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Original article
Impairment of contrast visual acuity as a functional correlate of retinal nerve fibre layer thinning and total macular volume reduction in multiple sclerosis
  1. Markus Bock1,2,
  2. Alexander U Brandt1,3,
  3. Jörn Kuchenbecker4,
  4. Jan Dörr1,2,
  5. Caspar F Pfueller1,2,
  6. Nicholetta Weinges-Evers1,
  7. Gunnar Gaede1,
  8. Hanna Zimmermann1,
  9. Judith Bellmann-Strobl2,
  10. Stephanie Ohlraun1,
  11. Frauke Zipp2,5,
  12. Friedemann Paul1,2
  1. 1NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
  2. 2Cecilie Vogt Clinic, Charité—Universitätsmedizin Berlin, Berlin, Germany
  3. 3gfnmediber GmbH, Berlin, Germany
  4. 4Department of Ophthalmology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
  5. 5Department of Neurology, University Medicine Mainz, Mainz, Germany
  1. Correspondence to Dr Friedemann Paul, NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Charitplatz 1, 10117 Berlin, Germany; friedemann.paul{at}


Objectives To analyse the association between retinal nerve fibre layer thickness (RNFLT) and total macular volume (TMV) as measured by optical coherence tomography, and contrast sensitivity (CS) measured by Functional Acuity Contrast Testing (FACT) in relapsing-remitting multiple sclerosis; and to investigate whether FACT testing by a contrast box device is feasible in multiple sclerosis (MS).

Methods fact was performed using the Optec 6500 P vision testing system with best correction under photopic and mesopic conditions without glare. The Area Under the Log Contrast Sensitivity Function (AUC) was calculated. RNFLT and TMV were assessed by Stratus optical coherence tomography. All participants underwent visual acuity testing (Snellen), spherical refractive error testing and cylindrical refractive error testing.

Results 85 relapsing-remitting multiple sclerosis patients (170 eyes) and 35 healthy controls (HC, 70 eyes) were measured. AUC Day and Night were lower in MS than in HC (p<0.001) when correcting for age, as were mean RNFLT and TMV (p<0.001 and p=0.018, respectively). Both RNFLT and TMV predicted contrast sensitivity in MS (AUC Day: standardised coefficient β=0.277, p<0.001, and β=0.262, p<0.001, respectively; AUC Night: β=0.202, p=0.009 and β=0.222, p=0.004, respectively, linear regressions). In HC, there was no correlation between RNFLT or TMV and contrast sensitivity.

Conclusion (1) Contrast sensitivity is reduced in MS versus HC; (2) RNFL and TMV as morphological measures of retinal axonal loss are predictors of contrast sensitivity as a functional visual parameter in MS but not in HC; and (3) FACT with the contrast box is a novel, feasible and rapid method to assess contrast sensitivity in MS.

  • Multiple sclerosis
  • vision
  • low contrast sensitivity
  • optical coherence tomography
  • optical quality
  • mesopic vision
  • day vision
  • night vision
  • retinal nerve fibre layer
  • retina
  • vision

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  • MB and AUB contributed equally.

  • Funding This work was supported by the German Research Foundation (DFG Exc 257 to JD, SO, CFP and FP) and grant KF2286101FO9 from the German Ministry of Economics to NeuroCure Clinical Research Center and gfnmediber.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethik Kommission der Charité.

  • Provenance and peer review Not commissioned; externally peer reviewed.