Retinal and Optic Nerve Degeneration in Patients with Multiple Sclerosis Followed up for 5 Years.

PURPOSE: To quantify retinal nerve fiber layer (RNFL) changes in patients with multiple sclerosis (MS) and healthy controls with a 5-year follow-up and to analyze correlations between disability progression and RNFL degeneration. DESIGN: Observational and longitudinal study. PARTICIPANTS: One hundred patients with relapsing-remitting MS and 50 healthy controls. METHODS: All participants underwent a complete ophthalmic and electrophysiologic exploration and were re-evaluated annually for 5 years. MAIN OUTCOME MEASURES: Visual acuity (Snellen chart), color vision (Ishihara pseudoisochromatic plates), visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (SLP), and visual evoked potentials. Expanded Disability Status Scale (EDSS) scores, disease duration, treatments, prior optic neuritis episodes, and quality of life (QOL; based on the 54-item Multiple Sclerosis Quality of Life Scale score). RESULTS: Optical coherence tomography (OCT) revealed changes in all RNFL thicknesses in both groups. In the MS group, changes were detected in average thickness and in the mean deviation using the GDx-VCC nerve fiber analyzer (Laser Diagnostic Technologies, San Diego, CA) and in the P100 latency of visual evoked potentials; no changes were detected in visual acuity, color vision, or visual fields. Optical coherence tomography showed greater differences in the inferior and temporal RNFL thicknesses in both groups. In MS patients only, OCT revealed a moderate correlation between the increase in EDSS and temporal and superior RNFL thinning. Temporal RNFL thinning based on OCT results was correlated moderately with decreased QOL. CONCLUSIONS: Multiple sclerosis patients exhibit a progressive axonal loss in the optic nerve fiber layer. Retinal nerve fiber layer thinning based on OCT results is a useful marker for assessing MS progression and correlates with increased disability and reduced QOL.

[Spectrum of ophthalmologic and social rehabilitation at the Tübinger Low-Vision Clinic : a retrospective analysis for 1999-2005]. / Ophthalmologische und soziale Rehabilitation sehbehinderter Patienten : Eine retrospektive Analyse an der Tübinger Sehbehindertenambulanz von 1999-2005.

BACKGROUND: In addition to medical care, the visual and social rehabilitation of low-vision patients is of increasing importance. The aim of our study was to evaluate the actual spectrum of patients concerning diagnoses and appropriate low-vision aids at a low-vision clinic. METHODS: In a retrospective study, the medical records of 4,711 patients treated at our low-vision clinic from January 1999 to December 2005 were reviewed and analyzed. The main outcome measurements were age, ophthalmologic diagnoses, magnification requirement, and prescribed low-vision aids, as well as social and professional rehabilitation measures. To evaluate the efficiency of visual rehabilitation, reading speed was measured in a subgroup of 930 patients before and after administration of low-vision aids. RESULTS: Age-related macular degeneration was, at 40%, the most frequent diagnosis. Other main diagnoses were tapetoretinal dystrophies, optic atrophy, and diabetic retinopathy. The median magnification need was 4x. A highly significant correlation existed between the measured magnification power and the magnification factor of the prescribed low-vision aids. Visual rehabilitation was frequently sufficient with simple optical low-vision aids such as high-plus reading additions and magnifiers. Closed-circuit television systems were necessary in 26%; however, 85% of these patients had a high magnification need of more than 6 x. For distance vision, a monocular telescope was the low-vision aid prescribed most often. A high proportion of patients needed more than two low-vision aids for different application areas. Forty percent of patients needed special social and professional rehabilitation measures. In a subgroup of 930 patients, the mean reading speed was 35+/-50 words/min before the use of low-vision aids, which increased significantly to 81+/-46 words/min with the use of such aids. Therefore, the reading speed essentially doubled following the use of low-vision aids. CONCLUSION: Our results provide actual, quantitative data about the need for and success of rehabilitation for visually impaired patients. A large number of patients suffer from age-related macular degeneration. Independent from the causal ophthalmologic diagnoses, most patients benefited greatly from the rehabilitation measures provided by the low-vision service and were thus able to improve their quality of life. In the face of the increasing number of visually impaired elderly patients, rehabilitation should start as early as possible.

Nonglaucomatous optic disk atrophy and excavation in the elderly.

The causes of nonglaucomatous optic disk atrophy and excavation are enumerated in people 65 years or older: congenital anomalies, myopia, ischemic disorders, transsynaptic degeneration, traumatic, compressive, hereditary, toxic and infectious optic neuropathy.

[The results of using therapeutic periorbital electrostimulations in neurology patients with partial atrophy of the optic nerves]. / Rezul'taty primeneniia lechebnykh periorbital'nykh élektrostimuliatsii u nevrologicheskikh bol'nykh s chastichnoi atrofiei zritel'nykh nervov.

Results of clinical application of method of non-contact periorbital electrostimulation in 6 groups of neurologic patients (total number-246) with optic nerve pathology of different origin (post-traumatic, hypertensive, inflammatory) are summarized. Analysis of interdependence between positive results and severity of visual disorders, type of the disease, responsible for partial atrophy of optic nerve, was performed. This method of restoration of vision in investigated patients proved to be effective both in hospitals and outpatient departments.

Low vision rehabilitation of multiple sclerosis: a case report.

A 34-year-old white male presented with a previous diagnosis of optic atrophy secondary to multiple sclerosis, seeking low vision rehabilitation. This case report is presented to illustrate the importance of prescribing both conventional optical low vision devices, as well as computer low vision aids in order to provide comprehensive low vision rehabilitation for a young visually impaired adult.

Leber optic atrophy low vision case report.

Leber optic atrophy (LOA) is a familial disorder primarily affecting males. We report the case of a 44-year-old male for whom the prescription of low vision aids was an important rehabilitative factor.

[Low-vision aids in visually handicapped children (author's transl)]. / Verordnung von Sehhilfen bei sehbehinderten Kindern

It is reported on 71 visually handicapped pupils. The visual acuity of 48 of these children could be tested with low-vision aids and the electronic television reading apparatus (Reinecker). With telescopic glasses (Zeiss, Keeler) 31 children had an average improvement of their visual acuity of two lines on a test board for near vision (Birkhäuser). With the reading apparatus 43 children showed an improvement of the visual acuity of 5 more lines. Only 3 to 21 pupils, who had been offered a regular use of the telescopic glasses, decided to have one. Finally our own experiences are compared with those of other authors.