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. 2024 Aug 19:15:1431394.
doi: 10.3389/fimmu.2024.1431394. eCollection 2024.

Heterophoria in multiple sclerosis patients: a proof of principle cross-sectional study

Jonas Graf #  1 , Margit Weise #  1 , Tanja Guthoff  2 , Carolin Balloff  1   3 , Marcia Gasis  1 , Heike Link  4 , Sebastian Küchlin  4 , Wolf Lagrèze  4 , Sven G Meuth  1 , Orhan Aktas #  1 , Philipp Albrecht #  1   3
Affiliations

Heterophoria in multiple sclerosis patients: a proof of principle cross-sectional study

Jonas Graf et al. Front Immunol. .

Abstract

Objectives: The pathophysiology of multiple sclerosis (MS) involves inflammatory neurodegeneration in the brainstem, cerebellum, and retina. The clinical relevance of oculomotor involvement in MS, however, remains uncertain.

Methods: In this cross-sectional study, we evaluated heterophoria as a (sub)clinical tool in 54 MS patients and 55 age-matched healthy controls (HCs). We quantified heterophoria in prism diopters for distance and near range with orthoptic examination. Our primary outcome was high degrees of horizontal heterophoria (HDHH) defined as measurements beyond ±2 standard deviations from the mean prism diopter of heterophoria of our HCs.

Results: More than one-third (37%, n=20/54) of MS patients but only 11% (n=6/55) of HCs were classified as HDHH [distance, MS=9% (n=5/54) versus HC=6% (n=3/55); near, MS=19% (n=10/54) versus HC=5% (n=3/55)]. Our MS patients presented more combined vertical and horizontal deviations at near range [MS 19% (n=10/54) versus for HC 7% (n=4/55)]. We observed the combination of HDHH both at distance and at near testing in 9% (n=5/54) of MS patients but not at all in HCs (n=0/55).

Discussion: Despite the high prevalence of heterophoria, HDHH may be an additional (sub)clinical tool of subclinical involvement in MS. Thus, orthoptic examination may be an additional tool to improve MS diagnostic procedures.

Keywords: clinical assessment; heterophoria; multiple sclerosis; orthoptic assessment; screening.

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Conflict of interest statement

JG has received within the past 3 years a Research Fellowship from the German Research Foundation DFG, project number 438899010. SM received honoraria for lecturing and travel expenses for attending meetings from Almirall, Amicus Therapeutics Germany, Bayer Health Care, Biogen, Celgene, Diamed, Genzyme, MedDay Pharmaceuticals, Merck Serono, Novartis, Novo Nordisk, ONO Pharma, Roche, Sanofi-Aventis, Chugai Pharma, QuintilesIMS, and Teva. His research funded by the German Ministry for Education and Research BMBF, German Research Foundation DFG, Else Kröner Fresenius Foundation, German Academic Exchange Service, Hertie Foundation, Interdisciplinary Center for Clinical Studies IZKF Muenster, German Foundation Neurology, and by Almirall, Amicus Therapeutics Germany, Biogen, Diamed, Fresenius Medical Care, Genzyme, Merck Serono, Novartis, ONO Pharma, Roche, and Teva. OA received, with approval of the Rector of Heinrich-Heine University, grants from the German Research Foundation DFG, the German Ministry for Education and Research BMBF as part of the German Competence Network Multiple Sclerosis KKNMS; for NEMOS NationNMO-PAT FKZ 01GI1602B, the Eugène Devic European Network EU-FP7, honoraria and travel/accommodation/meeting expenses from Alexion, Almirall, Biogen, Horizon, Janssen Cilag, Merck Serono, Novartis, Roche, and Sanofi-Genzyme. OA is founding member and co-coordinator of the German Neuromyelitis optica-Study Group NEMOS, www.nemos-net.de and member of the European Reference Network for Rare Eye Diseases ERN-EYE, co-funded by the Health Program of the European Union under the Framework Partnership Agreement No 739534 “ERN-EYE.” PA received, with approval of the Rector of Heinrich-Heine University and the CEO of University of Düsseldorf Hospital, personal fees, research grants, and/or non-financial support from Allergan, Biogen, Bristol Myers Squibb, Celgene, German Research Foundation DFG, EFRE-NRW, Janssen Cilag, Ipsen, Merck Serono, Merz Pharmaceuticals, Novartis, and Roche, and personal fees and non-financial support from Bayer Healthcare, Teva, and Sanofi-Aventis/Genzyme, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Proportion of multiple sclerosis (MS) patients and healthy controls (HCs) with and without heterophoria. Plots show results of the alternating cover test for distance (A) and near (B) range and the Maddox rod method for distance (C) and near (D) range, grouped by orthophoria, exophoria, and esophoria (“+ vertical” indicates the presence of an additional vertical deviation). Lack of Measurement data for five HCs (A, B). One HC and three MS patients were excluded because of suppression of fixation light distance (C).
See this image and copyright information in PMC

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