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New research · Ophthalmology
Cureus · 1d
ReviewCureus · 2026

Visual and Neuro-Ophthalmic Manifestations of John Cunningham (JC) Virus-Related Natalizumab-Associated Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: A Systematic Review.

Tornike Jangirashvili, Orchid Parthiv, Lolita Shengelia … Ribal M Tamer
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OphthalmologyReview

Subclinical visual field loss found in 17.4% of natalizumab-progressive multifocal leukoencephalopathy survivors on formal testing.

Visual and Neuro-Ophthalmic Manifestations of John Cunningham (JC) Virus-Related Natalizumab-Associated Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: A Systematic Review.

Tornike Jangirashvili … Ribal M Tamer
Cureus · 2026
Background

Natalizumab (Tysabri®; Biogen, Cambridge, Massachusetts), a recombinant humanized monoclonal antibody targeting the α4-integrin subunit, is among the most efficacious approved therapies for relapsing-remitting multiple sclerosis (relapsing-remitting multiple sclerosis).

Methods

Thirty-five studies were included: 20 observational cohorts or case series, seven systematic reviews or meta-analyses, and eight narrative reviews with extractable data.

17.4%
Results
17.4%
formal vision testing found hidden field loss survivors hadn't noticed
More results

Neuro-ophthalmic involvement was documented in 20-50% of natalizumab-associated progressive multifocal leukoencephalopathy patients across the included studies.

Visual symptoms constituted the initial presentation in up to 25% of affected individuals.

More results

Asymptomatic magnetic resonance imaging-detected progressive multifocal leukoencephalopathy was associated with a modified Rankin scale score of two or below at follow-up in 64% of patients, compared with 34% among those diagnosed after symptom onset (p = 0.012).

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Conclusion

Prospective studies designed to evaluate visual pathway outcomes in this population are needed.

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