Laura Balcer MD, MSCE

Adjunct Professor of Neurology

During the past 10 years, Dr. Balcer’s research has focused on the development of effective clinical visual function tests for clinical trials in multiple sclerosis (MS) and their relation to structural markers of axonal and neuronal loss in the anterior visual pathway using optical coherence tomography (OCT). Dr. Balcer’s work has identified low-contrast letter acuity (light gray letters on a white background) as a simple yet sensitive visual outcome. As a result of Dr. Balcer’s work, two pivotal phase 3 MS trials included this test as a tertiary endpoint (Balcer L.J., et al. Neurology 2007;68:1299-1304) and showed, for the first time, that low-contrast letter acuity can capture treatment effects and clinically meaningful changes. Most if not all recent and ongoing MS trials now include low-contrast letter acuity. Dr. Balcer leads a three-center collaboration with MS experts at Penn, Johns Hopkins, and the University of Texas Southwestern in Dallas. Data from these collaborative studies support a potential role for ocular imaging as a complement to low-contrast acuity testing in demonstrating axonal loss over time in MS clinical trials. OCT measures the thickness of the retinal nerve fiber layer, a unique structure within the central nervous system that consists of unmyelinated axons. Dr. Balcer’s research has taught us that retinal nerve fiber layer thinning, a marker for axonal degeneration, is a strong correlate of visual loss in MS and emphasizes that axonal loss is a major contributor to visual impairment in MS. Dr. Balcer and her collaborators have taken on leadership roles in the design of ongoing clinical trials in MS and acute optic neuritis that have incorporated low-contrast acuity and OCT imaging. As a result of Dr. Balcer’s investigations, the next generation of therapies for MS will likely use the anterior visual pathway as a model for determining efficacy. 

Dr. Balcer’s team’s expertise has been recently sought by groups of investigators to test new potential diagnostic and management tools for sports-related concussion. Two recent studies of the King-Devick test, a measure of rapid number naming, were published in Neurology and in the Journal of the Neurological Sciences.