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. 2025 Jun 16:16:1569451.
doi: 10.3389/fneur.2025.1569451. eCollection 2025.

Impact of visual discomfort symptoms on SDMT performance among persons with MS

Michelle H Chen  1   2 , Timothy J Rich  3   4 , Nancy Chiaravalloti  4   5 , Yael Goverover  6 , Silvana L Costa  4   5
Affiliations

Impact of visual discomfort symptoms on SDMT performance among persons with MS

Michelle H Chen et al. Front Neurol. .

Abstract

Background: Visual problems are common among persons with multiple sclerosis (MS) and may interfere with the assessment of cognitive functioning using visually mediated neuropsychological tests. The current study explored visual discomfort symptoms among persons with MS compared to healthy controls (HCs), using the Visual Discomfort Scale (VDS), which measures somatic and perceptual visual discomfort symptoms that interfere with reading.

Methods: Eighty-nine persons with MS and 30 HCs completed the VDS and the Symbol Digit Modalities Test (SDMT), a visually mediated test of information processing speed and gold standard for screening for MS-related cognitive dysfunction.

Results: Persons with MS endorsed higher frequencies of visual discomfort symptoms, including seeing the text or background moving or fading, headache/eye soreness, blurriness/diplopia, having to re-read, and slow reading, compared to HCs. More frequent visual discomfort symptoms were associated with worse performance on the SDMT. For participants with MS reporting moderate/high levels of visual discomfort symptoms, having a longer disease duration or progressive disease courses were correlated with worse performance on the SDMT.

Conclusion: It is important for clinicians to ask about specific visual discomfort problems that the patient experiences when interpreting a visually-mediated neuropsychological test such as the SDMT, especially for MS patients with longer disease duration or a progressive disease course.

Keywords: information processing speed; multiple sclerosis; symbol digit modalities test; visual discomfort scale; visual impairment.

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Conflict of interest statement

The 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.

Figures

Figure 1
Figure 1
Association between VDS and SDMT. VDS, visual discomfort scale. SDMT, symbol digit modalities test. Error band represents 95% confidence intervals.
Figure 2
Figure 2
Moderating effects of MS disease characteristics on the relationships between VDS and SDMT. (A) Shows the moderating effect of VDS range on the relationship between MS disease duration and SDMT score. (B) Shows the moderating effect of VDS range on the relationship between MS disease course and SDMT score. VDS, visual discomfort scale; SDMT, symbol digit modalities test. Error bands/bars represent 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Wallin MT, Culpepper WJ, Nichols E, Bhutta ZA, Gebrehiwot TT, Hay SI, et al. Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol. (2019) 18:269–85. doi: 10.1016/S1474-4422(18)30443-5, PMID: - DOI - PMC - PubMed
    1. Costello F. The afferent visual pathway: designing a structural-functional paradigm of multiple sclerosis. ISRN Neurol. (2013) 2013:1–17. doi: 10.1155/2013/134858, PMID: - DOI - PMC - PubMed
    1. Jasse L, Vukusic S, Durand-Dubief F, Vartin C, Piras C, Bernard M, et al. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler. (2013) 19:1618–26. doi: 10.1177/1352458513479840, PMID: - DOI - PubMed
    1. Balcer LJ, Miller DH, Reingold SC, Cohen JA. Vision and vision-related outcome measures in multiple sclerosis. Brain. (2015) 138:11–27. doi: 10.1093/brain/awu335, PMID: - DOI - PMC - PubMed
    1. Ma S-L, Shea JA, Galetta SL, Jacobs DA, Markowitz CE, Maguire MG, et al. Self-reported visual dysfunction in multiple sclerosis: new data from the VFQ-25 and development of an MS-specific vision questionnaire. Am J Ophthalmol. (2002) 133:686–92. doi: 10.1016/S0002-9394(02)01337-5, PMID: - DOI - PubMed

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