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Leveraging visual outcome measures to advance therapy development in neuroimmunologic disorders

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Item Type:Review
Title:Leveraging visual outcome measures to advance therapy development in neuroimmunologic disorders
Creators Name:Graves, J.S. and Oertel, F.C. and Van der Walt, A. and Collorone, S. and Sotirchos, E.S. and Pihl-Jensen, G. and Albrecht, P. and Yeh, E.A. and Saidha, S. and Frederiksen, J. and Newsome, S.D. and Paul, F.
Abstract:The visual system offers unparalleled precision in the assessment of neuroaxonal damage. With the majority of patients with multiple sclerosis (MS) experiencing afferent and efferent visual dysfunction, outcome measures capturing these deficits provide insight into neuroaxonal injury, even in those with minimal disability. Ideal for use in clinical trials, visual measures are generally inexpensive, accessible, and reproducible. Quantification of visual acuity, visual fields, visual quality of life, and electrophysiologic parameters allows assessment of function, whereas optical coherence tomography (OCT) provides reliable measures of the structural integrity of the anterior afferent visual pathway. The technology of oculomotor biometrics continues to advance, and discrete measures of fixation, smooth pursuit, and saccadic eye movement abnormalities are ready for inclusion in future trials of MS progression. Visual outcomes allow tracking of neuroaxonal injury and aid in distinguishing MS from diseases such as neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody-associated diseases (MOGAD). OCT has also provided unique insights into pathophysiology, including the identification of foveal pitting in NMOSD, possibly from damage to Müller cells, which carry an abundance of aquaporin-4 channels. For some study designs, the cost-benefit ratio favors visual outcomes over more expensive MRI outcomes. With the next frontier of therapeutics focused on remyelination and neuroprotection, visual outcomes are likely to take center stage. As an international community of collaborative, committed, vision scientists, this review by the International MS Visual System Consortium (IMSVISUAL) outlines the quality standards, informatics, and framework needed to routinely incorporate vision outcomes into MS and NMOSD trials.
Keywords:CNS Demyelinating Autoimmune Diseases, Health Care Outcome Assessment, Vision Disorders, Vision Tests, Visual Pathways
Source:Neurology Neuroimmunology & Neuroinflammation
Publisher:American Academy of Neurology
Page Range:e1126
Date:March 2022
Official Publication:https://doi.org/10.1212/NXI.0000000000001126
PubMed:View item in PubMed

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