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Acute optic neuritis: Unmet clinical needs and model for new therapies.

Galetta SL, Villoslada P, Levin N, Shindler K, Ishikawa H, Parr E, Cadavid D, Balcer LJ - Neurol Neuroimmunol Neuroinflamm (2015)

Bottom Line: Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI.The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined.Finally, we provide an overview of past and present investigational approaches for disease modification in ON.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA.

ABSTRACT
Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON.

No MeSH data available.


Related in: MedlinePlus

Relationship of thickness of retinal layers to quality of life and low-contrast visual acuityScatter plot and fitted linear regression line showing relationships of ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness to 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) composite scores and low-contrast visual acuity at 2.5% level. The regression lines represent fitted values for mean GCL + IPL thickness for each value of NEI-VFQ-25 or low-contrast visual acuity; the gray shaded areas show the 95% confidence intervals from the SEs of the predictions for the fitted lines. Linear correlations were significant. QOL = quality of life. Reprinted from Ophthalmology 119(6), Walter SD et al., Ganglion cell loss in relation to visual disability in multiple sclerosis, 1250–1257, 2012, with permission from Elsevier.26
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Figure 4: Relationship of thickness of retinal layers to quality of life and low-contrast visual acuityScatter plot and fitted linear regression line showing relationships of ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness to 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) composite scores and low-contrast visual acuity at 2.5% level. The regression lines represent fitted values for mean GCL + IPL thickness for each value of NEI-VFQ-25 or low-contrast visual acuity; the gray shaded areas show the 95% confidence intervals from the SEs of the predictions for the fitted lines. Linear correlations were significant. QOL = quality of life. Reprinted from Ophthalmology 119(6), Walter SD et al., Ganglion cell loss in relation to visual disability in multiple sclerosis, 1250–1257, 2012, with permission from Elsevier.26

Mentions: Visual deficits in patients with ON are likely to have a marked impact on daily activities and QOL. Patients frequently rate vision among the most important physical functions affected by MS.47 However, vision is poorly or insufficiently represented on standard objective measures of physical function, such as the Expanded Disability Status Scale, and functional assessment instruments, such as the Multiple Sclerosis Functional Composite (MSFC). Addition of SLCLA charts to the MSFC has been reported to better capture MS-related disability.48 One patient-reported outcome instrument, the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), has become a commonly used measurement of vision-specific health-related QOL. When administered to patients from the ONTT 5–8 years after the episode of acute ON, scores on the NEI-VFQ-25 were lower than for an older disease-free cohort.3 In patients with MS, correlations with NEI-VFQ-25 scores have been demonstrated for low-contrast visual acuity,49 binocular summation,12 motion perception,50 and loss of RGCs25 (figure 4). Moreover, a 10-item supplement has been developed to better capture aspects more relevant to neuro-ophthalmology, such as double vision and difficulties with viewing motion.51 A follow-up study has also reported its ability to distinguish patients with MS with a history of ON.52


Acute optic neuritis: Unmet clinical needs and model for new therapies.

Galetta SL, Villoslada P, Levin N, Shindler K, Ishikawa H, Parr E, Cadavid D, Balcer LJ - Neurol Neuroimmunol Neuroinflamm (2015)

Relationship of thickness of retinal layers to quality of life and low-contrast visual acuityScatter plot and fitted linear regression line showing relationships of ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness to 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) composite scores and low-contrast visual acuity at 2.5% level. The regression lines represent fitted values for mean GCL + IPL thickness for each value of NEI-VFQ-25 or low-contrast visual acuity; the gray shaded areas show the 95% confidence intervals from the SEs of the predictions for the fitted lines. Linear correlations were significant. QOL = quality of life. Reprinted from Ophthalmology 119(6), Walter SD et al., Ganglion cell loss in relation to visual disability in multiple sclerosis, 1250–1257, 2012, with permission from Elsevier.26
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4516397&req=5

Figure 4: Relationship of thickness of retinal layers to quality of life and low-contrast visual acuityScatter plot and fitted linear regression line showing relationships of ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness to 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) composite scores and low-contrast visual acuity at 2.5% level. The regression lines represent fitted values for mean GCL + IPL thickness for each value of NEI-VFQ-25 or low-contrast visual acuity; the gray shaded areas show the 95% confidence intervals from the SEs of the predictions for the fitted lines. Linear correlations were significant. QOL = quality of life. Reprinted from Ophthalmology 119(6), Walter SD et al., Ganglion cell loss in relation to visual disability in multiple sclerosis, 1250–1257, 2012, with permission from Elsevier.26
Mentions: Visual deficits in patients with ON are likely to have a marked impact on daily activities and QOL. Patients frequently rate vision among the most important physical functions affected by MS.47 However, vision is poorly or insufficiently represented on standard objective measures of physical function, such as the Expanded Disability Status Scale, and functional assessment instruments, such as the Multiple Sclerosis Functional Composite (MSFC). Addition of SLCLA charts to the MSFC has been reported to better capture MS-related disability.48 One patient-reported outcome instrument, the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), has become a commonly used measurement of vision-specific health-related QOL. When administered to patients from the ONTT 5–8 years after the episode of acute ON, scores on the NEI-VFQ-25 were lower than for an older disease-free cohort.3 In patients with MS, correlations with NEI-VFQ-25 scores have been demonstrated for low-contrast visual acuity,49 binocular summation,12 motion perception,50 and loss of RGCs25 (figure 4). Moreover, a 10-item supplement has been developed to better capture aspects more relevant to neuro-ophthalmology, such as double vision and difficulties with viewing motion.51 A follow-up study has also reported its ability to distinguish patients with MS with a history of ON.52

Bottom Line: Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI.The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined.Finally, we provide an overview of past and present investigational approaches for disease modification in ON.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA.

ABSTRACT
Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON.

No MeSH data available.


Related in: MedlinePlus