Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 14;5(5):e492.
doi: 10.1212/NXI.0000000000000492. eCollection 2018 Sep.

Temporal visual resolution and disease severity in MS

Noah Ayadi  1 , Jan Dörr  1 , Seyedamirhosein Motamedi  1 , Kay Gawlik  1 , Judith Bellmann-Strobl  1 , Janine Mikolajczak  1 , Alexander U Brandt  1 , Hanna Zimmermann  1 , Friedemann Paul  1
Affiliations

Temporal visual resolution and disease severity in MS

Noah Ayadi et al. Neurol Neuroimmunol Neuroinflamm. .

Abstract

Objective: To examine temporal visual resolution assessed as critical flicker frequency (CFF) in patients with MS and to investigate associations with visual system damage and general disability and cognitive function.

Methods: Thirty-nine patients with MS and 31 healthy controls (HCs) were enrolled in this cross-sectional study and underwent CFF testing, high- and low-contrast visual acuity, alertness and information processing speed using the paced auditory serial addition task (PASAT), and retinal optical coherence tomography (OCT). In patients with MS, visual evoked potentials (VEPs) and Expanded Disability Status Scale (EDSS) scores were assessed.

Results: CFF in patients with MS (mean ± SD: 40.9 ± 4.4 Hz) was lower than in HCs (44.8 ± 4.4 Hz, p < 0.001). There was no significant CFF difference between eyes with and without previous optic neuritis (ON). CFF was not associated with visual acuity, VEP latency, the peripapillary retinal nerve fiber layer thickness, and the combined ganglion cell and inner plexiform layer volume. Instead, reduced CFF was associated with worse EDSS scores (r2 = 0.26, p < 0.001) and alertness (r2 = 0.42, p = 0.00042) but not with PASAT (p = 0.33).

Conclusion: CFF reduction in MS occurs independently of ON and structural visual system damage. Its association with the EDSS score and alertness suggests that CFF reflects global disease processes and higher cortical processing rather than focal optic nerve or retinal damage.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Critical flicker frequency measurements in healthy controls
Comparison of CFF measurements between female and male HCs (A) and association of CFF measurements with age (B). HC = healthy control; mCFF = mean critical flicker frequency.
Figure 2
Figure 2. Critical flicker frequency measurements
Comparison of CFF measurements between HCs and patients with MS (A) and comparison of CFF measurements between eyes with optic neuritis (ON) and eyes without ON (NON) in patients with MS (B). HC = healthy control; mCFF = mean critical flicker frequency.
Figure 3
Figure 3. Critical flicker frequency measurements and visual function in MS
Association of CFF measurements with structural and visual functional parameters: pRNFL (A), GCIP (B), INL (C), TMV (D), HCVA (E), LCLA (F), P100 (G). After Bonferroni-Holm correction, no p value remained significant. GCIP = ganglion cell/inner plexiform layer; HCVA = high-contrast visual acuity; INL = inner nuclear layer; LCLA = low-contrast letter acuity; mCFF = mean critical flicker frequency; pRNFL = peripheral retinal nerve fiber layer; TMV = total macular volume; VEP = visual evoked potential.
Figure 4
Figure 4. Critical flicker frequency measurements in patients with MS
Association of CFF measurements with the EDSS (A) and with reaction time in MS (B). EDSS = Expanded Disability Status Scale; mCFF = mean critical flicker frequency.
See this image and copyright information in PMC

References

    1. Martínez-Lapiscina EH, Sanchez-Dalmau B, Fraga-Pumar E, et al. . The visual pathway as a model to understand brain damage in multiple sclerosis. Mult Scler 2014;20:1678–1685. - PubMed
    1. Kuchling J, Brandt AU, Paul F, Scheel M. Diffusion tensor imaging for multilevel assessment of the visual pathway: possibilities for personalized outcome prediction in autoimmune disorders of the central nervous system. EPMA J 2017;8:279–294. - PMC - PubMed
    1. Backner Y, Kuchling J, Massarwa S, et al. . Anatomical wiring and functional networking changes in the visual system following optic neuritis. JAMA Neurol 2018;75:287–295. - PMC - PubMed
    1. Schinzel J, Zimmermann H, Paul F, et al. . Relations of low contrast visual acuity, quality of life and multiple sclerosis functional composite: a cross-sectional analysis. BMC Neurol 2014;14:31. - PMC - PubMed
    1. Halliday AM, McDonald WI, Mushin J. Visual evoked response in diagnosis of multiple sclerosis. Br Med J 1973;4:661–664. - PMC - PubMed