title: Contrast letter acuity as a visual component for the Multiple Sclerosis Functional Composite.
abstract: BACKGROUND
  Visual dysfunction is one of the most common causes of disability in multiple sclerosis (MS). The Multiple Sclerosis Functional Composite (MSFC), a new clinical trial outcome measure, does not currently include a test of visual function.
  
  
  OBJECTIVE
  To examine contrast letter acuity as a candidate visual function test for the MSFC.
  
  
  METHODS
  Binocular contrast letter acuity testing (Sloan charts) was performed in a subgroup of participants from the International Multiple Sclerosis Secondary Progressive Avonex Controlled Trial (IMPACT Substudy) and in MS patients and disease-free control subjects from a cross-sectional study of visual outcome measures (Multiple Sclerosis Vision Prospective cohort [MVP cohort]). High-contrast visual acuity was measured in both studies; MVP cohort participants underwent additional binocular testing for contrast sensitivity (Pelli-Robson chart), color vision (D-15 desaturated test), and visual field (Esterman test, Humphrey Field Analyzer II).
  
  
  RESULTS
  Contrast letter acuity (Sloan charts, p < 0.0001, receiver operating characteristic curve analysis) and contrast sensitivity (Pelli-Robson chart, p = 0.003) best distinguished MS patients from disease-free control subjects in the MVP cohort. Correlations of Sloan chart scores with MSFC and Expanded Disability Statue Scale (EDSS) scores in both studies were significant and moderate in magnitude, demonstrating that Sloan chart scores reflect visual and neurologic dysfunction not entirely captured by the EDSS or MSFC.
  
  
  CONCLUSIONS
  Among clinical measures, contrast letter acuity (Sloan charts) and contrast sensitivity (Pelli-Robson chart) demonstrate the greatest capacity to identify binocular visual dysfunction in MS. Sloan chart testing also captures unique aspects of neurologic dysfunction not captured by current EDSS or MSFC components, making it a strong candidate visual function test for the MSFC.
authors.affiliation: Division of Neuro-Ophthalmology, Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. lbalcer@mail.med.upenn.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Balcer
authors.forename: M L
authors.initials: ML
authors.lastname: Baier
authors.forename: J A
authors.initials: JA
authors.lastname: Cohen
authors.forename: M F
authors.initials: MF
authors.lastname: Kooijmans
authors.forename: A W
authors.initials: AW
authors.lastname: Sandrock
authors.forename: M L
authors.initials: ML
authors.lastname: Nano-Schiavi
authors.forename: D C
authors.initials: DC
authors.lastname: Pfohl
authors.forename: M
authors.initials: M
authors.lastname: Mills
authors.forename: J
authors.initials: J
authors.lastname: Bowen
authors.forename: C
authors.initials: C
authors.lastname: Ford
authors.forename: F R
authors.initials: FR
authors.lastname: Heidenreich
authors.forename: D A
authors.initials: DA
authors.lastname: Jacobs
authors.forename: C E
authors.initials: CE
authors.lastname: Markowitz
authors.forename: W H
authors.initials: WH
authors.lastname: Stuart
authors.forename: G-S
authors.initials: GS
authors.lastname: Ying
authors.forename: S L
authors.initials: SL
authors.lastname: Galetta
authors.forename: M G
authors.initials: MG
authors.lastname: Maguire
authors.forename: G R
authors.initials: GR
authors.lastname: Cutter
mesh_terms: D000328:Adult; D015350:Contrast Sensitivity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D014787:Vision Tests; D014792:Visual Acuity