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Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Lo...
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| Published in: | Multiple sclerosis 2017-04, Vol.23 (5), p.734-747 |
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| container_title | Multiple sclerosis |
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| creator | Balcer, Laura J Raynowska, Jenelle Nolan, Rachel Galetta, Steven L Kapoor, Raju Benedict, Ralph Phillips, Glenn LaRocca, Nicholas Hudson, Lynn Rudick, Richard |
| description | Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS. |
| doi_str_mv | 10.1177/1352458517690822 |
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As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.</description><identifier>ISSN: 1352-4585</identifier><identifier>EISSN: 1477-0970</identifier><identifier>DOI: 10.1177/1352458517690822</identifier><identifier>PMID: 28206829</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acuity ; Electroretinograms ; Evoked Potentials, Visual - physiology ; Humans ; Invited Reviews ; Magnetic resonance imaging ; Multiple sclerosis ; Multiple Sclerosis - diagnosis ; Multiple Sclerosis - pathology ; Neuritis ; Neuroimaging ; Neurologic Examination - methods ; Neurological diseases ; NMR ; Nuclear magnetic resonance ; Optic neuritis ; Outcome Assessment (Health Care) - methods ; Quality of Life ; Retina ; Stroke ; Visual Acuity - physiology ; Visual evoked potentials ; Visual perception</subject><ispartof>Multiple sclerosis, 2017-04, Vol.23 (5), p.734-747</ispartof><rights>The Author(s), 2017</rights><rights>The Author(s), 2017 2017 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c598t-5c646b989d5df65cdbd42cd1400e6d9022e20cfee8ea873c29f6d79b0e4d9df03</citedby><cites>FETCH-LOGICAL-c598t-5c646b989d5df65cdbd42cd1400e6d9022e20cfee8ea873c29f6d79b0e4d9df03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28206829$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Balcer, Laura J</creatorcontrib><creatorcontrib>Raynowska, Jenelle</creatorcontrib><creatorcontrib>Nolan, Rachel</creatorcontrib><creatorcontrib>Galetta, Steven L</creatorcontrib><creatorcontrib>Kapoor, Raju</creatorcontrib><creatorcontrib>Benedict, Ralph</creatorcontrib><creatorcontrib>Phillips, Glenn</creatorcontrib><creatorcontrib>LaRocca, Nicholas</creatorcontrib><creatorcontrib>Hudson, Lynn</creatorcontrib><creatorcontrib>Rudick, Richard</creatorcontrib><creatorcontrib>Multiple Sclerosis Outcome Assessments Consortium</creatorcontrib><title>Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis</title><title>Multiple sclerosis</title><addtitle>Mult Scler</addtitle><description>Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.</description><subject>Acuity</subject><subject>Electroretinograms</subject><subject>Evoked Potentials, Visual - physiology</subject><subject>Humans</subject><subject>Invited Reviews</subject><subject>Magnetic resonance imaging</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - diagnosis</subject><subject>Multiple Sclerosis - pathology</subject><subject>Neuritis</subject><subject>Neuroimaging</subject><subject>Neurologic Examination - methods</subject><subject>Neurological diseases</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Optic neuritis</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Quality of Life</subject><subject>Retina</subject><subject>Stroke</subject><subject>Visual Acuity - physiology</subject><subject>Visual evoked potentials</subject><subject>Visual perception</subject><issn>1352-4585</issn><issn>1477-0970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><recordid>eNp1kc1rFTEUxYMo9kP3riTgxs3oTWYySTaCFLVCwY26DXnJnZqSmTyTSUv_ezO8WmrBVQLnd09y7iHkFYN3jEn5nvWCD0IJJkcNivMn5JgNUnagJTxt9yZ3m35ETkq5AgApe_GcHHHFYVRcHxP8aWPwYb2laaIx3XQuLWu2ZaUR1xUzta5uqi3U0utQqo10j3lKebaLQ5rq6tKMdEZbakbaBDrXuIZ9RFpcxJxKKC_Is8nGgi_vzlPy4_On72fn3cW3L1_PPl50Tmi1dsKNw7jTSnvhp1E4v_MDd54NADh6DZwjBzchKrRK9o7rafRS7wAHr_0E_Sn5cPDd192M3uGWJZp9DrPNtybZYP5VlvDLXKZrIwaQgrFm8PbOIKffFctq5lAcxmgXTLUYptqiNR-HDX3zCL1KNS8tnmG675nkoHWj4EC5toiScbr_DAOzdWged9hGXj8McT_wt7QGdAeg2Et88Or_DP8AEASmpQ</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Balcer, Laura J</creator><creator>Raynowska, Jenelle</creator><creator>Nolan, Rachel</creator><creator>Galetta, Steven L</creator><creator>Kapoor, Raju</creator><creator>Benedict, Ralph</creator><creator>Phillips, Glenn</creator><creator>LaRocca, Nicholas</creator><creator>Hudson, Lynn</creator><creator>Rudick, Richard</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170401</creationdate><title>Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis</title><author>Balcer, Laura J ; Raynowska, Jenelle ; Nolan, Rachel ; Galetta, Steven L ; Kapoor, Raju ; Benedict, Ralph ; Phillips, Glenn ; LaRocca, Nicholas ; Hudson, Lynn ; Rudick, Richard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c598t-5c646b989d5df65cdbd42cd1400e6d9022e20cfee8ea873c29f6d79b0e4d9df03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acuity</topic><topic>Electroretinograms</topic><topic>Evoked Potentials, Visual - physiology</topic><topic>Humans</topic><topic>Invited Reviews</topic><topic>Magnetic resonance imaging</topic><topic>Multiple sclerosis</topic><topic>Multiple Sclerosis - diagnosis</topic><topic>Multiple Sclerosis - pathology</topic><topic>Neuritis</topic><topic>Neuroimaging</topic><topic>Neurologic Examination - methods</topic><topic>Neurological diseases</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Optic neuritis</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Quality of Life</topic><topic>Retina</topic><topic>Stroke</topic><topic>Visual Acuity - physiology</topic><topic>Visual evoked potentials</topic><topic>Visual perception</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Balcer, Laura J</creatorcontrib><creatorcontrib>Raynowska, Jenelle</creatorcontrib><creatorcontrib>Nolan, Rachel</creatorcontrib><creatorcontrib>Galetta, Steven L</creatorcontrib><creatorcontrib>Kapoor, Raju</creatorcontrib><creatorcontrib>Benedict, Ralph</creatorcontrib><creatorcontrib>Phillips, Glenn</creatorcontrib><creatorcontrib>LaRocca, Nicholas</creatorcontrib><creatorcontrib>Hudson, Lynn</creatorcontrib><creatorcontrib>Rudick, Richard</creatorcontrib><creatorcontrib>Multiple Sclerosis Outcome Assessments Consortium</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Multiple sclerosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Balcer, Laura J</au><au>Raynowska, Jenelle</au><au>Nolan, Rachel</au><au>Galetta, Steven L</au><au>Kapoor, Raju</au><au>Benedict, Ralph</au><au>Phillips, Glenn</au><au>LaRocca, Nicholas</au><au>Hudson, Lynn</au><au>Rudick, Richard</au><aucorp>Multiple Sclerosis Outcome Assessments Consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis</atitle><jtitle>Multiple sclerosis</jtitle><addtitle>Mult Scler</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>23</volume><issue>5</issue><spage>734</spage><epage>747</epage><pages>734-747</pages><issn>1352-4585</issn><eissn>1477-0970</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><notes>ObjectType-Review-1</notes><abstract>Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>28206829</pmid><doi>10.1177/1352458517690822</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| source | SAGE:Jisc Collections:SAGE Journals Read and Publish 2023-2024: Reading List |
| subjects | Acuity Electroretinograms Evoked Potentials, Visual - physiology Humans Invited Reviews Magnetic resonance imaging Multiple sclerosis Multiple Sclerosis - diagnosis Multiple Sclerosis - pathology Neuritis Neuroimaging Neurologic Examination - methods Neurological diseases NMR Nuclear magnetic resonance Optic neuritis Outcome Assessment (Health Care) - methods Quality of Life Retina Stroke Visual Acuity - physiology Visual evoked potentials Visual perception |
| title | Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis |
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