Neuro-ophthalmologic Manifestations of Multiple Sclerosis

The inflammatory, demyelinating plaques that characterize multiple sclerosis (MS) frequently affect the visual pathways. Lesions of the afferent visual pathway (most commonly optic neuritis) result in problems conveying visual stimuli from the retina to the visual cortices. Lesions affecting the efferent visual system result in ocular dysmotility that impairs visual acuity by disrupting the precision of binocular eye movements or by causing excessive eye movements that prevent adequate foveation (e.g. nystagmus, saccadic intrusions). Significant advancements have been made in the techniques used to interrogate both the structural and the functional integrity of the visual system to dissect the pathobiological underpinnings of multiple sclerosis and to design better biomarkers and clinical trial outcomes. This chapter discusses the neuro-ophthalmic manifestations of multiple sclerosis, revolutionary advancements in optical coherence tomography and visual electrophysiology, and therapies for treating visual dysfunction in multiple sclerosis.