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Show Journal of Neuro- Oplitlmlmology 17( 1): 1H- 28, 1997. © 1997 Lippincotl- Ravcn Publishers, Philadelphia Visual Symptoms After Optic Neuritis Results from the Optic Neuritis Treatment Trial Patricia A. Cleary, M. S., Roy W. Beck, M. D., Ph. D, Linda B. Bourque, Ph. D., Jye- yu C. Backlund, M. S., and Paivi H. Miskala for the Optic Neuritis Study Group As pari of the Optic Neuritis Treatment Trial, vision- specific quality- of- life data were collected on the patients al their 6- month visits. The purpose of this study was to determine the types of visual tasks in day- to- day living in which patients have difficulty and to compare the patients' subjective assessment of visual impairment with measurements of visual acuity, contrast sensitivity, mean deviation, and color vision. The questionnaire was completed by 382 ( 87%) of the 438 patients who had 6- month study visits. Associations between ophthalmic test scores and self- reported vision were examined using both a summary problem index and selected individual items. Although a substantial percentage of the patients ( 63%) indicated that vision had not recovered to normal in the affected eye, the reported visual deficits generally were mild. For most of the visual tasks of daily living, patients reported little or no problem. Among the 215 patients who perceived their vision at 6 months to be somewhat or much worse than it was before optic neuritis, 20% had normal results on none of the four visual function tests, 14% had normal results on one of the four tests, 23% had two of four, 23% had three of four, and 20% had normal results on all four. Reported visual symptoms 6 months after optic neuritis generally were mild. When patients were symptomatic, the four visual function tests often did not detect abnormality. This finding supports previous reports that visual deficits are frequently perceived even when vision testing is normal. Key Words: Quality of life- Optic neuritis- Vision- Questionnaire. Optic neuritis is an acute inflammatory disease of the optic nerve. It usually occurs either as a solitary neuro- Manuscripl received May 8, 1996; accepted May 20, 1996 From the Biostatistics Center, George Washington University ( P. A. C., J. C. B.), Rockvillc, Maryland; Jaeb Center for Health Research, ( R. W. B.), and Department of Epidemiology, University of South Florida College of Public Health ( P. H. M.), Tampa, Florida; and University of California ( L. B. B.) Los Angeles, California, U. S. A. Address correspondence and reprint requests to Dr. R W. Beck, Jaeb Center for Health Research, 3010 E. 138th Ave., Suite 9, Tampa, FL 33613, U. S. A. A complete listing of members of the Optic Neuritis Study Group has been published previously ( 1). logic finding ( referred to as isolated optic neuritis) or in a patient with multiple sclerosis. In the latter circumstance, it often represents a " forme fruste" of multiple sclerosis ( 2). Typically, visual loss in optic neuritis is progressive over no more than several days. Severity of loss can vary from a slight deficit in the field of vision to complete loss of light perception. In most patients, vision spontaneously improves over several months. However, even if visual acuity recovers to 20/ 20, many patients have lasting symptoms of visual impairment, and abnormalities can frequently be found in contrast sensitivity, color vision, stereopsis, light- brightness sense, the visual field, afferent pupillary reaction, optic disc appearance, and the visual evoked potential ( 3- 5) The Optic Neuritis Treatment Trial ( ONTT), a multi-center collaborative study funded by the National Eye Institute of the National Institutes of Health, was designed to evaluate the effect on visual outcome of corticosteroid treatment of acute optic neuritis. As part of the ONTT, we also were interested both in assessing the impact of an episode of optic neuritis on the quality of life of the patients involved in the study and in obtaining some measure of the patients' reaction to being part of a clinical research trial. To accomplish this end, we asked the patients to complete a questionnaire after their 6- month follow- up visits ( the major end point for visual outcome). We evaluated the patients' responses on the questionnaire in order to answer the following questions. In what type of visual tasks in day- to- day living do the patients report difficulty? How often was measured visual function normal when patients perceived abnormality in vision 6 months after optic neuritis? Are there any differences between treatment groups in the patients' reports of subjective visual assessment? Patients and Methods Four hundred and fifty- seven patients were entered into the ONTT between July 1, 1988, and June 30, 1991, 18 VISUAL SYMPTOMS AFTER OPTIC NEURITIS 19 at 15 clinical centers in the United Slates. Institutional Review Board approval was obtained at each clinical center. Patients were randomized to one of three treatment groups: intravenous methylprednisolone sodium succinate ( 1,000 mg per day for 3 days followed by oral prednisone for 11 days- referred to as the intravenous group), oral prednisone ( 1 mg/ kg per day for 14 days- referred to as the prednisone group), or oral placebo for 14 days ( referred to as the placebo group). On study entry a complete ophthalmologic examination was performed, and the following visual function tests completed: visual acuity with a retroilluminated ETDRS chart, contrast sensitivity with the Pelli- Robson chart, color vision with the Farnsworth Munsell 100- hue test, and perimetry with both the Humphrey Field Analyzer and Goldmann perimeter. Additional baseline testing included a standardized neurologic examination, standardized magnetic resonance imaging of the head, blood tests ( glucose, antinuclear antibody, and fluorescent treponemal antigen determinations) and chest radiography. Patients in the intravenous group were hospitalized for the 3 days of intravenous treatment. All other treatment for all groups was given as a once- a- day morning dose on an outpatient basis. Each patient was seen for follow-up seven times during the first 6 months. An ocular examination and visual function testing were performed on the affected eye at each visit and on the fellow eye at four of seven follow- up visits ( day 15, day 30, week 13, and 6 months). Detailed descriptions of the study design and procedures, baseline characteristics of patients and 6- month visual function test results have been published ( 1,4,6,7). Six- month visual function data were obtained for 438 ( 96%) of the 457 randomized patients. Vision improved more rapidly in the intravenous group compared with the placebo group; by 6 months of follow- up visual function was only slightly better in the intravenous group ( 4), and by 1 year there were no significant differences between groups ( 8). Patients in the prednisone group followed a similar course of visual recovery compared with the placebo group but suffered more new attacks of optic neuritis than did the patients in the other two groups ( 27% in the prednisone group, 13% in the intravenous group, and 15% in the placebo group within the first 6 to 24 months) ( 4). Pt Questionnaire At the 6- month visit, the ONTT questionnaire ( see Appendix) was distributed to the 438 patients, who completed the questionnaire at home and returned it directly to the data- coordinating center. The forms were not reviewed by the clinic physicians or other clinic personnel. The questionnaire was based in part on a psychometric questionnaire developed for the Prospective Evaluation of Radial Keratotomy Study by Dr. Linda B. Bourque ( 9). Questions were added to specifically address the types of visual symptoms that may occur in patients with optic nerve disease. The content includes questions about the patient's current vision, the effect of optic neuritis on activities of daily living, and difficulty with various aspects of the trial. Three questions asked patients whether their vision in each eye and both eyes at the time of questionnaire administration was much worse, somewhat worse, about the same, somewhat better, or much better in the affected eye than their vision before treatment. Twenty- eight questions asked patients about their vision with both eyes during a variety of daily activities ( e. g., reading, watching movies). The questionnaire was pretested on nonsludy patients and refined. It did not undergo reliability testing before being implemented in the ONTT. Biostatistical Methods Comparison of the patients who completed the questionnaire with those who did not was made via the Pearson chi- square test for categorical variables, Fisher's Exact Test for binary variables, and the Student's t test for continuous variables ( 10). The principal components of the 28 items regarding the patients current vision tasks of day- to- day living were assessed ( 1 l). 1 The eigenvectors indicated that there were approximately equal loadings on all 28 items and similar correlation coefficients among items. 2 The interpretation of each component was not obvious. Therefore, an item- sum mean score was computed to provide a good summary of the data; it is referred to as the problem index. Spearman rank correlations between each visual problem and the problem index were calculated to evaluate the internal consistency of the items. Treatment group differences were evaluated with Pearson chi- square for categorical variables followed by pah- wise comparison controlling for multiple comparisons using Bonferroni critical values ( 12). Tests of treatment group differences with respect to the problem index were conducted with the Kruskal- Wallis rank test followed by pairwise treatment comparisons controlling for multiple comparisons using Bonferroni critical values ( 12). Results Completion of the Questionnaire The questionnaire was returned by 382 of the 438 patients ( 87%) to whom it was distributed at the 6- month visit. The range of completion rates was 71 to 100% across the 15 clinics. The questionnaire was returned promptly by most patients, but for 28%> it was not received for 5= 2 months. Within the problem index, all questions were answered by 91% of the patients, 8% left one question unanswered, and 2% left two or more questions unanswered. Comparing the completers of the questionnaire with the noncomplelers, there were no sig- ' A principal component is a linear combination of variables. 2 Eigenvectors explain ( he proportion of variance in principal components. ./ Newo- Ophlhulmol. Vol. 17. No. I. 1997 20 P. A. CLEARY ET AL. TABLE 1. Comparison of baseline characteristics of 0NIT patients who completed and those who did not complete the questionnaire Characteristics Treatment Intravenous Placebo Oral prednisone Gender Female Age in years ( SD) Race White Completed questionnaire ( n = 382) 33% 33% 34% 78% 32.4 ( 6.8) 89% Did not complete questionnaire ( n = 75)" 33% 32% 35% 72% 30.4 ( 6.2) 65% p value 0.99'' 0.28'' 0.018'" <().()() 1'' " Includes 19 patients who missed the 6- month visit and 56 who were given the questionnaire but did not return it. '' Based on chi- squarc test. '' Based on I test. '' Based on Fisher's Exact Test. nificant differences in treatment group assignment or gender; however, a higher proportion of the completers than noncompleters were white (/;< 0.001), and completers were slightly older than noncompleters (/; = ().() 18) ( Table 1). There were no significant differences compairing the completers and noncompleters in terms of visual function test results at baseline or at 6 months. Visual Tasks in Day- to- Day Living and Problem Index Table 2 provides the distribution of questionnaire responses for the patients' perception of their overall vision with one or both eyes. Compared with their vision before optic neuritis, 56% of the patients reported that the affected eye had worse eyesight, 35% about the same eyesight, and 9% better eyesight. Eight percent reported that the fellow eye had worse eyesight, 86% about the same eyesight, and 7% better eyesight. For 23 of 28 visual tasks in day- to- day living, most patients indicated that vision was the same or better than it was before the episode of optic neuritis ( Table 3). More than 50% of patients reported at least a slight problem in vision at night, in bright sunlight, when their eyes were tired, and when reading. Sixty- six percent reported at least a slight problem in feeling that the two eyes were different. The problem index, a summary of the 28 items of visual tasks in day- to- day living, had a non- Gaussian distribution, with a mean of 2.54 ( SD = 0.59), a median of 2.37 ( quar-tiles = 2.11, 2.85), and a range of 1.00^ 1.89. Subjective Versus Objective Visual Assessment The measured affected- eye visual function at 6 months is compared with the patients' subjective report in Table 4. Among the 215 patients who perceived their vision to be somewhat or much worse than before optic neuritis, visual acuity was measured to be normal in 66%, contrast sensitivity in 30%, color vision in 55%, and mean deviation of the visual field in 58%. We further evaluated the number of visual function tests that were normal in the affected eye at 6 months and compared these results with the patients' perception of their vision ( Table 5). Among the 215 patients who perceived their vision at 6 months to be somewhat or much worse than it was before optic neuritis, 20% had normal results on none of the four visual function tests, 14% had one of the four tests normal, 23% had two of four, 23% had three of four, and 20% had all four normal. Of the 122 patients with normal results on all four visual function tests, vision was perceived to be somewhat or much worse by 35%. Perceived Visual Recovery in Each Treatment Group In Table 6 the perceptions of vision by the patients in the three treatment groups are compared. Two separate questions on the questionnaire evaluate vision in the affected eye. For one question ( Do you feel your vision has returned to normal in the affected eye?) a higher percentage of patients in the intravenous group than in the other two groups answered affirmatively Q? = 0.039), whereas for the other question ( In comparison to your vision before optic neuritis, would you say that your present eyesight in the eye with optic neuritis is the same or better?), there was no significant difference between groups ( p = 0.615). Based on the problem index, vision was slightly better in the intravenous group than in the placebo group or oral prednisone group (/; = 0.009). DISCUSSION Assessment of quality of life often has an important and meaningful role in the assessment of the outcome of TABLE 2. Patients' overall perception of their visual difficulties ( n = 382)" Present eyesight Much worse Vision'' Somcwha worse About the same Somewhat better Much belter Both eyes A fleeted eye Fellow eye 6 15 1 34 41 7 50 35 86 5 4 6 5 5 I " ' this question was not completed by three patients for both eyes, three patients for the affected eye, and four patients for the fellow eye. '' Figures arc the percentages in each category. ./ Neiiio- Oplilluilmol. Vol. 17. No. 1. 1997 VISUAL SYMPTOMS AFTER OPTIC NEURITIS 21 TABLE 3. Patients' perception of their visual difficulties in daily living compared with vision before optic neuritis" Current visual problems Vision during day Vision at night Vision of colors Brightness of colors Vision of moving objects Vision in hot weather Vision during exercise Vision after shower Fluorescent light Regular light Vision in bright sunlight Vision on rainy days Vision when reading Vision looking far away Depth perception Not seeing parts of things Seeing peripherally Deciding distance of things Boundaries fuzzy Feeling two eyes are different Objects not as bright Vision when eyes tired Vision being foggy Vision when driving a car Household chores Watching television Looking at a computer monitor Vision in sports Better now 5 2 2 3 2 1 1 1 2 2 1 2 2 3 2 2 3 2 2 2 1 2 1 2 2 3 2 2 No difference 52 37 66 58 63 60 59 72 54 70 40 60 47 56 55 63 65 60 64 31 58 35 53 60 84 67 47 59 Slight problem 35 40 22 29 25 21 21 18 31 20 38 28 34 26 25 21 22 24 23 42 27 42 30 29 11 23 23 21 Moderate problem 8 17 7 8 8 11 9 8 7 7 16 9 13 11 12 8 7 11 8 16 11 16 10 5 3 5 8 7 Severe problem 1 5 2 2 2 3 2 2 4 2 6 2 4 5 6 3 3 3 2 8 2 6 3 1 1 1 3 2 Not applicable 0 0 0 0 1 5 8 1 2 0 0 0 0 0 0 2 0 0 1 2 1 0 2 3 0 1 18 10 Mean ± SD 2.48 ± 0.74 2.85 ± 0.88 2.40 ± 0.73 2.50 ± 0.78 2.45 ± 0.74 2.54 ± 0.84 2.48 ± 0.80 2.37 + 0.71 2.56 ± 0.83 2.37 ± 0.72 2.87 ± 0.90 2.50 ± 0.76 2.70 ± 0.87 2.59 ± 0.90 2.65 ± 0.93 2.46 ± 0.81 2.43 ± 0.80 2.54 ± 0.83 2.46 ± 0.77 2.95 ± 0.94 2.55 ± 0.80 2.88 + 0.89 2.60 ± 0.82 2.42 ± 0.69 2.15 ± 0.51 2.34 ± 0.66 2.54 ± 0.82 2.43 ± 0.76 Item- sum correlation (/•) 0.78 0.77 0.62 0.61 0.64 0.63 0.66 0.62 0.68 0.71 0.72 0.67 0.72 0.72 0.74 0.65 0.60 0.70 0.73 0.76 0.65 0.72 0.74 0.75 0.57 0.68 0.74 0.60 " Figures are given as the percentages in each category. Percentages may not sum to 100% because of rounding. a treatment trial. In the ONTT, a vision- specific quality-of- life instrument developed specifically for this trial was completed in conjuction with the primary outcome assessment examination 6 months after entry into the trial. The questionnaire completion rate was sufficiently high ( 87%) for valid results. There is an ethnic difference in the completion rate; whites have a higher rate than nonwhites. Thus, we are unable to conclude that the results can be generalized to all races who participated in the study. Although a substantial percentage of the patients ( 63%) indicated that vision had not recovered to normal in the affected eye, the reported visual deficits generally were mild. There were only a few tasks of daily living in TABLE 4. Patients' perception of their vision compared with visual function in the affected eye at 6 months Vision test in affected eye" Visual acuity Normal Abnormal Contrast sensitivity Normal Abnormal Color vision Normal Abnormal Mean deviation Normal Abnormal Much worse ( n = 58) 36 64 9 91 17 83 21 79 Patients' percept Somewhat worse ( n = 157) 76 24 38 62 69 31 72 28 ion of vision About the ( n same = 130) 88 12 66 34 82 18 85 15 in affected eye'' Somewhat better ( n = 15) 93 7 67 33 53 47 80 20 Much better ( n = 18) 94 6 56 44 67 33 89 11 " Definitions of normal: visual acuity 3= 20/ 20 ( logmar = 60.00); contrast sensitivity score vision score =£ 10.5 ( square root of the error score); mean deviation s=- 3.00 decibels. '' Figures are the percentages in each category. line 15; color ./ Neitro- Ophthalmol, Vol. 17. No. 1. 1997 22 P. A. CLEARY ET AL. TABLE 5. Number of visual function tests normal in the affected eye at 6 months compared with the patients' perception Number of visual function tests normal 0/ 4 1/ 4 2/ 4 3/ 4 4/ 4 Much worse ( n = 58) 53 24 14 3 5 Patients' Somewhat worse ( n = 157) 8 10 27 30 25 per cept ion of vision in About the same ( n = 130) 4 4 11 31 51 affected eye" Somewhat better ( n = 15) 0 13 20 27 40 Much better ( n = 18) 6 0 17 39 39 " Figures are the percentages in each category. which more than half of patients reported difficulty. However, without a control group of normal age-matched subjects, it is not possible to know whether these percentages are higher than expected. Of particular interest in the listing of current visual problems are the situations that relate to the possibility of Uhthoff's phenomenon: " vision in hot weather," " vision during exercise," and " vision after a shower." Only ~ 2- 3% of patients reported a severe problem and 8- 11% a moderate problem in these situations. Patients who felt that their vision was worse than before optic neuritis were more likely to have an abnormality on the visual function tests than patients who felt their vision was the same or better. However, visual function testing in the affected eye was nevertheless normal in a substantial number of the patients who perceived their vision to be impaired. This finding suggests that the tests used in this study were not sensitive enough to identify subtle changes in vision, which, although mild, are still noticeable to the patient. It is difficult to interpret the treatment group comparisons. There is a suggestion that patients in the intravenous group were more likely to have perceived better vision than the patients in the other groups. This result is similar to what was found in comparing the visual function test results in the three treatment groups at 6 months: slightly better vision at 6 months in the intravenous group ( 4). However, by 1 year of follow- up, there were no significant differences in visual function between the treatment groups ( 8). This quality- of- life instrument was developed during the trial without additional funding. By necessity, it was implemented in the trial without time for full reliability testing. Nevertheless, the information garnered from its use in the ONTT has helped define the types and frequencies of visual deficits that are present in patients after optic neuritis. TABLE 6. Patients' subjective assessment of vision by treatment group Treatment Assessment Intravenous ( n = 126)" Placebo ( n = 126)" Oral prednisone ( n = 130)" p value Present eyesight same or improved in affected eye Vision returned to normal in the affected eye Mean problem index ( SD) Pai ™ ise comparisons between treatment groups Present eyesight same or improved in affected eye Intravenous vs. placebo Placebo vs. oral prednisone Intravenous vs. oral prednisone Vision returned to normal in the affected eye Intravenous vs. placebo Placebo vs. oral prednisone Intravenous vs. oral prednisone Problem index Intravenous vs. placebo Placebo vs. oral prednisone Intravenous vs. oral prednisone 47% 46% 2.4 ( 0.6) 42% 33% 2.6 ( 0.6) 41% 33% 2.6 ( 0.6) 0.615 0.039 0.009 0.41 0.98 0.38 0.027 0.93 0.032 0.047 0.31 0.003' " One patient in the placebo group and two patients in the oral prednisone group did not answer the question about whether their present eyesight was the same or improved in the affected eye. Three patients in each group did not answer the question of whether their vision had returned to normal in the affected eye. '' Based on chi- squarc test result except for p values within problem index, which are based on the Kruskal- Wallis test. '' This p value is the only one that is statistically significant after adjustment for multiple comparisons using the Bonferroni step- down method. J Neuw- Ophtlmlmol, Vol. 17. No. I, 1997 VISUAL SYMPTOMS AFTER OPTIC NEURITIS 23 References 1. Cleary PA, Beck RW, Anderson MM, et al. Design, methods and conduct of the Optic Neuritis Treatment Trial. Controlled Clin Trials 1993; 14: 123^ 12. 2. Ebers GC. Optic neuritis and multiple sclerosis. Arch Neurol 1985; 42: 702^ 1. 3. Fleishman JA, Beck RW, Linares OA, Klein JW. Deficits in visual function after resolution of optic neuritis. Ophthalmology 1987; 94: 1029- 35. 4. Beck RW, Cleary PA, Anderson MA, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. New Engl J Med 1992; 326: 581- 8. 5. Beck RW, Cleary PA, Backlund JC, Optic Neuritis Study Group. The course of visual recovery after optic neuritis: experience of the Optic Neuritis Treatment Trial. Ophthalmology 1994; 101: 1771- 8. 6. Optic Neuritis Treatment Trial manual of procedures. Springfield, Va.: National Technical Information Service, 1990. ( NTIS accession no. PB90- I95728). 7. Optic Neuritis Study Group. The clinical profile of acute optic neuritis: experience of the Optic Neuritis Treatment Trial. Arch Ophthalmol 1991; 109: 1673- 8. 8. Keltner JL, Johnson CA, Spurr JO, Beck RW, Optic Neuritis Study Group. Visual field profile of optic neuritis: one- year follow- up in the Optic Neuritis Treatment Trial. Arch Ophthalmol 1994; 112: 946- 53. 9. Bourque LB, Cosand BB, Drews C, et al. Reported satisfaction, fluctuation of vision, and glare among patients one year after surgery in the Prospective Evaluation of Radial Keratotomy ( PERK) Study. Arch Ophthalmol 1986; 104: 356- 63. 10. Snedecor GW, Cochran WG. Statistical methods, 7th cd. Ames: Iowa State University Press, 1980. 11. Hartman HH. Modern factor analysis, 2nd ed. Chicago: University of Chicago Press, 1967. 12. Miller RG. Simultaneus statistical inference, 2nd ed. New York: Springer- Verlag, 1981. J Neuro- Ophlhalmol, Vol. 17, No. 1, 1997 P. A. CLEARY ET AL. PATIENT QUESTIONNAIRE The Optic Neuritis Treatment Trial DATE QUESTIONNAIRE COMPLETED MONTH / DATE / YEAR As part of the Optic Neuritis Treatment Trial, we are interested in finding out about your current vision, some of your experiences since entering the study, and about how optic neuritis has affected your life. The questionnaire includes questions about your vision and about any problems you might have had since you entered the Optic Neuritis Treatment Trial. We are interested in your opinions, ideas, and experiences. There are no right or wrong answers. All the information you provide will be published only in summary, statistical form. None of the information collected will affect your health care in any way. In order to get accurate information about optic neuritis and how it affects prople's vision, we need information from all our patients. So please help us by answering the questions to the best of your ability. Once you have completed the questionnaire, put it in the envelope provided, seal the envelope, and mail it. It will go directly to the center that collects the data from the study in Washington, D. C. and will not be reviewed by your physician or the clinic personnel. For each question, CIRCLE the number corresponding to your response. If you are undecided on an answer ( i. e., you feel that you fall in between two possible responses), please do your best to choose one of the listed responses. 1. In comparison to your own vision before optic neuritis, would you say that your present eyesight using both eyes is much worse, somewhat worse, about the same, somewhat better, or much better? In answering this question, think about your vision wearing your regular correction ( e. g., glasses, contacts) and with both eyes open. Much worse 1 Somewhat worse 2 About the same 3 Somewhat better 4 Much better 5 In comparison to your own vision before optic neuritis, would you say that your present eyesight in the eye with optic neuritis is much worse, somewhat worse, about the same, somewhat better, or much better? In answering this question, think about your vision using only the eye that experienced the episode of optic neuritis that brought you into the study and wearing your regular correction ( e. g., glasses, contacts). If both eyes have suffered optic neuritis, in this question we are interested in your vision only in the eye that had the episode of optic neuritis that brought you into the study. Much worse 1 Somewhat worse 2 About the same 3 Somewhat better 4 Much better 5 In comparison to your own vision before optic neuritis, would you say that your present eyesight in the eye without optic neuritis is much worse, somewhat worse, about the same, somewhat better, or much better? In answering this question, think about your vision using only the eye that did not experience the episode of optic neuritis that brought you into the study and wearing your regular correction ( e. g., glasses, contacts). If both eyes have suffered optic neuritis, in this question we are interested in your vision only in the eye that did not have the episode of optic neuritis that brought you into the study. Much worse 1 Somewhat worse 2 About the same 3 Somewhat better 4 Much better 5 • o- Ophlhalmol, Vol. 17. No. 1. 1997 VISUAL SYMPTOMS AFTER OPTIC NEURITIS 25 4. In the next set of questions we need to find out how different aspects of your current vision ( with both eyes open) compare with these same aspects of your vision before you experienced the attack of optic neuritis that brought you into the Optic Neuritis Treatment Trial. In answering the questions, think about your vision wearing your regular correction ( e. g., glasses, contacts) and with both eyes open. A list of experiences that some people have had with their vision follows. Using a scale of " 1 " to " 5 , " indicate whether you arc having any trouble now that you did not have before the attack of optic neuritis. Circle " 1 " if you feel that your vision is better now on a certain aspect Circle " 2 " if you notice no difference now compared to before the optic neuritis Circle " 3" if you are having a slight problem now compared to before Circle " 4" if you are having a moderate problem Circle " 5 " if you are having a severe problem Circle " 9 " if any question does not apply to you because you do not participate in that activity ( such as, you don't drive) Current vision compared to vision before optic neuritis m H w 39 OT P< < w Pi J w « Q O O P< * 5 P-W pa H < o u • z 3 PH PH < 1. Your vision during the day? 2. Your vision at night? 3. Distinguishing colors? 4. The brightness of colors? 5. Watching moving objects, like at a football game? 6. Your vision in hot weather? 7. Your vision when you exercise? 8. Your vision after a hot shower or bath? 9. Fluorescent lights? 10. Regular ( incandescent) lights? 11. Vision in bright sunlight? 12. Seeing on rainy days? 13. Vision when reading or doing close work? 14. Vision when looking at faraway objects? 15. Depth perception? 16. Not seeing parts of things when you look at them? 17. Ability to see peripherally ( to the side)? 18. Deciding how far away something is? 19. A feeling that the boundaries between things arc fuzzy? 20. Feeling your two eyes are somehow different? 21. Objects not being as bright as they used to be? 22. Vision when eyes are tired? 23. Vision being foggy? 24. Driving a car? 25. Household chores? 26. Watching television? 27. Looking at a computer monitor 28. Participating in sports/ physical activities? 29. Anything else? . SPECIFY: 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 J Neuw- Ophtlmlmol, Vol. 17, No. I. 1997 P. A. CLEARY ET AL. Do you feel your vision has returned to normal in the affected eye since your optic neuritis episode that brought you into the ONTT? Yes SKIP TO Q6 1 No ANSWER A, B, C 2 A. How much improvement have you noticed in this eye since the onset of the optic neuritis? None 1 A little 2 A moderate amount 3 A lot, but not back to normal 4 B. How noticeable is the impairment in vision? Very noticeable 1 Somewhat noticeable 2 Only a little noticeable 3 C. How much does the impairment affect your overall visual function? A lot 1 Somewhat 2 A little 3 Are there any situations not already mentioned that either make your vision problems beter or worse? No, nothing else makes it better or worse 1 Yes, other things make it better ANSWER A 2 Yes, other things make it worse ANSWER B 3 Yes, there are things that make it better and things that make it worse ANSWER A & B 4 A. What makes it better? What makes it worse? Thinking only about changes in your vision since you entered this study, have you had any vision problems that caused you to permanently change your lifestyle in a major way? For example, have you changed jobs, quit work, changed or quit leisure activities, or changed the way you go about your daily activities because of your vision! Yes ANSWER A 1 No GOTOQ8 2 A. In what way( s) have you changed your life because of your vision? B. How long ago did you make this change( s)? C. Why did you make this change( s)? Imol, Vol. 17, No. I, 1997 VISUAL SYMPTOMS AFTER OPTIC NEURITIS 27 8. Do you recall experiencing any side effects from the treatment you were give for the optic neuritis? Yes ANSWER A. No Go To Q9.... A. List any side effects of the treatment that you experienced. 9. Did you gain any weight since you entered the study? Yes and still note the extra weight ANSWER A 1 Yes but am now back at my baseline Go To Q10 2 No Go To Q10 3 A. Approximately how much more do you weigh now than before you entered the study? Less than 5 pounds 1 Between 5 and 10 pounds 2 Between 10 and 20 pounds 3 More than 20 pounds 4 Now we need some background information about you. 10. What was the highest grade in school that you completed and received credit lor? Less than 8 1 9- 11 2 High School graduate 3 Some college or technical training 4 College graduate 5 Posl- college training 6 11. The U. S. Census divides jobs into groups listed below. What is/ was your main occupation? Circle only one. CLERICAL WORKERS ( ex: bank tellers, file clerks, mail carriers, dispatchers, office machine opcralors, secretaries) 01 PROFESSIONAL AND TECHNICAL ( ex: accountants, engineers, physicians, nurses, social workers, teachers, dral'lsmcn, actors, computer programmers) 02 SERVICE WORKERS ( ex: janitors, waiters, nursing aides, airline stewardesses, elevator opcralors, hairdressers, barbers, cooks, maids) 03 CRAFTSMEN ( ex: bakers, floor layers, foremen, machinists, mechanics and repairmen, sheet metal workers, tailors) 04 OPERATIVES ( ex: assemblers, clothing pressers, produce graders, machine operators, sailors, textile operatives, bus drivers, taxicab drivers, delivery men) 05 MANAGERS AND ADMINISTRATORS ( ex: treasurers, buyers, office managers, government officials, sales managers, restaurant managers) 06 LABORERS ( ex: fisherman and oystermen, garbage collectors, warehousemen, laborers, lumbermen and woodchop-pers) 07 FARMERS AND FARM MANAGERS 08 FARM LABORERS 09 SALES WORKERS ( ex: newsboys, real estate agents, retail sales clerks, manufacturers, sales representatives) 10 STUDENT/ HOMEMAKER 11 The final set of questions asks about your experiences in the Optic Neuritis Treatment Trial. 12. Thinking back to before you entered the Optic Neuritis Treatment Trial, what were your major reasons for participating in this study? J Neitro- Ophtlmlmol, Vol. 17, No. I. IV97 28 P. A. CLEARY ET AL. 13 What is the best thing that this study did for you? To you? 14 What is the worst thing that this study did for you? To you? IS As part of your participation in the Optic Neuritis Treatment Trial, you have taken a lot of tests. Below we have listed some of these tests, as well as other aspects of the study. Using a scale from one ( 1) to five ( 5) where " / " stands for " very easy" or ' ' no problem'' and ' ' 5'' for ' ' very difficult'' or ' ' big problem", please tell us how difficult you found each of these things by circling the appropriate number. a. Magnetic Resonance Scan ( MRI) b. Lumbar puncture ( spinal tap) c. Side- effect of drugs d. Visual field testing e. Lengthy waits for tests or clinic visits f. Frequent follow- up visits p. Other: Specify VERY EASY 1 1 1 1 1 1 1 NEUTRAL 2 2 2 2 2 2 2 3 3 3 3 3 3 3 VERY DIFFICULT 4 4 4 4 4 4 4 5 5 5 5 5 5 5 DID NOT EXPERIENCE 9 9 9 9 9 9 9 16. Finally, if you had it to do over again, would you enroll in the Optic Neuritis Treatment Trial? YES NO If " YES", why. If " NO", why not? 17. Is there anything else that you would like to tell us about optic neuritis, the Optic Neuritis Treatment Trial, or your experiences with them? PLEASE PUT YOUR COMPLETED QUESTIONNAIRE IN THE PRE- STAMPED PRE- ADDRESSED ENVELOPE PROVIDED. SEAL THE ENVELOPE AND MAIL IT. Thank you for your help. ./ Neuiv- Ophthalmol, Vol. 17, No. 1, 1997 [CLontt] |
