J Clin Neurol.  2018 Jul;14(3):333-338. 10.3988/jcn.2018.14.3.333.

Efficacy of Gaze Photographs in Diagnosing Ocular Myasthenia Gravis

• Ahn J
• Park KS
• Kim JS
• Hwang JM

• KMID: 2415049
• DOI: http://doi.org/10.3988/jcn.2018.14.3.333

Abstract

BACKGROUND AND PURPOSE
The various tests that are routinely used to diagnose generalized myasthenia gravis, such as the edrophonium test, serum anti-acetylcholine-receptor antibodies (AChR-Ab), and repetitive nerve stimulation (RNS) tests, have lower diagnostic sensitivity in ocular myasthenia gravis (OMG). Diagnosing OMG becomes even more difficult when the clinical symptoms are subtle. There is no gold-standard diagnostic test available for OMG patients, and so this study compared the diagnostic sensitivity of gaze photographs with conventional tests in OMG.
METHODS
Records of gaze photographs were available for 25 of 31 consecutive patients diagnosed with OMG. Each patient underwent a neuro-ophthalmologic examination, serum AChR-Ab, RNS, edrophonium test, ice tests, and the acquisition of gaze photographs. The margin reflex distance 1 (MRD1) was measured on each of the gaze photographs, with MRD1 < 2 mm or an interlid MRD1 difference of ≥2 mm on any of the gaze photographs defined as a positive sign of OMG. The diagnostic sensitivities of the tests were assessed.
RESULTS
The mean age at onset was 38.5 years (range, 2-76 years), and 13 patients (52%) were men. The diagnostic sensitivities of the RNS test, AChR-Ab test, gaze photographs, and ice test were 56%, 64%, 80%, and 73%, respectively.
CONCLUSIONS
The diagnostic sensitivity was higher for gaze photographs than for the other tests applied to OMG patients.

Keyword

gaze photographs; diagnosis; ocular myasthenia gravis; diagnostic sensitivity

MeSH Terms

Age of Onset
Antibodies
Diagnosis
Diagnostic Tests, Routine
Edrophonium
Humans
Ice
Male
Myasthenia Gravis*
Reflex
Antibodies
Edrophonium
Ice

Figure

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  Fig. 1 A fixation support for use when taking gaze photographs. The patient's head could be fixed in a standardized stationary position with the chin and forehead resting on the support.

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  Fig. 2 Gaze photographs of a patient who showed negative results in anti-acetylcholine-receptor antibody and repetitive nerve stimulation tests, but showed a variable degree of ptosis of the left eye.

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