title: Visual field impairment captures disease burden in multiple sclerosis.
abstract: Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at high risk of disability progression will be useful for improving clinical-therapeutic decisions in clinical routine. To evaluate the role of visual field testing in non-optic neuritis eyes (non-ON eyes) as a biomarker of disability progression in MS. In 109 patients of the MS-VisualPath cohort, we evaluated the association between visual field abnormalities and global and cognitive disability markers and brain and retinal imaging markers of neuroaxonal injury using linear regression models adjusted for sex, age, disease duration and use of disease-modifying therapies. We evaluated the risk of disability progression associated to have baseline impaired visual field after 3 years of follow-up. Sixty-two percent of patients showed visual field defects in non-ON eyes. Visual field mean deviation was statistically associated with global disability; brain (normalized brain parenchymal, gray matter volume and lesion load) and retinal (peripapillary retinal nerve fiber layer thickness and macular ganglion cell complex thickness) markers of neuroaxonal damage. Patients with impaired visual field had statistically significative greater disability, lower normalized brain parenchymal volume and higher lesion volume than patients with normal visual field testing. MS patients with baseline impaired VF tripled the risk of disability progression during follow-up [OR = 3.35; 95 % CI (1.10-10.19); p = 0.033]. The association of visual field impairment with greater disability and neuroaxonal injury and higher risk of disability progression suggest that VF could be used to monitor MS disease burden.
authors: Department of Ophthalmology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Santiago
authors: S
authors: Ortiz-Perez
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Magí
authors: M
authors: Andorra
authors: Department of Ophthalmology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Bernardo
authors: B
authors: Sanchez-Dalmau
authors: Department of Ophthalmology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Rubén
authors: R
authors: Torres-Torres
authors: Investigacion Estadistica SL, Barcelona, Spain.
authors: David
authors: D
authors: Calbet
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Erika J
authors: EJ
authors: Lampert
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Salut
authors: S
authors: Alba-Arbalat
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Ana M
authors: AM
authors: Guerrero-Zamora
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Irati
authors: I
authors: Zubizarreta
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Nuria
authors: N
authors: Sola-Valls
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Sara
authors: S
authors: Llufriu
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: María
authors: M
authors: Sepúlveda
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Albert
authors: A
authors: Saiz
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain.
authors: Pablo
authors: P
authors: Villoslada
authors: Department of Neurology, Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, Barcelona, ES, 08036, Spain. elenahmlapiscina@gmail.com.
authors: Elena H
authors: EH
authors: Martinez-Lapiscina
mesh_terms: D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000209:etiology*; D058609:Visual Field Tests; D014794:Visual Fields
keywords: Brain atrophy; Disability progression; Multiple sclerosis; Neurodegeneration; Perimetry; Visual fields