Early Recognition of Symptoms by
Ophthalmologists Could Help Delay the Onset Of Multiple Sclerosis
in High-Risk Patients
Ophthalmologists can play a crucial
role in diagnosing the earliest signs of multiple sclerosis (MS)
and even delaying the onset of the disease, researchers said
during the annual meeting of the American Academy of Ophthalmology
(AAO) in Dallas. A
large percentage of people with MS first experience symptoms that
could be identified by ophthalmologists.
The first indication that a person may
have MS is a single, clinical, demyelinating event of the optic
nerve, spinal cord, or cerebellum/brain stem. A clinically
definite case of MS is not considered until someone has had two
clinical demyelinating events, separated by time and location in
the central nervous system.
High-risk individuals often first experience damage to the
optic nerve, which presents as blurry or lost vision.
"Nearly 50 percent of individuals who
are eventually diagnosed with MS first present with optic
neuritis, a eye condition that often leads people to see their
ophthalmologists," CHAMPS researcher Steven Galetta, M.D.,
Director, Neuro-Ophthalmology Service and Professor of Neurology/
Ophthalmology at the University of Pennsylvania Medical Center,
told ophthalmologists at the AAO meeting. "Therefore, it is
essential that ophthalmologists recognize the early symptoms of
the disease and refer at-risk patients to a
These high-risk patients should be
identified and treated early, because there is now evidence that
we can delay the onset of the disease and slow its
The CHAMPS study was a randomized,
double blind, placebo-controlled, Phase III clinical trial
involving 383 patients determined to have a high probability of
developing CDMS based on brain MRI changes and clinical events
consistent with MS.
Participants received weekly intramuscular injections of
either 30 mcg of Avonex or placebo. The study, reported in the
New England Journal of Medicine, was conducted at 50 clinical
centers in the U.S. and Canada.
The primary study outcome was the
development of CDMS, which was defined as the occurrence of either
1) a new neurological event (optic neuritis, spinal cord syndrome,
or brain stem syndrome) or 2) progressive neurological
MRI results were the secondary outcome.
The CHAMPS study yielded the following
The rate of development of CDMS was
44 percent lower in the Avonex- treated group than in the
The increase in brain MRI T2 lesion
volume was 91 percent lower in the Avonex-treated group than in
the placebo-treated group.
With the results of this study showing a strong benefit
of Avonex treatment at the time of the first clinical event,
there is added justification for obtaining brain MRIs at the
earliest symptoms of MS.
Previously, MRIs were considered useful
in predicting the possibility of developing CDMS but were not
considered necessary because they would not affect treatment and
Over 200 new cases of MS are diagnosed
each week in the United States alone. Many more individuals are
at risk of developing the disease, which is the most common
neurological disorder affecting young people in this
"To date, there are no accepted
guidelines for treating patients who have experienced a single
MS-like attack but who have not yet developed clinically definite
MS," Dr. Galetta said.
"This study is extremely important because it indicates
that initiating therapy with Avonex in high-risk patients at the
first sign of optic neuritis, or other neurological symptoms, with
silent MRI lesions can significantly delay the development of the