Abstract

Background: The aim of this study was the evaluation of diagnostic clinical tests sensitivity in ophtalmological demyelinating neuropathy.
Material/Methods: The study group comprised 21 patients (38 eyes) with diagnosed sclerosis multiplex (SM) without previous episodes of posterior ophtalmological neuritis in the history of the disease. We performed static perimetry of the central visual field (30 degrees, by Octopus 101), pattern visual evoked potentials (p VEP), color photographs of the optic disc and magnetic resonance imaging (MRI) of the central nervous system, optic nerves and optic chiasm.
Results: Visual acuity and color vision were normal. There was a statistically significant elongation in the latency of P100 during pattern VEP ( > 118 ms, 3x SD) and a significant reduction in mean light sensitivity (MS) of the central visual field. MRI revealed demyelinization in the cortex and/or spinal cord of all patients and a demyelinating lesion in the optic nerve of one patient. There was no Gd-DTPA enhacement. Statical analysis demonstrated no correlation between results of pattern VEP, MRI, morphology of optic discs, duration of SM, stage of the disease (according to Kurtzke's scale), or age of patients. Regression analysis demonstrated statistically significant relationships (p < 0.05) between results of central static perimetry, duration and stage of the disease.
Conclusions: Static perimetry showed reduced sensitivity towards light even in case of full visual acuity and lack of optic nerve disease symptoms. Pattern VEP revealed optic nerve dysfunction prior to the appearance of demyelinization plaques, Record changes are not connected with disease advancement. MRI is only slightly correlated with neurologic and ophthalmologic symptomatology in multiple sclerosis. Functional changes of the optic nerve precede hyperintensive foci in the retrobulbar segment of optic nerves.

Keywords: static perimetry, Multiple Sclerosis, Magnetic Resonance Imaging, visual evoked potentials (VEP)