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Abstract
Neurologists have long recognized the importance of the visual system in the diagnosis and monitoring of neurologic disorders. This is particularly true because approximately 50% of the brain's pathways subserve afferent and efferent aspects of vision. During the past 30 years, researchers and clinicians have further refined this concept to include investigation of the visual system for patients with specific neurologic diagnoses, including multiple sclerosis (MS), concussion, Parkinson disease (PD), and conditions along the spectrum of Alzheimer disease (AD, mild cognitive impairment, and subjective cognitive decline). This review highlights the visual “toolbox” that has been developed over the past 3 decades and beyond to capture both structural and functional aspects of vision in neurologic disease. Although the efforts to accelerate the emphasis on structure-function relationships in neurologic disorders began with MS during the early 2000s, such investigations have broadened to recognize the need for outcomes of visual pathway structure, function, and quality of life for clinical trials of therapies across the spectrum of neurologic disorders. This review begins with a patient case study highlighting the importance using the most modern technologies for visual pathway assessment, including optical coherence tomography. We emphasize that both structural and functional tools for vision testing can be used in parallel to detect what might otherwise be subclinical events or markers of visual and, perhaps, more global neurologic decline. Such measures will be critical because clinical trials and therapies become more available across the neurologic disease spectrum.
Glossary
- AD=
- Alzheimer disease;
- EDSS=
- Expanded Disability Status Scale;
- ETDRS=
- Early Treatment Diabetic Retinopathy Study;
- FA=
- Friedrich ataxia;
- GCIPL=
- ganglion cell layer/inner plexiform layer;
- GEE=
- generalized estimating equation;
- ICCs=
- intraclass correlation coefficients;
- ISI=
- intersaccadic interval;
- KD=
- King-Devick;
- MCI=
- mild cognitive impairment;
- MICK=
- Mobile Integrated Cognitive Kit;
- MS=
- multiple sclerosis;
- MSFC=
- MS Functional Composite;
- ON=
- optic neuritis;
- mTBI=
- mild traumatic brain injury;
- MULES=
- Mobile Universal Lexicon Evaluation System;
- NEI-VFQ-25=
- 25-Item National Eye Institute Visual Functioning Questionnaire;
- OCT=
- optical coherence tomography;
- ONTT=
- Optic Neuritis Treatment Trial;
- PASAT=
- Paced Serial Auditory Addition Task;
- PD=
- Parkinson disease;
- RAN=
- rapid automatized naming;
- RNFL=
- retinal nerve fiber layer;
- SCD=
- subjective cognitive decline;
- SUN=
- Staggered Uneven Number;
- VOG=
- video-oculography
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Solicited and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
- Received April 26, 2022.
- Accepted in final form September 14, 2022.
- © 2022 American Academy of Neurology
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