Visual Stress: A Symptom of ME/CFS

A University of Leicester research team has discovered a vision-related abnormality that could help diagnose ME/CFS. 

The abnormality, called "pattern glare," produces distortions, such as curving, wavering, and colors, when viewing stripes. Pattern glare has been associated with migraines and Irlen Syndrome (a visual processing disorder). It can lead to headaches, photophobia, and eyestrain. 

This is not the first study to find a correlation between visual disturbances and ME/CFS. In May 2014, an Australian group found a greater occurrence of  Irlen Syndrome in ME/CFS patients (Loew et al. "Symptoms of Meares-Irlen/Visual Stress Syndrome in subjects diagnosed with Chronic Fatigue Syndrome.") 

A previous Australian study found significant variations in blood lipids as well as urine amino and organic acids in ME/CFS patients with Irlen Syndrome. They proposed that ocular symptoms might be caused by activation of the immune system due to "some infective agent." (Robinson et al. "A biochemical analysis of people with chronic fatigue who have Irlen Syndrome: Speculation concerning immune system dysfunction.")

Coincidentally, I had an eye exam shortly before the University of Leicester study was published. On viewing a cross-hatch pattern, I remarked that it had blue horizontal stripes, and purple vertical stripes. "It's black and white," said the technician. 

Both of my children have pattern glare - one has migraines, and the other Irlen Syndrome. 

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Visual stress could be a symptom of Chronic Fatigue Syndrome, research suggests

Press Release: University of Leicester, November 24, 2015. People suffering from Chronic Fatigue Syndrome (CFS) could experience higher levels of visual stress than those without the condition, according to new research from the University of Leicester.

CFS, also known as Myalgic Encephalomyelitis (ME), is a condition that causes persistent exhaustion that affects everyday life and doesn't go away with sleep or rest. Diagnosis of the condition is difficult as its symptoms are similar to other illnesses.

A research team from the University of Leicester led by Dr Claire Hutchinson from the Department of Neuroscience, Psychology and Behaviour has examined patients with and without CFS and has found that those suffering from the condition are more vulnerable to pattern-related visual stress, which causes discomfort and exhaustion when viewing repetitive striped patterns, such as when reading text.

The results of the study, which is published in the journal Perception, could help in the diagnosis of CFS, as the findings suggest that there are visual system abnormalities in people with ME/CFS that may represent an identifiable and easily measurable behavioural marker of the condition.

Dr Hutchinson explained: "Diagnosis of ME/CFS is controversial. With the exception of disabling fatigue, there are few definitive clinical features of the condition and its core symptoms, overlap with those often prevalent in other conditions. As a result, ME/CFS is often a diagnosis of exclusion, being made as a last resort and possibly after a patient has experienced a series of inappropriate treatments of misdiagnosed disorders.

"It is imperative therefore that research focuses on identifying significant clinical features of CFS/ME with a view to elucidating its underlying pathology and delineating it from other illnesses. Doing so will help researchers and healthcare professionals gain important insights into the condition, aid diagnosis and, in the longer term, inform evidence-based therapeutic interventions."

The study assessed vulnerability of ME/CFS patients to pattern-related visual stress using a standardised test called the pattern glare test, in which people report the number of visual distortions they experience when looking at three repetitive striped patterns of different levels of detail.

During the study twenty patients with CFS and twenty patients without the condition were recruited.

Participants viewed 3 patterns, the spatial frequencies (SF) of which were either 0.3 (low-SF), 2.3 (mid-SF) and 9.4 (high-SF) cycles per degree (c/deg). They then reported the number of distortions they experienced when viewing each pattern.

Patients with ME/CFS reported more distortions on the intermediate striped pattern (Pattern 2) than people without the condition.

Dr Hutchinson added: "The existence of pattern-related visual stress in ME/CFS may represent an identifiable and easily measurable behavioural marker of ME. This could, in conjunction with other diagnostic tests, help delineate it from other conditions."

The work was funded by ME Research UK who provided funding for a 1-year MPhil studentship, awarded to Rachel Wilson, who was supervised by Drs Claire Hutchinson and Kevin Paterson from the University of Leicester's Department of Neuroscience, Psychology and Behaviour.

Dr Neil Abbot, Research & Operations Director at ME Research UK, added: "Around three-quarters of people with ME/CFS report a range of eye and vision-related symptoms that interfere with their everyday lives, yet there has been very little scientific investigation of the problem.

"Dr Claire Hutchinson and her team have previously confirmed the existence of eye movement difficulties in ME/CFS patients, and that symptoms, including eye pain, can be severe. Her new report in Perception extends these findings and raises the possibility that vision anomalies, including pattern-related visual stress, may have a diagnostic role in the disease."

Citation: Wilson RL, Paterson KB, Hutchinson CV. Increased Vulnerability to Pattern-Related Visual Stress in Myalgic Encephalomyelitis. Perception 2015 Nov 3.

Abstract

The objective of this study was to determine vulnerability to pattern-related visual stress in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A total of 20 ME/CFS patients and 20 matched (age, gender) controls were recruited to the study. Pattern-related visual stress was determined using the Pattern Glare Test. Participants viewed three patterns, the spatial frequencies (SF) of which were 0.3 (low-SF), 2.3 (mid-SF), and 9.4 (high-SF) cycles per degree (c/deg). They reported the number of distortions they experienced when viewing each pattern. ME/CFS patients exhibited significantly higher pattern glare scores than controls for the mid-SF pattern. Mid-high SF differences were also significantly higher in patients than controls. These findings provide evidence of altered visual perception in ME/CFS. Pattern-related visual stress may represent an identifiable clinical feature of ME/CFS that will prove useful in its diagnosis. However, further research is required to establish if these symptoms reflect ME/CFS-related changes in the functioning of sensory neural pathways.

Profound, Debilitating Fatigue in Autoimmune Disease Overlaps with ME/CFS

A number of researchers have proposed that ME/CFS eventually become an autoimmune disease. There is plenty of scientific evidence to support this theory.

Persistent viral infections, particularly infections with Epstein-Barr virus (EBV) can lead to systemic autoimmune disease. (See: Epstein-Barr Virus in Systemic Autoimmune Diseases)

Among other things, EBV inhibits natural killer cell (NK) function (a common immune system finding in ME/CFS patients) allowing EBV to proliferate and spread to many parts of the body. Each time EBV reactivates, the immune system responds by attacking increasing numbers of cells. Eventually, this process leads to organ degeneration. (Remember, CFS was originally thought to be a chronic EBV infection.)

Autoimmune activity has been documented in ME/CFS. (See: Is Chronic Fatigue Syndrome an Autoimmune Disease?) In an important study published in 2009, Hokama et al, found anti-cardiolipin antibodies in the sera of patients with CFS. Anti-cardiolipin antibodies (ACA) are formed when immune system cells attack mitochondria. ACA are found in lupus as well as other autoimmune diseases, which may account for the profound fatigue experienced by patients with autoimmune disease.

A number of physicians and researchers, including Dr. Kenny De Meirleir and Michael Maes, have pointed out that chronic infection eventually leads to autoimmunity. Recent research by Peterson et al. on cerebrospinal fluid in ME/CFS patients also indicates the development of autoimmunity in ME/CFS.

Given these strong overlaps, as well as the success of rituximab in treating Norwegian patients with ME, it makes perfect sense that patients with recognized autoimmune disease should share the defining symptom of CFS - fatigue.

Please see these related posts for additional information on autoimmunity and ME/CFS:

Immune Activation, Chronic Inflammation and Mitochondrial Dysfunction in Autoimmune Disease and ME/CFS

Cerebrospinal Fluid, Autoimmunity, and Cognitive Dysfunction in ME/CFS

Is Chronic Fatigue Syndrome an Autoimmune Disease?

Fluge and Mella on Rituximab and Autoimmunity in ME

ME/CFS: From Infectious Disease to Autoimmune Disorder
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Profound, debilitating fatigue found to be a major issue for autoimmune disease patients in new national survey

Press Release: American Autoimmune Related Diseases Association (AARDA), March 23, 2015. Fatigue described as "profound," "debilitating," and "preventing them from doing the simplest everyday tasks," is a major issue for autoimmune disease (AD) patients, impacting nearly every aspect of their lives. It affects their mental and emotional well-being and their ability to work. And while most AD patients have discussed their fatigue with their physicians, many have not been prescribed treatment for their fatigue.

Those are among the major findings of a new online survey of autoimmune disease patients conducted by the American Autoimmune Disease Related Diseases Association (AARDA), the nation's only not-for-profit autoimmune disease patient advocacy organization, to examine the connection between autoimmune disease and fatigue. AARDA released the findings of the survey of 7,838 AD patients at a national summit held to commemorate National Autoimmune Disease Awareness Month at the National Press Club in Washington, D.C.

Major findings include:

• Almost all (98 percent) AD patients surveyed report they suffer from fatigue.

• Nine-in-10 (89 percent) say it is a "major issue" for them and six-in-10 (59 percent) say it is "probably the most debilitating symptom of having an AD."

• More than two-thirds (68 percent) say their "fatigue is anything but normal. It is profound and prevents [them] from doing the simplest everyday tasks."

• While nearly nine-in-10 (87 percent) report they have discussed their fatigue with their doctor, six-in 10 (59 percent) say they have not been prescribed or suggested treatment by their doctors.

• Seven-in-10 (70 percent) believe others judge them negatively because of their fatigue.

• Three-quarters (75 percent) say their fatigue has impacted their ability to work; nearly four-in-10 (37 percent) say they are in financial distress because of it; one-in-five (21 percent) say it has caused them to lose their jobs; while the same number (21 percent) report they have filed for disability as a result of their fatigue.

Fatigue impacts nearly every aspect of AD patients' lives including overall quality of life (89 percent), career/ability to work (78 percent), romantic (78 percent), family (74 percent) and professional relationships (65 percent) and their self esteem (69 percent), among others.

"In this busy, busy world, it's normal to be tired, but the kind of fatigue autoimmune disease patients suffer from is anything but normal," said Virginia T. Ladd, President and Executive Director of AARDA.

"The overwhelming response AARDA received to this survey shows without a shadow of doubt that fatigue is not a 'fuzzy' symptom, it's real. Yet, for too long, it has been ignored and/or misunderstood by the medical community and the public at large. It's time we bring more research funding to this issue to advance understanding and effective treatments for fatigue."

The survey revealed that fatigue has a significant impact on AD patients' mental and emotional well-being. They say it has resulted in increased emotional distress (88 percent), a sense of isolation (76 percent), anxiety (72 percent) and depression (69 percent).

According to one AD patient, "It's difficult for other people to understand our ongoing fatigue when it can't be seen by them. It's so hard just trying to get others to really, really understand how very tired you are sometimes -- even our own doctors don't understand. One wonders if even our doctors may think we are for the most part just mental cases and/or whiners."

Visual Processing, "Noise," and Attention in CFS/ME - What We Do and Do Not Notice

It is always gratifying when researchers use simple and quantifiable tests to confirm a "subjective" symptom of ME/CFS. (Use whichever part of that acronym you prefer.) In this case, Dr. Claire V. Hutchison, a much published researcher at the University of Leicester (GB), and Dr. Stephen Badham, a research fellow at the University of Warwick (GB), combined their interests in visual processing and cognition to come up with an elegant study designed to measure the degree to which people with CFS/ME (we'll reverse it this time) can filter visual "noise." The ability to filter environmental "noise," that is simultaneous audial or visual input from a variety of sources, is one of the most frequently mentioned symptoms of ME and CFS, and one which impairs the ability to process information. These two researchers were able to document that deficit. (See the abstract below.)

Take this test and see how well you do. (I failed. Miserably.)

Patterns of abnormal visual attention in myalgic encephalomyelitis

By C.V. Hutchinson and S.P. Badham

Abstract

Purpose: To experimentally assess visual attention difficulties commonly reported by those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Methods:Twenty-nine ME/CFS patients and 29 controls took part in the study. Performance was assessed using the Useful Field of View (UFOV), a spatial cueing task and visual search.

Results:Patients and controls performed similarly on the processing speed subtest of the UFOV. However, patients exhibited marginally worse performance compared with controls on the divided attention subtest and significantly worse performance on the selective attention subtest. In the spatial cueing task, they were slower than controls to respond to the presence of the target, particularly when cues were invalid. They were also impaired, relative to controls, on visual search tasks.

Conclusions:We have provided experimental evidence for ME/CFS-related difficulties in directing visual attention. These findings support the subjective reports of those with ME/CFS and could represent a potential means to improve diagnosis.

Source: Optom Vis Sci. 2013 Jun;90(6):607-14. doi: 10.1097/OPX.0b013e318294c232. Hutchinson CV, Badham SP. College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, Leicestershire; and School of Psychology, University of Warwick, Coventry, United Kingdom.

When Chronic Fatigue Syndrome Harms Vision

By Beth W. Orenstein.

Many people diagnosed with chronic fatigue syndrome (CFS) also experience problems with their vision. Doctors believe that these vision-related chronic fatigue symptoms stem from brain dysfunction more than eye dysfunction. The signals that the brain sends to the eyes to let you know where you are and what you’re seeing may not be functioning properly when you have chronic fatigue syndrome.

Vision Problems and Chronic Fatigue Syndrome: It’s All a Blur

Most often, patients report having periods where everything appears blurry or seems foggy. “This will happen most commonly when they stand up and get lightheaded,” says Peter Rowe, MD, director of the Chronic Fatigue Clinic at Johns Hopkins Children’s Center in Baltimore.

Other vision problems that chronic fatigue syndrome patients report include:

• Difficulty or slowness in focusing on objects, usually those that are close up
• Not being able to see objects in side or peripheral vision — some say they feel as though they have tunnel vision
• Feeling dizzy and not being able to tolerate looking at moving objects
• Seeing floaters and flashes of light
• Being intolerant to light — “They find it uncomfortable to be in brightly lit rooms and outdoors in the bright sunshine,” Dr. Rowe says.
• Feeling as though eyes are dry or that they burn, itch, or feel gritty
  
  

The Effects of Vision Problems on Activities

Chronic fatigue syndrome patients usually find that their vision problems worsen toward the evening as they get more tired, Rowe says. As a result, people with chronic fatigue syndrome often find they have difficulty concentrating, particularly when reading.

Vision problems and the related discomfort also can make it hard for CFS patients to finish everyday tasks. You may have difficulty judging distances, which makes driving a problem. Also, headaches and dizziness may make it difficult to stand to cook or clean.

Getting the Right Eye Care When You Have Chronic Fatigue

Chronic fatigue syndrome patients will often visit an optometrist or ophthalmologist when they experience vision problems. “But usually the eye exam of someone with chronic fatigue syndrome is normal,” Rowe says. Prescription lenses may not help because vision changes rapidly. If you do wear glasses, tints may reduce sensitivity to light.

Because blurred or foggy vision is the most common problem, the solution is to improve the blood flow to the brain, Rowe says. “Visual blurring tends to be a temporary symptom and more related to lightheadedness and brain blood flow.” You may need to see a cardiologist or a neurologist to treat dizziness or lightheadedness.

Certainly, if you have chronic fatigue syndrome and find that you can’t tolerate bright lighting, you should wear good sunglasses when you’re outdoors, Rowe says.

Medications Can Help Vision Problems

Dry or irritated eyes can be treated with drops that lubricate the eyes; they may provide temporary relief. Warm compresses may also help, as will drinking fluids. Some chronic fatigue syndrome patients experience the opposite problem: watery eyes often caused by allergies; in this case, you may find it helpful to take over-the-counter antihistamines.

If you experience floaters, see an eye care professional immediately to be sure the cause is not a retinal tear. In patients with chronic fatigue syndrome, the floaters you see are generally harmless and do not require treatment. Over-the-counter pain medications or prescription drugs may help with headaches brought on by fatigue or dizziness.

Patients are likely to find that their chronic fatigue symptoms, including vision problems, worsen the more fatigued they are. You should talk to your doctor about the best way to treat the CFS symptoms that you find the most disruptive and disabling.

Originally posted on Everydayhealth.com, March 4, 2010