This document discusses visual field changes in patients with multiple sclerosis (MS). MS is a chronic neurodegenerative disease that attacks the central nervous system and has an autoimmune nature. While symptoms affecting the anterior visual pathway like optic neuritis are not universal in MS patients, subclinical visual involvement is common. The document finds that three-quarters of MS patients without a history of visual symptoms had abnormal visual fields, with the most common defect being an arcuate scotoma. Other abnormalities included depression of the visual field and paracentral scotomas.

1. VISUAL FIELD CHANGES IN MS
Nagla Hassan
MIOR

3. WHAT IS M.S. ?
 Multiple sclerosis (MS) is a chronic
complex neurodegenerative disease that
attacks the central nervous system and
has autoimmune nature.
 The main pathological feature of MS is
the periventricular inflammatory lesions
with a formation of demyelinating
plaques .
 Earlier in the disease, axons are not
affected followed by irreversible axonal
damage and finally neurological insults
occur.

4.  Relapsing-remitting multiple sclerosis (RRMS)
is the most common presentation of MS,
representing about 85% of MS patients.
 It is characterized by relapses or exacerbations
followed by periods of partial or total inactivity
of the disease that are called remissions.
 Optic neuritis (ON) may be the first presentation
of MS in 20% of patients. Furthermore, it may
occur in about 50% of cases during the disease .

5. VISUAL FIELD (VF) CHANGES IN M.S. PATIENTS
 One of the unexplained features of multiple sclerosis
(MS) is the predilection which the disease shows for
the anterior visual pathway—the optic nerves,
chiasm and |tracts.
 Symptoms referable to the anterior visual pathway
are by no means universal in MS, a typical attack
of optic neuritis occurring in only between 27 % of
and 62 % of MS patients according to different
series. Some other patients have mild and often ill-
remembered symptoms but many give no history
whatsoever of visual disturbance.

6.  Because of this discrepancy between the
clinical and pathological findings which has led
to the recent interest in visual field of detecting
subclinical visual involvement in patients
suspected of having MS. Such detection, in
confirming or strengthening a diagnosis of MS,
aids the management of the individual patient
and increases understanding of the natural
history and epidemiology of the disease.
 Three-quarters of the MS patients with no
history of visual symptoms had abnormal
fields. The commonest defect found was an
arcuate scotoma.

7. CRITERIA OF ABNORMALITIES :
 A scotoma was only regarded as being
significant if it crossed at least two adjacent
radii 15° apart, if it was greater than 1° in
breadth, and if it could be demonstrated
repeatedly.
 An arcuate defect was defined as an absolute or
relative scotoma between 10° and 25°
eccentricity which was arched about the point
of fixation.
 Abnormal depression of the visual field was
taken to be present when the isoptre for the 2
mm test object fell within 15° of fixation. A
paracentral scotoma was one within 10° of the
fixation point but which did not involve it.

8.  The commonest defect found was an
arcuate scotoma.
 Depression of the visual field was the
most common abnormality .
 And although a paracentral scotoma as
well as depression in some fields .

10. HERE ARE EXAMPLES OF CHANGES IN VISUAL
FIELD IN PATIENTS WITH M.S.