum toxin in the management of internuclear ophthalmoplegia.Journal of the American Association for Pediatric Ophthalmology and Strabismus. 2007; 11: 456-459
- Spectral filters can improve reading and visual search in patients with multiple sclerosis.Journal of Neurology. 2007; 254: 1729-1735
NHS National Institute for Health and Clinical Excellence. Clinical Guideline 8: Multiple Sclerosis: Management of multiple sclerosis in primary and secondary care. Issue date: November 2003.
- Factors perceived as being related to accidental falls by persons with multiple sclerosis.Disability and Rehabilitation. 2009; 31: 1301-1310
- An unusual presentation of optic neuritis and the Pulfrich phenomenon.Journal of Neurology, Neurosurgery and Psychiatry. 2007; 78: 906-907
- Visual function 15 years after optic neuritis: a final follow-up report from the optic neuritis treatment trial.Ophthalmology. 2008; 115: 1079-1082
- The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological lesions: a quantitative study.Brain. 1987; 110: 1579-1616
- Multiple sclerosis associated with Leber's Hereditary Optic Neuropathy.Journal of the Neurological Sciences. 2009; 286: 24-27
- Symptomatic retrochiasmal lesions in multiple sclerosis: clinical features, visual evoked potentials, and magnetic resonance imaging.Neurology. 1992; 42: 68-76
- Ocular comorbidity in multiple sclerosis.The Lancet. 2003; 361: 1230
- The neuro-ophthalmologic and electrophysiologic evaluation of hypothermia in multiple sclerosis patients with a history of optic neuritis.Multiple Sclerosis Journal. 2010; 16: S270-S271
- Global data on visual impairment in the year 2002.Bulletin of the World Health Organization. 2004; 82: 844-851
- Eye movement disorders in multiple sclerosis and optic neuritis.Brain. 1983; 106: 121-140
Royal National Institute of Blind People. Available from: 〈http://www.rnib.org.uk/livingwithsightloss/registeringsightloss/pages/registration_benefits.aspx〉. [accessed 19.12.12].
- Recommendations from the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force.Annals of Neurology. 1997; 42: 379-382
Salter AR, Tyry T, Vollmer T, Cutter GR, Marrie RA. “Seeing” in NARCOMS: a look at vision- related quality of life in the NARCOMS registry. Multiple Sclerosis Journal, in press.
- The prevalence of nystagmus: the Leicestershire nystagmus survey.Investigative Ophthalmology & Visual Science. 2009; 50: 5201-5206
- Improvement of internuclear ophthalmoparesis in a multiple sclerosis patient taking dalfampridine.Neurology. 2013; 80 (Meeting Abstracts 1): P06.015
- Influence of cognitive impairment on driving performance in multiple sclerosis.Neurology. 2001; 56: 1089-1094
- Vision and driving in multiple sclerosis.Archives of Physical Medicine and Rehabilitation. 2010; 91: 315-317
- Examining the relationship between cognition and driving performance in multiple sclerosis.Archives of Physical Medicine and Rehabilitation. 2010; 91: 465-473
- The effects of gabapentin and memantine in acquired and congenital nystagmus: a retrospective study.British Journal of Ophthalmology. 2006; 90: 839-843
- Subclinical visual involvement in multiple sclerosis: a study by MRI, VEPs, frequency-doubling perimetry, standard perimetry, and contrast sensitivity.Investigative Ophthalmology & Visual Science. 2005; 46: 1264-1268
- The pathophysiology of multiple sclerosis: the mechanisms underlying The production of symptoms and the natural history of the disease.Philosophical Transactions of the Royal Society of London B. 1999; 354: 1649-1673
- Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin.Journal of Neurology. 2010; 257: 322-327
- Drug therapy for acquired pendular nystagmus in multiple sclerosis.Journal of Neurology. 1997; 244: 9-16
- The morbidity of multiple sclerosis.Quarterly Journal of Medicine. 1992; 83: 325-337
- Visual fatigue phenomenon and prescribing tinted lenses in patients with optic neuritis.British Journal of Ophthalmology. 1984; 68: 208-211
- Visual function more than 10 years after optic neuritis: experience of the Optic Neuritis Treatment Trial.American Journal of Ophthalmology. 2004; 137: 77-83
- Crossover trial of gabapentin and memantine as treatment for acquired nystagmus.Annals of Neurology. 2010; 67: 676-680
- Persistent ocular motor manifestations and related visual consequences in multiple sclerosis.in: Basic and clinical ocular motor and vestibular research. vol. 1233. Annals of the New York Academy of Science, 2011 (p. 327–34)
- Retinal periphlebitis in multiple sclerosis: a marker of disease activity?.European Neurology. 1993; 33: 93-96
- Adaptive cortical plasticity in higher visual processing areas after acute optic neuritis.Annals of Neurology. 2005; 57: 622-633
- Memantine induces reversible neurologic impairment in patients with MS.Neurology. 2009; 72: 1630-1633
- Visuoperceptual impairment in multiple sclerosis patients diagnosed with neuropsychological tasks.Multiple Sclerosis Journal. 2000; 6: 241-254
- Long- and short-term variability of automated perimetry results in patients with optic neuritis and healthy subjects.Archives of Ophthalmology. 1998; 116: 53-61
- The one-and-a-half syndrome—a unilateral disorder of the pontine tegmentum: a study of 20 cases and review of the literature.Neurology. 1983; 33: 971-980
- The pathophysiology of acute optic neuritis. An association of gadolinium leakage with clinical and electrophysiological deficits.Brain. 1991; 114: 2437-2450
Article info
Publication history
Published online: June 10, 2013
Accepted:
April 29,
2013
Received:
February 20,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
