Dr Joshua Barton was awarded a Postgraduate Scholarship titled, “Subclinical disease progression and repair in multiple sclerosis: novel application of standardised functional visual biomarkers”, which was fully funded by the Trish MS Research Foundation.
The current methods available to clinicians and researchers to measure the progression of disease and disability in people with MS are relatively insensitive and must be measured over relatively long periods of time to detect changes. However, people with early MS often have changes to their brains which do not result in symptoms, so called ‘sub-clinical changes’ which can affect disability later in the disease. Clinical trials for medications that aim to slow or halt disability progression are also hampered by this lack of sensitive measures for progression.
Dr Barton, a clinician currently receiving advanced training in neurology, has undertaken a postgraduate scholarship, fully funded by the Trish MS Research Foundation, to develop a tablet based tool that will track sub-clinical changes in real-time.
In the first year of his PhD research, Dr Barton developed an iPad based tool that is able to accurately measure an individual’s function of visual contrast sensitivity. The benefit of this measure, as opposed to the traditional visual outcome measures used in clinical trials, is that the contrast sensitivity function encompasses both visual spatial sensitivity and visual contrast sensitivity. Dr Barton collaborated with the University of Sydney’s School of Information Technology to develop the iPad tool.
The iPad tool is much faster than standard testing, taking approximately two minutes per eye tested and has the added benefit of being able to be used independently by patients. This allows home-based self-testing by people with MS at a time that is convenient to them.
Dr Barton has recruited a group of people with MS to use the iPad tool to perform fortnightly self-assessments on their vision. These people will also undergo regular MRI scans to determine whether any lesions develop. This allows Dr Barton to see if the iPad tool is able to detect any lesion development which is clinically silent (doesn’t result in an obvious relapse). This work is ongoing with results to come.
Dr Barton has also recruited 50 people who are receiving the MS medication, alemtuzumab, who will use the iPad visual test to detect any visual changes. Again this tablet based testing will be tracked over time and compared with the traditional MRI and clinical measures of relapse activity and disability progression. This will help Dr Barton to identify if the tool is more sensitive to detect treatment response in comparison with the traditional measures.
During his research, Dr Barton has also developed a method for detecting the onset of the visual evoked potential (VEP). This is a measure of nerve conduction speed in the visual system and should provide a more accurate assessment of nerve speed than other techniques currently available.