ReviewMultiple sclerosis (Houndmills, Basingstoke, England)2017
Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis.
Review in Multiple sclerosis (Houndmills, Basingstoke, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 98 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
98 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Clinical and Paraclinical Biomarkers and the Hitches to Assess Conversion to Secondary Progressive Multiple Sclerosis: A Systematic Review.Frontiers in neurology · 2021Pooled it
- Early complement genes are associated with visual system degeneration in multiple sclerosis.Brain : a journal of neurology · 2019Pooled it
- Combined cognitive rehabilitation and neurofeedback therapy: effects on executive function and cognitive flexibility in people with multiple sclerosis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Trial
- Overall Disability Response Score: An integrated endpoint to assess disability improvement and worsening over time in patients with multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2022Trial
- Effect of Initial Aflibercept, Laser, or Observation on Low-Contrast Visual Acuity in Eyes With Diabetic Macular Edema and Good Vision: Ancillary Study Within a Randomized Clinical Trial.Translational vision science & technology · 2021Trial
- Retinal Layer Thickness for Risk Stratification of Progression Independent of Relapse Activity in Relapsing-Remitting Multiple Sclerosis.Brain and behavior · 2026Observational
- Contrast Sensitivity and Low-Contrast Visual Acuity in Children With Low Vision.Investigative ophthalmology & visual science · 2026Article
- Article
- Article
- Relation of Visual Function, Retinal Thickness by Optical Coherence Tomography, and MRI Brain Volume in Pediatric-Onset Multiple Sclerosis.Neurology(R) neuroimmunology & neuroinflammation · 2025Article
- Review
- Investigating colour vision and its structural correlates 15 years following a first demyelinating event.Journal of neurology, neurosurgery, and psychiatry · 2025Article
- OCT-Based Retina Assessment Reflects Visual Impairment in Multiple Sclerosis.Investigative ophthalmology & visual science · 2025Article
- From diagnosis to treatment: exploring the mechanisms underlying optic neuritis in multiple sclerosis.Journal of translational medicine · 2025Review
- Visual function in the diagnosis of multiple sclerosis and optic neuritis.International journal of ophthalmology · 2025Article
- Measuring Disease Progression in Multiple Sclerosis Clinical Drug Trials and Impact on Future Patient Care.CNS drugs · 2025Review
- From implementation to discontinuation: multi-year experience with the multiple sclerosis performance test as a digital monitoring tool.Frontiers in digital health · 2025Article
- Retinal Function in Advanced Multiple Sclerosis.Investigative ophthalmology & visual science · 2024Observational
- Retinal Damage and Visual Network Reconfiguration Defines Visual Function Recovery in Optic Neuritis.Neurology(R) neuroimmunology & neuroinflammation · 2024Article
- Demyelination and neurodegeneration early in experimental autoimmune encephalomyelitis contribute to functional deficits in the anterior visual pathway.Scientific reports · 2024Article
38 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.