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Review
. 2022 Dec 1;42(4):428-441.
doi: 10.1097/WNO.0000000000001668. Epub 2022 Oct 21.

Tracking Eye Movements for Diagnosis in Myasthenia Gravis: A Comprehensive Review

Minh N L Nguyen  1 , Anneke van der Walt, Joanne Fielding, Meaghan Clough, Owen B White
Affiliations
Review

Tracking Eye Movements for Diagnosis in Myasthenia Gravis: A Comprehensive Review

Minh N L Nguyen et al. J Neuroophthalmol. .

Abstract

Background: Around 60%--75% of myasthenia gravis (MG) patients initially present with nonspecific ocular symptoms. Failed recognition of these symptoms may delay the diagnosis of MG up to 5 years or more, leading to a reduced likelihood of remission and increased morbidity. Current diagnostic tests are either poorly sensitive for patients presenting with ocular symptoms alone or are time consuming, invasive, require a high level of technical expertise, and generally are universally difficult to obtain. This review will explore quantitative eye and pupil tracking as a potential noninvasive, time-effective, and less technically demanding alternative to current diagnostic tests of MG.

Evidence acquisition: Comprehensive literature review.

Results: Thirty-two publications using oculography for the diagnosis of MG and 6 studies using pupillometry were evaluated. In MG patients, extra ocular muscle fatigue was evident in reports of intersaccadic, intrasaccadic and postsaccadic abnormalities, changes in optokinetic nystagmus, slow eye movements, disconjugate saccades, and pupillary constrictor muscle weakness.

Conclusions: Our review identified several potentially useful variables that derive from oculography and pupillometry studies that could assist with a timely diagnosis of MG. Limitations of this review include heterogeneity in design, sample size, and quality of the studies evaluated. There is a need for larger, well-designed studies evaluating eye-tracking measures in the diagnosis of MG, especially for patients presenting with purely ocular symptoms.

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Conflict of interest statement

M. N. L. Nguyen reports no conflicts of interest. A. van der Walt served on advisory boards and receives unrestricted research grants from Novartis, Biogen, Merck, and Roche. She has received speaker's honoraria and travel support from Novartis, Roche, and Merck. She receives grant support from the National Health and Medical Research Council of Australia and MS Research Australia. J. Fielding receives funding from Genzyme and Biogen and has received honorarium from Novartis. M. Clough, and O. B. White reports no conflicts of interest.

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