Rosenkranz Sina C, Kaulen Barbara, Zimmermann Hanna G, Bittner Ava K, Dorr Michael, Stellmann Jan-Patrick
Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie, Hamburg, Germany.
Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Front Neurosci. 2021 Feb 23;15:591302. doi: 10.3389/fnins.2021.591302. eCollection 2021.
Impairment of visual function is one of the major symptoms of people with multiple sclerosis (pwMS). A multitude of disease effects including inflammation and neurodegeneration lead to structural impairment in the visual system. However, the gold standard of disability quantification, the expanded disability status scale (EDSS), relies on visual assessment charts. A more comprehensive assessment of visual function is the full contrast sensitivity function (CSF), but most tools are time consuming and not feasible in clinical routine. The quantitative CSF (qCSF) test is a computerized test to assess the full CSF. We have already shown a better correlation with visual quality of life (QoL) than for classical high and low contrast charts in multiple sclerosis (MS).
To study the precision, test duration, and repeatability of the qCSF in pwMS. In order to evaluate the discrimination ability, we compared the data of pwMS to healthy controls.
We recruited two independent cohorts of MS patients. Within the precision cohort ( = 54), we analyzed the benefit of running 50 instead of 25 qCSF trials. The repeatability cohort ( = 44) was assessed by high contrast vision charts and qCSF assessments twice and we computed repeatability metrics. For the discrimination ability we used the data from all pwMS without any previous optic neuritis and compared the area under the log CSF (AULCSF) to an age-matched healthy control data set.
We identified 25 trials of the qCSF algorithm as a sufficient amount for a precise estimate of the CSF. The median test duration for one eye was 185 s (range 129-373 s). The AULCSF had better test-retest repeatability (Mean Average Precision, MAP) than visual acuity measured by standard high contrast visual acuity charts or CSF acuity measured with the qCSF (0.18 vs. 0.11 and 0.17, respectively). Even better repeatability (MAP = 0.19) was demonstrated by a CSF-derived feature that was inspired by low-contrast acuity charts, i.e., the highest spatial frequency at 25% contrast. When compared to healthy controls, the MS patients showed reduced CSF (average AULCSF 1.21 vs. 1.42, < 0.01).
High precision, usability, repeatability, and discrimination support the qCSF as a tool to assess contrast vision in pwMS.
视觉功能受损是多发性硬化症患者（pwMS）的主要症状之一。包括炎症和神经退行性变在内的多种疾病影响会导致视觉系统的结构损伤。然而，残疾量化的金标准——扩展残疾状态量表（EDSS）依赖于视力评估图表。对视觉功能更全面的评估是全对比度敏感度函数（CSF），但大多数工具耗时且在临床常规中不可行。定量CSF（qCSF）测试是一种用于评估全CSF的计算机化测试。我们已经表明，在多发性硬化症（MS）中，与经典的高对比度和低对比度图表相比，qCSF与视觉生活质量（QoL）的相关性更好。
研究pwMS中qCSF的精度、测试时长和可重复性。为了评估辨别能力，我们将pwMS的数据与健康对照进行了比较。
我们招募了两个独立的MS患者队列。在精度队列（n = 54）中，我们分析了进行50次而非25次qCSF试验的益处。重复性队列（n = 44）通过高对比度视力图表和qCSF评估进行了两次评估，我们计算了重复性指标。对于辨别能力，我们使用了所有既往无视神经炎的pwMS的数据，并将对数CSF下面积（AULCSF）与年龄匹配的健康对照数据集进行了比较。
我们确定qCSF算法的25次试验足以精确估计CSF。单眼的中位测试时长为185秒（范围129 - 373秒）。AULCSF的重测可重复性（平均平均精度，MAP）优于标准高对比度视力图表测量的视力或qCSF测量的CSF视力（分别为0.18对0.11和0.17）。受低对比度视力图表启发的CSF衍生特征，即25%对比度下的最高空间频率，显示出更好的可重复性（MAP = 0.19）。与健康对照相比，MS患者的CSF降低（平均AULCSF 1.21对1.42，P < 0.01）。
高精度、易用性、可重复性和辨别能力支持qCSF作为评估pwMS对比度视力的工具。
