Ocular involvement occurs frequently at all stages of amyotrophic lateral sclerosis: Preliminary experience in a large Italian cohort.

The study aimed to obtain optometric findings of amyotrophic lateral sclerosis (ALS) patients in different stages of the disease, and to determine the relation between ocular data and ALS-related features. The optometric protocol included tests of the ocular motility, error refraction, binocular alignment, and an ocular symptoms questionnaire. The functional measures included the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-r) and Milano-Torino staging (Mi-ToS); the cognitive impairment was assessed using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Two hundred consecutive ALS patients were recruited. Nearly $70%$ of patients reported at least one ocular symptom. The severely symptomatic group was characterized by significantly lower ALSFRS-r scores, and higher MiToS. Abnormal near point of convergence values were significantly related to lower ALSFRS-r total and bulbar-subscale scores. Patients with more accurate saccades and pursuits exhibited significantly higher ECAS scores. In conclusion, this study emphasizes the importance of optometric evaluations in multidisciplinary assessments to address ocular impairment early in the disease process.