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Vision-Related Quality of Life in Multiple Sclerosis: Correlation with New Measures of Low- and High-Contrast Letter Acuity
  1. Ellen M. Mowry (ellen.mowry{at}ucsf.edu)
  1. University of Pennsylvania School of Medicine, United States
    1. Michael J. Loguidice (semprefamiglia13{at}gmail.com)
    1. University of Pennsylvania School of Medicine, United States
      1. Anthony B. Daniels (anthony.b.daniels{at}gmail.com)
      1. University of Pennsylvania School of Medicine, United States
        1. Dina A. Jacobs (daj37{at}mail.med.upenn.edu)
        1. University of Pennsylvania School of Medicine, United States
          1. Clyde E. Markowitz (cmarkowi{at}mail.med.upenn.edu)
          1. University of Pennsylvania School of Medicine, United States
            1. Steven L. Galetta (galetta{at}mail.med.upenn.edu)
            1. University of Pennsylvania School of Medicine, United States
              1. M. Ligia Nano-Schiavi (ligiabill{at}aol.com)
              1. University of Pennsylvania School of Medicine, United States
                1. Gary R. Cutter (cutterg{at}prodigy.net)
                1. University of Alabama, Birmingham, United States
                  1. Maureen G. Maguire (maguirem{at}mail.med.upenn.edu)
                  1. University of Pennsylvania School of Medicine, United States
                    1. Laura J. Balcer (laura.balcer{at}uphs.upenn.edu)
                    1. University of Pennsylvania School of Medicine, United States

                      Abstract

                      Objective: To examine the relation between low-contrast letter acuity, a new visual function test for multiple sclerosis (MS) trials, and vision-targeted health-related quality of life (HRQOL).

                      Methods: Patients in this cross-sectional study were part of an ongoing investigation of visual function in MS. Patients were tested binocularly using low-contrast letter acuity and ETDRS visual acuity (VA) charts. The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), 10-Item Neuro-Ophthalmic Supplement to the NEI-VFQ-25, Impact of Visual Impairment Scale (IVIS), and Short Form-36 Health Survey (SF-36) were administered.

                      Results: Among 167 patients, the mean age was 48±10 years, with median Expanded Disability Status Scale 2.0 (range 1.0 to 7.5), and median binocular Snellen acuity equivalent (ETDRS charts) 20/16 (range 20/12.5 to 20/100). Reductions in vision-specific HRQOL were associated with lower (worse) scores for low-contrast letter acuity and VA (p<0.001, linear regression, accounting for age). Two-line differences in visual function were associated, on average, with >4-point (6.7- to 10.9-point) worsening in NEI-VFQ-25 composite, reductions that are considered clinically meaningful. Scores for the 10-Item Neuro-Ophthalmic Supplement to the NEI-VFQ-25 also correlated well with visual function. Associations between reduced low-contrast acuity and worse vision-targeted HRQOL remained significant in models accounting for high-contrast VA, EDSS, and history of acute optic neuritis.

                      Conclusions: Low-contrast letter acuity scores correlate well with HRQOL in MS. Two-line differences in scores for low-contrast acuity and VA reflect clinically meaningful differences in vision-targeted HRQOL. Low-contrast acuity testing provides information on patient-reported aspects of vision, supporting use of these measures in MS clinical trials.

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