Contrast letter acuity as a visual component for the Multiple Sclerosis Functional Composite.

BACKGROUND: Visual dysfunction is one of the most common causes of disability in multiple sclerosis (MS). The Multiple Sclerosis Functional Composite (MSFC), a new clinical trial outcome measure, does not currently include a test of visual function. OBJECTIVE: To examine contrast letter acuity as a candidate visual function test for the MSFC. METHODS: Binocular contrast letter acuity testing (Sloan charts) was performed in a subgroup of participants from the International Multiple Sclerosis Secondary Progressive Avonex Controlled Trial (IMPACT Substudy) and in MS patients and disease-free control subjects from a cross-sectional study of visual outcome measures (Multiple Sclerosis Vision Prospective cohort [MVP cohort]). High-contrast visual acuity was measured in both studies; MVP cohort participants underwent additional binocular testing for contrast sensitivity (Pelli-Robson chart), color vision (D-15 desaturated test), and visual field (Esterman test, Humphrey Field Analyzer II). RESULTS: Contrast letter acuity (Sloan charts, p < 0.0001, receiver operating characteristic curve analysis) and contrast sensitivity (Pelli-Robson chart, p = 0.003) best distinguished MS patients from disease-free control subjects in the MVP cohort. Correlations of Sloan chart scores with MSFC and Expanded Disability Statue Scale (EDSS) scores in both studies were significant and moderate in magnitude, demonstrating that Sloan chart scores reflect visual and neurologic dysfunction not entirely captured by the EDSS or MSFC. CONCLUSIONS: Among clinical measures, contrast letter acuity (Sloan charts) and contrast sensitivity (Pelli-Robson chart) demonstrate the greatest capacity to identify binocular visual dysfunction in MS. Sloan chart testing also captures unique aspects of neurologic dysfunction not captured by current EDSS or MSFC components, making it a strong candidate visual function test for the MSFC.

A Multiple Sclerosis (MS) Center Injection Training Program.

Injectable treatments for Multiple Sclerosis inspire hope and challenges. Abilities, anxiety levels and acceptance of treatment modalities vary so a creative program and comprehensive care plan combined to meet individual needs. A flexible, two session program developed at the University of Pennsylvania MS Center includes planning, practice, and even "homework" before the initiation of drug therapy. Hints are given to manage anticipated side effects and written instructions supplement product literature. Training focuses on subcutaneous or intramuscular injection technique. Since IM injections require special skills, those prescribed Avonex (beta Interferon la) are given "anatomy lessons"; they ease tension and are fun. Learning is informal, stories are shared and expectations discussed. The patient is encouraged to maintain an informed, active role in his care, adopt a wellness lifestyle and participate fully in goals of treatment. Physical, psychological and cognitive capabilities are assessed. Safety, compliance, and relationship issues are evaluated. Rapport developed during training goes far to promote adherence to therapy, minimize lifestyle disruption and preserve an acceptable quality of life. The nurse as liaison to other professionals, particularly the prescribing physician, facilitates innovative management of treatment issues. Moving patients and carepartners toward self responsibility, informed choices and competent administration of treatments benefits all. New models of care develop and by empowering others, we empower ourselves.