Comment: Ocular Manifestations of Multiple Sclerosis: A Population-Based Study

This is the authors' abstract. We don't add key points for this paper.

We read with interest the article, “Ocular manifestations of Multiple Sclerosis: A Population-Based Study” by Kraker et al1 and found it incredibly informative. The article covered almost all aspects of the topic and talked about disease prevalence in the population. However, we believe if certain issues had been addressed, it would have contributed to the significance of the article in much better ways. To begin with, there are numerous ocular symptoms of multiple sclerosis (MS), such as uveitis, retinitis, pars planitis, diplopia, and peripheral vasculitis. The frequency of these visual problems and their disease course, along with their prognosis, were not mentioned.2 In addition, there are various medications that patients with MS are prescribed. The authors did not discuss the frequency of ocular side effects when taking these medications. For example, it has been reported that the occurrence of uveitis is reduced in patients on fingolimod.3 Another concern was that there are many commonly prevalent comorbidities, such as diabetes, in the population worldwide. If present in patients with MS, diabetes can worsen the ocular aspects of multiple sclerosis and add to the burden of opthalmoplegic-related illness.4 The authors did not mention this in their article. Finally, the authors failed to mention the prevalence of visual symptoms in patients with a positive family history of MS. According to a study in Saudi Arabia, there was an increased risk of internuclear opthalmolplegia, vision disorders such as uveitis, optic neuritis, and oculomotor disorders in patients who had a family history of MS.5 In conclusion, the published article was well written and highlighted the fundamental aspects of the topic. However, we believe that if the aforementioned points were addressed, it would have significantly added to the value of the article.