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Visual field impairment captures disease burden in multiple sclerosis

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Abstract

Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at high risk of disability progression will be useful for improving clinical-therapeutic decisions in clinical routine. To evaluate the role of visual field testing in non-optic neuritis eyes (non-ON eyes) as a biomarker of disability progression in MS. In 109 patients of the MS-VisualPath cohort, we evaluated the association between visual field abnormalities and global and cognitive disability markers and brain and retinal imaging markers of neuroaxonal injury using linear regression models adjusted for sex, age, disease duration and use of disease-modifying therapies. We evaluated the risk of disability progression associated to have baseline impaired visual field after 3 years of follow-up. Sixty-two percent of patients showed visual field defects in non-ON eyes. Visual field mean deviation was statistically associated with global disability; brain (normalized brain parenchymal, gray matter volume and lesion load) and retinal (peripapillary retinal nerve fiber layer thickness and macular ganglion cell complex thickness) markers of neuroaxonal damage. Patients with impaired visual field had statistically significative greater disability, lower normalized brain parenchymal volume and higher lesion volume than patients with normal visual field testing. MS patients with baseline impaired VF tripled the risk of disability progression during follow-up [OR = 3.35; 95 % CI (1.10–10.19); p = 0.033]. The association of visual field impairment with greater disability and neuroaxonal injury and higher risk of disability progression suggest that VF could be used to monitor MS disease burden.

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Acknowledgments

We are extremely grateful to the MS-VisualPath participants and fieldworkers without whose contribution, this study would not be possible.

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Authors and Affiliations

  1. Department of Neurology, Center of Neuroimmunology, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain

    Magí Andorra, Erika J. Lampert, Salut Alba-Arbalat, Ana M. Guerrero-Zamora, Irati Zubizarreta, Nuria Sola-Valls, Sara Llufriu, María Sepúlveda, Albert Saiz, Pablo Villoslada & Elena H. Martinez-Lapiscina

  2. Department of Ophthalmology, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain

    Santiago Ortiz-Perez, Bernardo Sanchez-Dalmau & Rubén Torres–Torres

  3. Investigacion Estadistica SL, Barcelona, Spain

    David Calbet

Authors
  1. Santiago Ortiz-Perez
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  2. Magí Andorra
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  3. Bernardo Sanchez-Dalmau
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  4. Rubén Torres–Torres
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  5. David Calbet
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  6. Erika J. Lampert
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  7. Salut Alba-Arbalat
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  8. Ana M. Guerrero-Zamora
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  9. Irati Zubizarreta
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  10. Nuria Sola-Valls
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  12. María Sepúlveda
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  13. Albert Saiz
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  14. Pablo Villoslada
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  15. Elena H. Martinez-Lapiscina
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Corresponding author

Correspondence to Elena H. Martinez-Lapiscina.

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Data

Elena H. Martínez-Lapiscina had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This study was supported by Instituto de Salud Carlos III, Spain: PS09/00259 and RD07/0060/01 to PV and RD12/0032/0002 to AS. EHML was supported by a fellowship from the Instituto de Salud Carlos III, Spain (Rio Hortega Program: CM13/00150). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflicts of interest

AS has received compensation for consulting services and speaking from Bayer-Schering, Merck-Serono, Biogen-Idec, Sanofi-Aventis, Teva Pharmaceutical Industries Ltd and Novartis. PV has received consultancy fees from Heidelberg Engineering regarding the clinical applications of optical coherence tomography. Elena H Martinez-Lapiscina has received for speaking honoraria from Biogen Idec and Genzyme and travel reimbursement from TEVA for The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and Sociedad Española de Neurología (SEN) and from Bayer Healthcare for American Academy of Neurology (AAN) over the last 3 years. All other authors have no conflicts of interest to declare.

Ethical standard

This means that the study has compliance with ethical standars which is a key requirement to obtain the approval by the mentioned committee.

Informed consent

It is stated in methods that Hospital Clinic of Barcelona Institutional Review Board approvals were obtained and all participants provided written informed consent.

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Ortiz-Perez, S., Andorra, M., Sanchez-Dalmau, B. et al. Visual field impairment captures disease burden in multiple sclerosis. J Neurol 263, 695–702 (2016). https://doi.org/10.1007/s00415-016-8034-2

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  • DOI: https://doi.org/10.1007/s00415-016-8034-2

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