The King–Devick (K–D) test of rapid number naming is a visual performance measure that captures saccadic eye movements. Patients with multiple sclerosis (MS) have slowed K–D test times associated with neurologic disability and reduced quality of life. We assessed eye movements during the K–D test to identify characteristics associated with slowed times. Participants performed a computerized K–D test with video-oculography. The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and its 10-Item Neuro-Ophthalmic Supplement measured vision-specific quality of life (VSQOL). Among 25 participants with MS (age 37 ± 10 years, range 20–59) and 42 controls (age 33 ± 9 years, range 19–54), MS was associated with significantly longer (worse) K–D times (58.2 ± 19.8 vs. 43.8 ± 8.6 s, P = 0.001, linear regression models, accounting for age). In MS, test times were slower among patients with higher (worse) Expanded Disability Status Scale scores (P = 0.01). Average inter-saccadic intervals (ISI) were significantly longer in MS participants compared to controls (362 ± 103 vs. 286 ± 50 ms, P = 0.001), and were highly associated with prolonged K–D times in MS (P = 0.006). MS participants generated greater numbers of saccades (P = 0.007). VSQOL scores were reduced in MS patients with longer (worse) K–D times (P = 0.04–0.001) and longer ISI (P = 0.002–0.001). Patients with MS have slowed K–D times that may be attributable to prolonged ISI and greater numbers of saccades. The K–D test and its requisite eye movements capture VSQOL and make rapid number naming a strong candidate efferent visual performance measure in MS.
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Sources of funding: 5K12HDOO1097 NICHD and NCMRR, National Institutes of Health Rehabilitation Medicine Scientist Training Program (JRR). We would like to thank Ilya Kister, MD for referring study participants.
Conception and design of the study: CH, JRR, TEH, EMF, LJB, IS, SLG, JCR. Acquisition and analysis of data: CH, JRR, TEH, WD, JB, JR, RN, LH, IS, LJB, JCR. Substantial manuscript drafting: CH, JRR, TEH, WD, TCF, EMF, LJB, SLG, JCR.
Conflicts of interest
No author has received any financial compensation or consultant fees from King Devick Test, Inc. No author has other disclosures pertinent to this study.
This human study has been approved by the appropriate ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helskinki and its later amendments.
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Figure C. Main sequence plots of MS patients and controls for all saccades during the K–D test. Dots represent individual saccades (MS participants in green, controls in black). Dashed lines represent 5th and 95th percentiles for controls. C1. Plot of peak velocity versus amplitude showing that as saccade amplitude increases, the peak velocity increases in an asymptotic distribution. C2. Plot of duration versus amplitude. No major differences are seen in these relationships between MS patients and control subjects in C1 or C2 (PDF 521 kb)
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Hainline, C., Rizzo, JR., Hudson, T.E. et al. Capturing saccades in multiple sclerosis with a digitized test of rapid number naming. J Neurol 264, 989–998 (2017). https://doi.org/10.1007/s00415-017-8484-1
- Multiple sclerosis
- King–Devick Test
- Rapid number naming
- Inter-saccadic Interval