Contributions
Abstract: P401
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Neuro-ophthalmology
Introduction: Opticus neuritis (ON) is a frequent manifestation of multiple sclerosis (MS). Determining threshold frequency of a flickering light (critical flicker fusion, CFF) allows early detection of visual impairment due to demyelination, and thus might play a role in substantiating the suspicion of an incipient ON, enabling early treatment-modification.
Aim and objectives: The aim of this study is to correlate CFF thresholds with visual acuity/contrast sensitivity in a population of MS patients with and without ON. Furthermore, CFF will be correlated to loss of retinal neurons, as quantified by inner retinal layer thickness using optical coherence tomography (OCT).
Methods: In this pilot study, 114 patients with MS and with prior optic neuritis (MS+ON; n=40) or without prior optic neuritis (MS-ON; n=74) and 89 controls (N) were tested in the Multilple Sclerosis Clinic of Aalborg University Hospital, Denmark, using several smartphone visual function tests (Landolt C acuity, Landolt C contrast sensitivity, and CFF). Testing was performed with the patient wearing their glasses at a distance of 0.4 meters.
The results were analyzed utilising Kruskal Wallis test with pairwise multiple comparisons using Dunn's method.
Results: Each smartphone test took approximately 15 seconds to complete and was intuitive enough that patients were able to immediately perform the task. Findings showed that CFF threshold values were significantly reduced in MS patients with or without previous ON compared to controls. As the only visual test, CFF showed no significant difference between MS-ON and MS+ON.
Statistical Comparison of Smartphone Visual Function Tests in MS Patients and Normals
Contrast Sensitivity
N vs. MS-ON P = 0,0006*
N vs. MS+ON P< 0,0001*
MS-ON vs. MS+ON P< 0,0066*
Visual Acuity
N vs. MS-ON P = 0,016*
N vs. MS+ON P < 0,0001*
MS-ON vs. MS+ON P = 0,0005*
CFF 15 Hz
N vs. MS-ON P = 0,0011*
N vs. MS+ON P = 0,0017*
MS-ON vs. MS+ON P = 0,0331
CFF 30 Hz
N vs. MS-ON P = 0,0001*
N vs. MS+ON P < 0,0001*
MS-ON vs. MS+ON P = 0,1213
Conclusion: Critical flicker fusion, a test of visual speed of conduction, provided some of the greatest discrimination between eyes of MS patients with or without a previous diagnosis of ON compared to normal eyes. This finding motivates the importance of using a behavioral visual test of visual conduction speed, such as critical flicker fusion, which is resistant to optical blur, to monitor various causes of visual dysfunction including MS.
Disclosure: Kasra Zarei: nothing to disclose
Sabina David: nothing to disclose
Claudia Christina Pfleger: nothing to disclose
Dalia Berman: nothing to disclose
Johannes Ledolter: nothing to disclose
Pieter Poolman: Personal Financial Interest (FaceX LLC)
Oliver Gramlich: nothing to disclose
Jane Bailey: nothing to disclose
Randy Kardon: Consultant (Novartis), Nonremunerative (Fight for Sight; Department of Veterans Affairs Research Foundation, Iowa City, IA), Personal Financial Interest (FaceX LLC),
Abstract: P401
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Neuro-ophthalmology
Introduction: Opticus neuritis (ON) is a frequent manifestation of multiple sclerosis (MS). Determining threshold frequency of a flickering light (critical flicker fusion, CFF) allows early detection of visual impairment due to demyelination, and thus might play a role in substantiating the suspicion of an incipient ON, enabling early treatment-modification.
Aim and objectives: The aim of this study is to correlate CFF thresholds with visual acuity/contrast sensitivity in a population of MS patients with and without ON. Furthermore, CFF will be correlated to loss of retinal neurons, as quantified by inner retinal layer thickness using optical coherence tomography (OCT).
Methods: In this pilot study, 114 patients with MS and with prior optic neuritis (MS+ON; n=40) or without prior optic neuritis (MS-ON; n=74) and 89 controls (N) were tested in the Multilple Sclerosis Clinic of Aalborg University Hospital, Denmark, using several smartphone visual function tests (Landolt C acuity, Landolt C contrast sensitivity, and CFF). Testing was performed with the patient wearing their glasses at a distance of 0.4 meters.
The results were analyzed utilising Kruskal Wallis test with pairwise multiple comparisons using Dunn's method.
Results: Each smartphone test took approximately 15 seconds to complete and was intuitive enough that patients were able to immediately perform the task. Findings showed that CFF threshold values were significantly reduced in MS patients with or without previous ON compared to controls. As the only visual test, CFF showed no significant difference between MS-ON and MS+ON.
Statistical Comparison of Smartphone Visual Function Tests in MS Patients and Normals
Contrast Sensitivity
N vs. MS-ON P = 0,0006*
N vs. MS+ON P< 0,0001*
MS-ON vs. MS+ON P< 0,0066*
Visual Acuity
N vs. MS-ON P = 0,016*
N vs. MS+ON P < 0,0001*
MS-ON vs. MS+ON P = 0,0005*
CFF 15 Hz
N vs. MS-ON P = 0,0011*
N vs. MS+ON P = 0,0017*
MS-ON vs. MS+ON P = 0,0331
CFF 30 Hz
N vs. MS-ON P = 0,0001*
N vs. MS+ON P < 0,0001*
MS-ON vs. MS+ON P = 0,1213
Conclusion: Critical flicker fusion, a test of visual speed of conduction, provided some of the greatest discrimination between eyes of MS patients with or without a previous diagnosis of ON compared to normal eyes. This finding motivates the importance of using a behavioral visual test of visual conduction speed, such as critical flicker fusion, which is resistant to optical blur, to monitor various causes of visual dysfunction including MS.
Disclosure: Kasra Zarei: nothing to disclose
Sabina David: nothing to disclose
Claudia Christina Pfleger: nothing to disclose
Dalia Berman: nothing to disclose
Johannes Ledolter: nothing to disclose
Pieter Poolman: Personal Financial Interest (FaceX LLC)
Oliver Gramlich: nothing to disclose
Jane Bailey: nothing to disclose
Randy Kardon: Consultant (Novartis), Nonremunerative (Fight for Sight; Department of Veterans Affairs Research Foundation, Iowa City, IA), Personal Financial Interest (FaceX LLC),