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Gonzalez Caldito N, Antony B, He Y, Lang A, Nguyen J, Rothman A, Ogbuokiri E, Avornu A, Balcer L, Frohman E, Frohman TC, Bhargava P, Prince J, Calabresi PA, Saidha S. Analysis of Agreement of Retinal-Layer Thickness Measures Derived from the Segmentation of Horizontal and Vertical Spectralis OCT Macular Scans. Curr Eye Res 2017; 43:415-423. [PMID: 29240464 DOI: 10.1080/02713683.2017.1406526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Optical coherence tomography (OCT) is a reliable method used to quantify discrete layers of the retina. Spectralis OCT is a device used for this purpose. Spectralis OCT macular scan imaging acquisition can be obtained on either the horizontal or vertical plane. The vertical protocol has been proposed as favorable, due to postulated reduction in confound of Henle's fibers on segmentation-derived metrics. Yet, agreement of the segmentation measures of horizontal and vertical macular scans remains unexplored. Our aim was to determine this agreement. MATERIALS AND METHODS Horizontal and vertical macular scans on Spectralis OCT were acquired in 20 healthy controls (HCs) and 20 multiple sclerosis (MS) patients. All scans were segmented using Heidelberg software and a Johns Hopkins University (JHU)-developed method. Agreement was analyzed using Bland-Altman analyses and intra-class correlation coefficients (ICCs). RESULTS Using both segmentation techniques, mean differences (agreement at the cohort level) in the thicknesses of all macular layers derived from both acquisition protocols in MS patients and HCs were narrow (<1 µm), while the limits of agreement (LOA) (agreement at the individual level) were wider. Using JHU segmentation mean differences (and LOA) for the macular retinal nerve fiber layer (RNFL) and ganglion cell layer + inner plexiform layer (GCIP) in MS were 0.21 µm (-1.57-1.99 µm) and -0.36 µm (-1.44-1.37 µm), respectively. CONCLUSIONS OCT segmentation measures of discrete retinal-layer thicknesses derived from both vertical and horizontal protocols on Spectralis OCT agree excellently at the cohort level (narrow mean differences), but only moderately at the individual level (wide LOA). This suggests patients scanned using either protocol should continue to be scanned with the same protocol. However, due to excellent agreement at the cohort level, measures derived from both acquisitions can be pooled for outcome purposes in clinical trials.
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Affiliation(s)
| | - Bhavna Antony
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - Yufan He
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - Andrew Lang
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - James Nguyen
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Alissa Rothman
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Esther Ogbuokiri
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Ama Avornu
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Laura Balcer
- c Department of Neurology , New York University Langone Medical Center , New York , NY , USA
| | - Elliot Frohman
- d Department of Neurology and Ophthalmology , University of Texas Austin Dell Medical School , Austin TX , USA
| | - Teresa C Frohman
- d Department of Neurology and Ophthalmology , University of Texas Austin Dell Medical School , Austin TX , USA
| | - Pavan Bhargava
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jerry Prince
- b Department of Electrical and Computer Engineering , Johns Hopkins University , Baltimore , MD , USA
| | - Peter A Calabresi
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Shiv Saidha
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Pisa M, Guerrieri S, Di Maggio G, Medaglini S, Moiola L, Martinelli V, Comi G, Leocani L. No evidence of disease activity is associated with reduced rate of axonal retinal atrophy in MS. Neurology 2017; 89:2469-2475. [DOI: 10.1212/wnl.0000000000004736] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023] Open
Abstract
Objective:To explore, in a longitudinal study, the usefulness of optical coherence tomography (OCT) in monitoring people with multiple sclerosis (MS) by testing the association between retinal nerve fiber layer (RNFL) thinning and clinical and brain MRI criteria of no evidence of disease activity (NEDA).Methods:OCT, visual evoked potentials (VEPs), and disability, using the Expanded Disability Status Scale (EDSS), were tested at baseline and after 2 years in 72 patients, 63 with routine yearly brain MRI.Results:Longitudinal mean binocular RNFL thinning, in absence of optic neuritis during follow-up, was correlated with EDSS worsening, also controlling for baseline EDSS, RNFL, disease duration, and MS subtype (Spearman ρ −0.462, p < 0.001; partial correlation coefficient −0.437, p < 0.001). At follow-up, patients classified as NEDA (20; 31.7%) had RNFL loss of −0.93 μm ± 1.35 SD, while patients with active disease had −2.83 μm ± 2 SD thinning (t test; p < 0.001). At logistic regression, mean RNFL reduction correctly classified 76.2% of patients as NEDA at 2 years (R2 0.355; p = 0.003). A cutoff of −1.25 μm RNFL loss classified NEDA status with specificity 81.4% and sensitivity 80% (receiver operating characteristic curve: area under the curve 0.8; p < 0.001). No significant longitudinal correlations were found between changes in RNFL and in VEP latencies or scores.Conclusions:NEDA is associated with a relatively preserved RNFL over 2 years. A greater neuroretinal loss was detected even in patients with clinical evidence of disease activity independently from changes in brain MRI lesions, prompting further validation of OCT as an additional tool in MS monitoring.
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104
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Bsteh G, Hegen H, Teuchner B, Amprosi M, Berek K, Ladstätter F, Wurth S, Auer M, Di Pauli F, Deisenhammer F, Berger T. Peripapillary retinal nerve fibre layer as measured by optical coherence tomography is a prognostic biomarker not only for physical but also for cognitive disability progression in multiple sclerosis. Mult Scler 2017; 25:196-203. [DOI: 10.1177/1352458517740216] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Peripapillary retinal nerve fibre layer (pRNFL) thickness is emerging as a marker of axonal degeneration in multiple sclerosis (MS). Objective: We aimed to prospectively assess the predictive value of pRNFL for progression of physical and cognitive disability in relapsing-remitting MS (RRMS). Methods: In this 3-year longitudinal study on 151 RRMS patients, pRNFL was measured by spectral-domain optical coherence tomography (OCT). We used proportional hazard models, correcting for age, sex, disease duration, Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT) at baseline, to test a pRNFL thickness ≤88 µm at baseline for prediction of EDSS progression and cognitive decline. We also evaluated the decrease in pRNFL thickness from baseline to year 3 in a multivariate linear regression model. Results: pRNFL thickness ≤88 µm was independently associated with a threefold increased risk of EDSS progression ( p < 0.001) and a 2.7-fold increased risk of cognitive decline within the subsequent 3 years ( p < 0.001). Mean pRNFL delta was −5.3 µm (SD, 4.2). It was significantly negatively impacted by EDSS progression, cognitive decline, higher age and disease duration, while positively impacted by disease-modifying therapy (DMT). Conclusion: Cross-sectional and longitudinal monitoring of pRNFL is useful as a biomarker for prediction of physical and cognitive disability progression in patients with RRMS in everyday clinical practice.
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Affiliation(s)
- Gabriel Bsteh
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Teuchner
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Amprosi
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Ladstätter
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Wurth
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Deisenhammer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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106
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Kucharczuk J, Maciejek Z, Sikorski BL. Optical coherence tomography in diagnosis and monitoring multiple sclerosis. Neurol Neurochir Pol 2017; 52:140-149. [PMID: 29395116 DOI: 10.1016/j.pjnns.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
This paper presents application of optical coherence tomography (OCT) for diagnosis and monitoring of multiple sclerosis (MS). The peripapillary retinal nerve fibre layer thinning and the reduced total macular volume analysis are shown. With the course of the MS, the severity of these abnormalities increases which reflects the progressive degeneration of retinal ganglion cells and nerve fibres. The OCT parameters are sensitive, non-invasive indicators useful in assessing the progression of inflammation and neurodegeneration in MS.
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Affiliation(s)
- Jan Kucharczuk
- Department of Ophthalmology, 10th Military Research Hospital with Polyclinic, Bydgoszcz, Poland
| | - Zdzisław Maciejek
- Department of Neurology, 10th Military Research Hospital with Polyclinic, Bydgoszcz, Poland
| | - Bartosz L Sikorski
- Department of Ophthalmology, Nicolaus Copernicus University, Bydgoszcz, Poland.
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Pulido-Valdeolivas I, Zubizarreta I, Martinez-Lapiscina EH, Villoslada P. Precision medicine for multiple sclerosis: an update of the available biomarkers and their use in therapeutic decision making. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1393315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Irene Pulido-Valdeolivas
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Irati Zubizarreta
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
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108
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Smith AL, Cohen JA, Hua LH. Therapeutic Targets for Multiple Sclerosis: Current Treatment Goals and Future Directions. Neurotherapeutics 2017; 14:952-960. [PMID: 28653282 PMCID: PMC5722758 DOI: 10.1007/s13311-017-0548-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, and the most common cause of nontraumatic disability in young adults. Most patients have a relapsing-remitting course, and roughly half of them will eventually enter a degenerative progressive phase, marked by gradual accrual of disability over time in the absence of relapses. Early initiation of treatment has delayed the onset of disability progression. Thus, there is increased interest in treating to target in MS, particularly targeting no evidence of disease activity. This review will describe the most common treatment goals in MS: the Rio scores, disease-free survival, and no evidence of disease activity. We will also cover how well current disease-modifying therapies achieve no evidence of disease activity, and discuss future options for improving MS treatment targets.
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Affiliation(s)
- Andrew L Smith
- Mellen Center for MS Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
| | - Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Le H Hua
- Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 W. Bonneville, Las Vegas, NV, USA
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Klistorner A, Graham EC, Yiannikas C, Barnett M, Parratt J, Garrick R, Wang C, You Y, Graham SL. Progression of retinal ganglion cell loss in multiple sclerosis is associated with new lesions in the optic radiations. Eur J Neurol 2017; 24:1392-1398. [PMID: 28799222 DOI: 10.1111/ene.13404] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/04/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE The mechanism of retinal ganglion cell and retinal nerve fiber layer loss in multiple sclerosis (MS) remains unknown. This study aimed to investigate the association between temporal retinal nerve fiber layer (tRNFL) thinning and disease activity in the brain determined by T2 lesions on magnetic resonance imaging (MRI). METHODS Fifty-five consecutive patients with relapsing-remitting MS and 25 controls were enrolled. All patients underwent annual optical coherence tomography and high-resolution MRI scans for tRNFL thickness and brain lesion volume analysis, respectively. RESULTS Significant tRNFL thickness reduction was observed over the 3-year follow-up period at a relatively constant rate (1.02 μm/year). Thinning of tRNFL fibers was more prominent in younger patients (P = 0.01). The tRNFL loss was associated with new MRI lesions in the optic radiations (ORs). There was significantly greater tRNFL thinning in patients with new lesional activity in the ORs compared with patients with new lesions outside the ORs (P = 0.009). CONCLUSIONS This study supports the notion that retrograde transneuronal degeneration caused by OR lesions might play a role in progressive retinal nerve fiber layer loss. In addition, the results of the study also indicate that the disease-related neurodegenerative changes in the retina start much earlier than the clinical diagnosis of MS.
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Affiliation(s)
- A Klistorner
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, NSW.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW.,Sydney Neuroimaging Analysis Centre, Sydney, NSW
| | - E C Graham
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - M Barnett
- Sydney Neuroimaging Analysis Centre, Sydney, NSW.,Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - J Parratt
- Royal North Shore Hospital, Sydney, NSW
| | - R Garrick
- St Vincent's Hospital, Sydney, NSW, Australia
| | - C Wang
- Sydney Neuroimaging Analysis Centre, Sydney, NSW.,Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Y You
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, NSW.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW
| | - S L Graham
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW
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Knier B, Leppenetier G, Wetzlmair C, Aly L, Hoshi MM, Pernpeintner V, Biberacher V, Berthele A, Mühlau M, Zimmer C, Hemmer B, Korn T. Association of Retinal Architecture, Intrathecal Immunity, and Clinical Course in Multiple Sclerosis. JAMA Neurol 2017; 74:847-856. [PMID: 28460032 DOI: 10.1001/jamaneurol.2017.0377] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Biomarkers to estimate long-term outcomes in patients with multiple sclerosis (MS) and to assign patients to individual treatment regimens are urgently needed. Objective To assess whether retinal layer volumes are correlated with immune cell subsets and immunoglobulin indices in the cerebrospinal fluid and whether retinal layer volumes alone or in combination with intrathecal variables are associated with worsening of disease in patients with relapsing-remitting MS. Design, Setting, and Participants This observational cohort study included 312 patients with relapsing-remitting MS in 2 independent cohorts (72 patients with short disease duration [cohort 1] and 240 patients with longer disease duration [cohort 2]) treated at a single German university hospital from April 15, 2013, through November 11, 2015. Main Outcomes and Measures The common ganglion cell and inner plexiform layer (GCIPL) and inner nuclear layer (INL) volumes were tested for association with the immunoglobulin indices and the frequencies of immune cells in the cerebrospinal fluid (including B cells, T cells, and natural killer cells) (cohort 1). Volumes of GCIPL alone (cohorts 1 and 2) or GCIPL corrected for intrathecal B-cell frequencies (cohort 1) were tested for their association with worsening disability. Results A total of 312 patients (212 women [67.9%] and 100 men [32.1%]; median age, 34.0 years [interquartile range (IQR), 28.0-42.0 years]) were available for analysis. In cohort 1 (50 women [69.4%] and 22 men [30.6%]; median age, 31.0 years [IQR, 26.3-38.3 years]), with short disease durations (median, 1.0 months [IQR, 1.0-2.0 months]), low GCIPL volumes were associated with increased intrathecal B-cell frequencies (median, 1.96% [IQR, 1.45%-4.20%]) and intrathecal IgG synthesis (median cerebrospinal fluid/serum IgG index, 0.78 [IQR, 0.53-1.07]). The INL volumes correlated with the frequencies of intrathecal CD56bright natural killer cells (r = 0.28; P = .007). Individuals with low GCIPL volumes (<1.99 mm3) had a 6.4-fold risk for worsening disability during follow-up compared with patients with higher GCIPL values (95% CI, 1.7-24.2; P = .007). This finding was reproduced in cohort 2 (162 women [67.5%] and 78 men [32.5%]; median age, 34.0 years [IQR, 29.0-42.0 years]) consisting of patients with longer disease durations (median, 36.0 months [IQR, 21.0-60.0 months]) (hazard ratio, 2.4; 95% CI, 1.2-4.8; P = .02). In both cohorts, INL volumes correlated with the prospective increase in T2 lesion load and the number of gadolinium-enhancing lesions. Conclusions and Relevance Retinal layers reflect different aspects of disease activity during MS. Loss of GCIPL is associated with intrathecal B-cell immunity and constitutes an independent risk factor for worsening disability, whereas high INL volumes are associated with activity on magnetic resonance imaging in the brain parenchyma. Thus, retinal optical coherence tomography might be a means to support stratification of patients with MS for different therapeutic regimens.
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Affiliation(s)
- Benjamin Knier
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany2Department of Experimental Neuroimmunology, Technische Universität München, Munich, Germany
| | - Gildas Leppenetier
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Carmen Wetzlmair
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany2Department of Experimental Neuroimmunology, Technische Universität München, Munich, Germany
| | - Muna-Miriam Hoshi
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Verena Pernpeintner
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Viola Biberacher
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany3Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany5Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany2Department of Experimental Neuroimmunology, Technische Universität München, Munich, Germany5Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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111
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Britze J, Pihl-Jensen G, Frederiksen JL. Retinal ganglion cell analysis in multiple sclerosis and optic neuritis: a systematic review and meta-analysis. J Neurol 2017; 264:1837-1853. [PMID: 28567539 DOI: 10.1007/s00415-017-8531-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to summarise existing findings regarding optical coherence tomography (OCT) measurements of ganglion cell layer (GCL) alterations in optic neuritis (ON) and multiple sclerosis (MS). Peer-reviewed studies published prior to April 2016 were searched using PubMed, EMBASE, Web of Science and Scopus. Studies were included if they measured GCL thickness using OCT in patients with either ON, MS or clinically isolated syndrome. For the meta-analysis, we compared GCL thickness in MS patients with and without prior ON, to healthy controls. 42/252 studies were reviewed. In acute ON, studies showed significant thinning of the GCL within the first 5 weeks (n = 5), earlier than retinal nerve fibre layer (RNFL) thinning. GCL thinning at 1-2 months after acute ON predicted visual function at 6 months (n = 3). The meta-analysis showed that the thickness of the GCL was significantly reduced in MS patients both with and without previous ON compared to healthy controls. GCL thinning was associated with visual function in most studies (n = 10) and expanded disability status scale (EDSS) scores (n = 6). In acute ON, thinning of the GCL is measurable prior to RNFL thinning, and GCL thickness after 1-2 months may predict visual function after 6 months. Furthermore, GCL thinning occurs in MS both with and without prior ON, and may be associated with visual function and EDSS score. This suggests that the GCL is a promising biomarker, which may be used to examine in vivo neurodegeneration in ON and MS.
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Affiliation(s)
- Josefine Britze
- Department of Neurology, Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark
| | - Gorm Pihl-Jensen
- Department of Neurology, Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark
| | - Jette Lautrup Frederiksen
- Department of Neurology, Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
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Balk LJ, Coric D, Nij Bijvank JA, Killestein J, Uitdehaag BM, Petzold A. Retinal atrophy in relation to visual functioning and vision-related quality of life in patients with multiple sclerosis. Mult Scler 2017; 24:767-776. [PMID: 28511578 PMCID: PMC5971367 DOI: 10.1177/1352458517708463] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Inner retinal layer atrophy in patients with multiple sclerosis (MS) has been validated as a structural imaging biomarker for neurodegeneration. Objective: To determine how retinal layer thickness relates to high-contrast visual acuity (HCVA), low-contrast visual acuity (LCVA) and vision-related quality of life (QoL) and to investigate the effect of previous episodes on MS-associated optic neuritis (MSON). Methods: Spectral-domain optical coherence tomography (SD-OCT) was performed in 267 patients with MS. Images were segmented for the peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell inner plexiform layer (GCIPL). Ophthalmological evaluations included history of MSON, HCVA, LCVA, and vision-related QoL. Results: Independent of MSON, HCVA and LCVA were significantly associated with pRNFL and GCIPL thicknesses. Vision-related QoL was positively associated with pRNFL (β = 0.92, p = 0.06) and GCIPL (β = 0.93, p = 0.02) thicknesses. These associations were independent of MSON. Not only binocular but also monocular atrophy of the inner retinal layers was associated with lower vision-related QoL. Conclusion: This study showed that retinal atrophy has a significant impact on visual functioning in patients with MS. OCT may therefore provide useful insight to patients with visual dysfunction, and our findings support including OCT and vision-related QoL measures into optic neuritis treatment trials.
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Affiliation(s)
- Lisanne J Balk
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Danko Coric
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny A Nij Bijvank
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Ophthalmology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Ophthalmology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/UCL Institute of Neurology, University College London (UCL), London, UK/Moorfields Eye Hospital, London, UK
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114
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Karahan E, Karti O, Koskderelioglu A, Karti DT, Uyar M, Kale MY, Gedizlioglu M. Pupil cycle time: as indicator of visual pathway dysfunction in multiple sclerosis. Acta Neurol Belg 2017; 117:75-81. [PMID: 28054250 DOI: 10.1007/s13760-016-0740-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 12/24/2016] [Indexed: 11/25/2022]
Abstract
To evaluate the value of pupil cycle time (PCT) as an indicator of optic nerve dysfunction in patients with multiple sclerosis (MS), 42 patients with MS and 35 control subjects were included to the study. Patients with MS with a history of ON were accepted as group 1, without a history of ON as group 2 and healthy control subjects as group 3. Groups were compared with Chi-square and one-way ANOVA tests. Correlations of PCT results with age, best corrected visual acuity, duration of MS, visual field (VF) test, visual evoked potential (VEP) latans, retinal nerve fiber layer (RNFL), and ganglion cell layer-inner plexiform layer (GCL-IPL) thicknesses were analyzed. Mean PCT was 1286.4 ± 357.8 ms in group 1, 1021.3 ± 102.3 ms in group 2, and 872.5 ± 69.4 ms in group 3 (p < 0.001). Moderate-to-significant correlations were found between PCT measurements and duration of MS, VF test, VEP latans, RNFL, and GCL-IPL thicknesses. PCT might be an alternative method to evaluate the optic nerve function in patients with MS.
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Affiliation(s)
- Eyyup Karahan
- Department of Ophthalmology, Van Training and Research Hospital, Van, Turkey
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı cad. no : 59 Bozyaka, Izmir, Turkey.
| | - Aslı Koskderelioglu
- Department of Neurology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı cad. no : 59 Bozyaka, Izmir, Turkey
| | - Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı cad. no : 59 Bozyaka, Izmir, Turkey
| | - Murat Uyar
- Department of Ophthalmology, Sifa University, Izmir, Turkey
| | | | - Muhtesem Gedizlioglu
- Department of Neurology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı cad. no : 59 Bozyaka, Izmir, Turkey
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115
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Behbehani R, Abu Al-Hassan A, Al-Salahat A, Sriraman D, Oakley JD, Alroughani R. Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis. PLoS One 2017; 12:e0172120. [PMID: 28192539 PMCID: PMC5305239 DOI: 10.1371/journal.pone.0172120] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 01/31/2017] [Indexed: 01/21/2023] Open
Abstract
Introduction Optical coherence tomography (OCT) with retinal segmentation analysis is a valuable tool in assessing axonal loss and neuro-degeneration in multiple sclerosis (MS) by in-vivo imaging, delineation and quantification of retinal layers. There is evidence of deep retinal involvement in MS beyond the inner retinal layers. The ultra-structural retinal changes in MS in different MS phenotypes can reflect differences in the pathophysiologic mechanisms. There is limited data on the pattern of deeper retinal layer involvement in progressive MS (PMS) versus relapsing remitting MS (RRMS). We have compared the OCT segmentation analysis in patients with relapsing-remitting MS and progressive MS. Methods Cross-sectional study of 113 MS patients (226 eyes) (29 PMS, 84 RRMS) and 38 healthy controls (72 eyes). Spectral domain OCT (SDOCT) using the macular cube acquisition protocol (Cirrus HDOCT 5000; Carl Zeiss Meditec) and segmentation of the retinal layers for quantifying the thicknesses of the retinal layers. Segmentation of the retinal layers was carried out utilizing Orion software (Voxeleron, USA) for quantifying the thicknesses of individual retinal layers. Results The retinal nerve finer layer (RNFL) (p = 0.023), the ganglion-cell/inner plexiform layer (GCIPL) (p = 0.006) and the outer plexiform layer (OPL) (p = 0.033) were significantly thinner in PMS compared to RRMS. There was significant negative correlation between the outer nuclear layer (ONL) and EDSS (r = -0.554, p = 0.02) in PMS patients. In RRMS patients with prior optic neuritis, the GCIPL correlated negatively (r = -0.317; p = 0.046), while the photoreceptor layer (PR) correlated positively with EDSS (r = 0.478; p = 0.003). Conclusions Patients with PMS exhibit more atrophy of both the inner and outer retinal layers than RRMS. The ONL in PMS and the GCIPL and PR in RRMS can serve as potential surrogate of disease burden and progression (EDSS). The specific retinal layer predilection and its correlation with disability may reflect different pathophysiologic mechanisms and various stages of progression in MS.
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Affiliation(s)
- Raed Behbehani
- Al-Bahar Ophthalmology Center, Ibn Sina Hospital, Kuwait City, Kuwait
- Neurology Clinic, Dasman Institute, Dasman, Kuwait
- * E-mail:
| | | | - Ali Al-Salahat
- Al-Bahar Ophthalmology Center, Ibn Sina Hospital, Kuwait City, Kuwait
| | | | - J. D. Oakley
- Voxeleron LLC, Pleasanton, CA, United States of America
| | - Raed Alroughani
- Neurology Clinic, Dasman Institute, Dasman, Kuwait
- Division of Neurology, Amiri Hospital, Sharq, Kuwait
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116
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Antony BJ, Carass A, Lang A, Kim BJ, Zack DJ, Prince JL. Longitudinal Analysis of Mouse SDOCT Volumes. ACTA ACUST UNITED AC 2017; 10137. [PMID: 29138527 DOI: 10.1117/12.2257432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Spectral-domain optical coherence tomography (SDOCT), in addition to its routine clinical use in the diagnosis of ocular diseases, has begun to find increasing use in animal studies. Animal models are frequently used to study disease mechanisms as well as to test drug efficacy. In particular, SDOCT provides the ability to study animals longitudinally and non-invasively over long periods of time. However, the lack of anatomical landmarks makes the longitudinal scan acquisition prone to inconsistencies in orientation. Here, we propose a method for the automated registration of mouse SDOCT volumes. The method begins by accurately segmenting the blood vessels and the optic nerve head region in the scans using a pixel classification approach. The segmented vessel maps from follow-up scans were registered using an iterative closest point (ICP) algorithm to the baseline scan to allow for the accurate longitudinal tracking of thickness changes. Eighteen SDOCT volumes from a light damage model study were used to train a random forest utilized in the pixel classification step. The area under the curve (AUC) in a leave-one-out study for the retinal blood vessels and the optic nerve head (ONH) was found to be 0.93 and 0.98, respectively. The complete proposed framework, the retinal vasculature segmentation and the ICP registration, was applied to a secondary set of scans obtained from a light damage model. A qualitative assessment of the registration showed no registration failures.
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Affiliation(s)
- Bhavna J Antony
- Department of Electrical and Computer Engineering, Johns Hopkins University
| | - Aaron Carass
- Department of Electrical and Computer Engineering, Johns Hopkins University
| | - Andrew Lang
- Department of Electrical and Computer Engineering, Johns Hopkins University
| | - Byung-Jin Kim
- Wilmer Eye Institute, Johns Hopkins University School of Medicine
| | - Donald J Zack
- Wilmer Eye Institute, Johns Hopkins University School of Medicine
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University
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Button J, Al-Louzi O, Lang A, Bhargava P, Newsome SD, Frohman T, Balcer LJ, Frohman EM, Prince J, Calabresi PA, Saidha S. Disease-modifying therapies modulate retinal atrophy in multiple sclerosis: A retrospective study. Neurology 2017; 88:525-532. [PMID: 28077493 DOI: 10.1212/wnl.0000000000003582] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/10/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To retrospectively investigate whether disease-modifying therapies (DMTs) exert differential effects on rates of retinal atrophy in relapsing-remitting multiple sclerosis (RRMS), as assessed using optical coherence tomography (OCT). METHODS A total of 402 patients with RRMS followed at the Johns Hopkins MS Center who underwent Cirrus-HD OCT were assessed for eligibility. Inclusion criteria included at least 1 year of OCT follow-up and adherence to a single DMT during the period of follow-up. Combined thickness of the ganglion cell + inner plexiform (GCIP) and other retinal layers was computed utilizing automated macular segmentation. Retinal thickness changes were analyzed using mixed-effects linear regression. RESULTS The effects of glatiramer acetate (GA; n = 48), natalizumab (NAT; n = 46), and interferon-β-1a subcutaneously (IFNSC; n = 35) and intramuscularly (IFNIM; n = 28) were assessed. Baseline analyses revealed no significant differences between groups in terms of age, sex, optic neuritis history, or follow-up duration. During follow-up, relative to NAT-treated patients, IFNSC- and GA-treated patients exhibited 0.37 μm/y (p < 0.001) and 0.14 μm/y (p = 0.035) faster rates of GCIP thinning, respectively, adjusting for the interval between initiation of DMT and OCT monitoring (gap time), age, sex, relapses, and disease duration. In the IFNSC group, GCIP thinning was 1.53 μm/y faster during the first year of therapy vs during the time interval afterwards (p < 0.001). CONCLUSIONS Rates of GCIP atrophy in patients with RRMS vary according to DMT utilization. Our findings support OCT for monitoring neurodegenerative treatment effects in the retina, an easily accessible tissue, and as a practical outcome measure in RRMS clinical trials.
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Affiliation(s)
- Julia Button
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Omar Al-Louzi
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Andrew Lang
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Pavan Bhargava
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Scott D Newsome
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Teresa Frohman
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Laura J Balcer
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Elliot M Frohman
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Jerry Prince
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Peter A Calabresi
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York
| | - Shiv Saidha
- From the Departments of Neurology (J.B., O.A.-L., P.B., S.D.N., P.A.C., S.S.) and Electrical and Computer Engineering (A.L., J.P.), Johns Hopkins University, Baltimore, MD; Department of Internal Medicine (O.A.-L.), North Shore Medical Center, Salem, MA; Department of Neurology and Ophthalmology (T.F., E.M.F.), University of Texas Southwestern, Dallas; and Department of Neurology (L.J.B.), New York University Langone Medical Center, New York.
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Cheung CYL, Ikram MK, Chen C, Wong TY. Imaging retina to study dementia and stroke. Prog Retin Eye Res 2017; 57:89-107. [PMID: 28057562 DOI: 10.1016/j.preteyeres.2017.01.001] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/07/2016] [Accepted: 01/01/2017] [Indexed: 02/07/2023]
Abstract
With increase in life expectancy, the number of persons suffering from common age-related brain diseases, including neurodegenerative (e.g., dementia) and cerebrovascular (e.g., stroke) disease is expected to rise substantially. As current neuro-imaging modalities such as magnetic resonance imaging may not be able to detect subtle subclinical changes (resolution <100-500 μm) in dementia and stroke, there is an urgent need for other complementary techniques to probe the pathophysiology of these diseases. The retina - due to its anatomical, embryological and physiological similarities with the brain - offers a unique and accessible "window" to study correlates and consequences of subclinical pathology in the brain. Retinal components such as the microvasculature and retinal ganglion cell axons can now be visualized non-invasively using different retinal imaging techniques e.g., ocular fundus photography and optical coherence tomography. Advances in retinal imaging may provide new and potentially important insights into cerebrovascular neurodegenerative processes in addition to what is currently possible with neuro-imaging. In this review, we present an overview of the current literature on the application of retinal imaging in the study of dementia and stroke. We discuss clinical implications of these studies, novel state-of-the-art retinal imaging techniques and future directions aimed at evaluating whether retinal imaging can be an additional investigation tool in the study of dementia and stroke.
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Affiliation(s)
- Carol Yim-Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - M Kamran Ikram
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Departments of Neurology & Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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119
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Gordon-Lipkin E, Calabresi PA. Optical coherence tomography: A quantitative tool to measure neurodegeneration and facilitate testing of novel treatments for tissue protection in multiple sclerosis. J Neuroimmunol 2016; 304:93-96. [PMID: 28038893 DOI: 10.1016/j.jneuroim.2016.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/11/2016] [Indexed: 01/04/2023]
Abstract
Optical coherence tomography (OCT) is a relatively new imaging technology that has been introduced as a powerful biomarker in neurological disease, including multiple sclerosis. In this review, OCT as an imaging technique, its reproducibility and validation in multiple sclerosis, application to other neurodegenerative diseases and future technological directions are discussed.
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Affiliation(s)
- Eliza Gordon-Lipkin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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120
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Erlich-Malona N, Mendoza-Santiesteban CE, Hedges TR, Patel N, Monaco C, Cole E. Distinguishing ischaemic optic neuropathy from optic neuritis by ganglion cell analysis. Acta Ophthalmol 2016; 94:e721-e726. [PMID: 27364519 DOI: 10.1111/aos.13128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/14/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine whether a pattern of altitudinal ganglion cell loss, as detected and measured by optical coherence tomography (OCT), can be used to distinguish non-arteritic ischaemic optic neuropathy (NAION) from optic neuritis (ON) during the acute phase, and whether the rate or severity of ganglion cell loss differs between the two diseases. METHODS We performed a retrospective, case-control study of 44 patients (50 eyes) with ON or NAION and 44 age-matched controls. Non-arteritic ischaemic optic neuropathy and ON patients had OCT at presentation and four consecutive follow-up visits. Controls had OCT at one point in time. The ganglion cell complex (GCC) was evaluated in the macula, and the retinal nerve fibre layer (RNFL) was evaluated in the peripapillary region. Ganglion cell complex thickness, RNFL thickness and GCC mean superior and inferior hemispheric difference were compared between NAION and ON patients at each time-point using unpaired t-tests and between disease and control subjects at first measurement using paired t-tests. RESULTS Mean time from onset of symptoms to initial presentation was 10.7 ± 6.6 days in NAION and 11.7 ± 8.6 days in ON (p = 0.67). There was a significantly greater vertical hemispheric difference in GCC thickness in NAION patients than ON patients at all time-points (5.5-10.7 μm versus 3.1-3.6 μm, p = 0.01-0.049). Mean GCC thickness was significantly decreased at less than 2 weeks after onset in NAION compared to age-matched controls (72.1 μm versus 82.1 μm, p < 0.001), as well as in ON compared to age-matched controls (74.3 μm versus 84.5 μm, p < 0.001). Progression and severity of GCC and RNFL loss did not differ significantly between NAION and ON. CONCLUSION A quantitative comparison of mean superior and inferior hemispheric GCC thickness with OCT may be used to distinguish NAION from ON.
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Affiliation(s)
- Natalie Erlich-Malona
- New England Eye Center; Tufts University School of Medicine; Tufts Medical Center; Boston Massachusetts USA
| | - Carlos E. Mendoza-Santiesteban
- New England Eye Center; Tufts University School of Medicine; Tufts Medical Center; Boston Massachusetts USA
- Dysautonomia Center; New York University Schools of Medicine; NYU Langone Medical Center; New York USA
- Ophthalmology Department; Pontifical Catholic University of Chile; Santiago Chile
| | - Thomas R. Hedges
- New England Eye Center; Tufts University School of Medicine; Tufts Medical Center; Boston Massachusetts USA
| | - Nimesh Patel
- New England Eye Center; Tufts University School of Medicine; Tufts Medical Center; Boston Massachusetts USA
| | - Caitlin Monaco
- New England Eye Center; Tufts University School of Medicine; Tufts Medical Center; Boston Massachusetts USA
| | - Emily Cole
- New England Eye Center; Tufts University School of Medicine; Tufts Medical Center; Boston Massachusetts USA
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121
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El Ayoubi NK, Ghassan S, Said M, Allam J, Darwish H, Khoury SJ. Retinal measures correlate with cognitive and physical disability in early multiple sclerosis. J Neurol 2016; 263:2287-2295. [PMID: 27544501 DOI: 10.1007/s00415-016-8271-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
Further studies are needed to determine the role of retinal optical coherence tomography (OCT) in non-optic neuritis (ON) eyes of patients with early MS. The objective of this study is to explore the relationship between retinal layers' thickness and cognitive as well as physical disability in patients with the early RRMS. Participants in this cross-sectional study were adults with early RRMS, stable on interferon beta-1a, or fingolimod therapy, and without a history of ON in one or both eyes. Patients were evaluated clinically, underwent a battery of cognitive tests, and a retinal OCT scan which was also performed on a group of healthy age- and gender-matched controls. We studied 47 patients with RRMS, on interferon beta-1a (N = 32) or fingolimod (N = 15), and 18 healthy controls. Multivariate analyses controlling for age, disease duration, treatment, and education when exploring cognitive function, showed that pRNFL thickness correlated negatively with 9HPT (standardized Beta -0.4, p < 0.0001), and positively with SDMT (standardized Beta 0.72, p = 0.007). In patients with early RRMS without optic neuropathy, retinal thickness measures correlated with physical disability and cognitive disability, supporting their potential as biomarkers of axonal loss.
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Affiliation(s)
- Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut and Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Stephanie Ghassan
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut and Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Marianne Said
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut and Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Joelle Allam
- Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Darwish
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut and Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon.,Faculty of Medicine, Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut and Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon. .,Department of Neurology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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122
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Leocani L, Rocca MA, Comi G. MRI and neurophysiological measures to predict course, disability and treatment response in multiple sclerosis. Curr Opin Neurol 2016; 29:243-53. [DOI: 10.1097/wco.0000000000000333] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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123
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Graham SL, Klistorner A. Afferent visual pathways in multiple sclerosis: a review. Clin Exp Ophthalmol 2016; 45:62-72. [DOI: 10.1111/ceo.12751] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Stuart L Graham
- Faculty of Medicine and Human Science; Macquarie University; Sydney New South Wales Australia
- Save Sight Institute; Sydney University; Sydney New South Wales Australia
| | - Alexander Klistorner
- Faculty of Medicine and Human Science; Macquarie University; Sydney New South Wales Australia
- Save Sight Institute; Sydney University; Sydney New South Wales Australia
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124
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Grieb P, Jünemann A, Rekas M, Rejdak R. Citicoline: A Food Beneficial for Patients Suffering from or Threated with Glaucoma. Front Aging Neurosci 2016; 8:73. [PMID: 27092075 PMCID: PMC4824764 DOI: 10.3389/fnagi.2016.00073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/28/2016] [Indexed: 12/13/2022] Open
Abstract
Oral form of citicoline, a nootropic and neuroprotective drug in use for almost five decades, recently was pronounced a food supplement in both USA and EU. The idea of adding citicoline to topical treatment of primary open angle glaucoma (POAG) aimed at decreasing intraocular pressure (IOP) appeared as a logical consequence of accepting neurodegenerative character of this disease. Experimental data, and also few clinical studies indicate that this substance has potential to counteract some important pathological mechanisms which seem to contribute to POAG initiation and progression, such as excitotoxicity and oxidative stress.
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Affiliation(s)
- Pawel Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences Warsaw, Poland
| | - Anselm Jünemann
- Department of Ophthalmology, University of Rostock Rostock, Germany
| | - Marek Rekas
- Department of Ophthalmology, Military Institute of Medicine Warsaw, Poland
| | - Robert Rejdak
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of SciencesWarsaw, Poland; Department of General Ophthalmology, Medical University of LublinLublin, Poland
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Antony BJ, Chen M, Carass A, Jedynak BM, Al-Louzi O, Solomon SD, Saidha S, Calabresi PA, Prince JL. Voxel Based Morphometry in Optical Coherence Tomography: Validation & Core Findings. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9788. [PMID: 27199503 DOI: 10.1117/12.2216096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) of the human retina is now becoming established as an important modality for the detection and tracking of various ocular diseases. Voxel based morphometry (VBM) is a long standing neuroimaging analysis technique that allows for the exploration of the regional differences in the brain. There has been limited work done in developing registration based methods for OCT, which has hampered the advancement of VBM analyses in OCT based population studies. Following on from our recent development of an OCT registration method, we explore the potential benefits of VBM analysis in cohorts of healthy controls (HCs) and multiple sclerosis (MS) patients. Specifically, we validate the stability of VBM analysis in two pools of HCs showing no significant difference between the two populations. Additionally, we also present a retrospective study of age and sex matched HCs and relapsing remitting MS patients, demonstrating results consistent with the reported literature while providing insight into the retinal changes associated with this MS subtype.
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Affiliation(s)
- Bhavna J Antony
- Department of Electrical and Computer Engineering, Johns Hopkins University
| | - Min Chen
- Penn Image Computing and Science Laboratory, The University of Pennsylvania
| | - Aaron Carass
- Department of Electrical and Computer Engineering, Johns Hopkins University
| | | | - Omar Al-Louzi
- Department of Neurology, Johns Hopkins School of Medicine
| | | | - Shiv Saidha
- Department of Neurology, Johns Hopkins School of Medicine
| | | | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University
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Antony BJ, Lang A, Swingle EK, Al-Louzi O, Carass A, Solomon S, Calabresi PA, Saidha S, Prince JL. Simultaneous Segmentation of Retinal Surfaces and Microcystic Macular Edema in SDOCT Volumes. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9784. [PMID: 27199502 DOI: 10.1117/12.2214676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging modality that has begun to find widespread use in retinal imaging for the detection of a variety of ocular diseases. In addition to structural changes in the form of altered retinal layer thicknesses, pathological conditions may also cause the formation of edema within the retina. In multiple sclerosis, for instance, the nerve fiber and ganglion cell layers are known to thin. Additionally, the formation of pseudocysts called microcystic macular edema (MME) have also been observed in the eyes of about 5% of MS patients, and its presence has been shown to be correlated with disease severity. Previously, we proposed separate algorithms for the segmentation of retinal layers and MME, but since MME mainly occurs within specific regions of the retina, a simultaneous approach is advantageous. In this work, we propose an automated globally optimal graph-theoretic approach that simultaneously segments the retinal layers and the MME in volumetric OCT scans. SD-OCT scans from one eye of 12 MS patients with known MME and 8 healthy controls were acquired and the pseudocysts manually traced. The overall precision and recall of the pseudocyst detection was found to be 86.0% and 79.5%, respectively.
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Affiliation(s)
- Bhavna J Antony
- Department of Electrical and Computer Engineering, The Johns Hopkins University
| | - Andrew Lang
- Department of Electrical and Computer Engineering, The Johns Hopkins University
| | - Emily K Swingle
- Department of Biomedical Engineering, The Ohio State University
| | - Omar Al-Louzi
- Department of Neurology, The Johns Hopkins University School of Medicine
| | - Aaron Carass
- Department of Electrical and Computer Engineering, The Johns Hopkins University
| | - Sharon Solomon
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine
| | - Peter A Calabresi
- Department of Neurology, The Johns Hopkins University School of Medicine
| | - Shiv Saidha
- Department of Neurology, The Johns Hopkins University School of Medicine
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, The Johns Hopkins University
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Martinez-Lapiscina EH, Arnow S, Wilson JA, Saidha S, Preiningerova JL, Oberwahrenbrock T, Brandt AU, Pablo LE, Guerrieri S, Gonzalez I, Outteryck O, Mueller AK, Albrecht P, Chan W, Lukas S, Balk LJ, Fraser C, Frederiksen JL, Resto J, Frohman T, Cordano C, Zubizarreta I, Andorra M, Sanchez-Dalmau B, Saiz A, Bermel R, Klistorner A, Petzold A, Schippling S, Costello F, Aktas O, Vermersch P, Oreja-Guevara C, Comi G, Leocani L, Garcia-Martin E, Paul F, Havrdova E, Frohman E, Balcer LJ, Green AJ, Calabresi PA, Villoslada P. Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study. Lancet Neurol 2016; 15:574-84. [PMID: 27011339 DOI: 10.1016/s1474-4422(16)00068-5] [Citation(s) in RCA: 229] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fibre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available. METHODS In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis, and progressive multiple sclerosis. Patients were recruited from centres in Spain, Italy, France, Germany, Czech Republic, Netherlands, Canada, and the USA, with the first cohort starting in 2008 and the latest cohort starting in 2013. We assessed disability worsening using the Expanded Disability Status Scale (EDSS). The pRNFL thickness and macular volume were assessed once at study entry (baseline) by optical coherence tomography (OCT) and was calculated as the mean value of both eyes without optic neuritis for patients without a history of optic neuritis or the value of the non-optic neuritis eye for patients with previous unilateral optic neuritis. Researchers who did the OCT at baseline were masked to EDSS results and the researchers assessing disability with EDSS were masked to OCT results. We estimated the association of pRNFL thickness or macular volume at baseline in eyes without optic neuritis with the risk of subsequent disability worsening by use of proportional hazards models that included OCT metrics and age, disease duration, disability, presence of previous unilateral optic neuritis, and use of disease-modifying therapies as covariates. FINDINGS 879 patients with clinically isolated syndrome (n=74), relapsing-remitting multiple sclerosis (n=664), or progressive multiple sclerosis (n=141) were included in the primary analyses. Disability worsening occurred in 252 (29%) of 879 patients with multiple sclerosis after a median follow-up of 2·0 years (range 0·5-5 years). Patients with a pRNFL of less than or equal to 87 μm or less than or equal to 88 μm (measured with Spectralis or Cirrus OCT devices) had double the risk of disability worsening at any time after the first and up to the third years of follow-up (hazard ratio 2·06, 95% CI 1·36-3·11; p=0·001), and the risk was increased by nearly four times after the third and up to the fifth years of follow-up (3·81, 1·63-8·91; p=0·002). We did not identify meaningful associations for macular volume. INTERPRETATION Our results provide evidence of the usefulness of monitoring pRNFL thickness by OCT for prediction of the risk of disability worsening with time in patients with multiple sclerosis. FUNDING Instituto de Salud Carlos III.
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Affiliation(s)
| | - Sam Arnow
- University of California, San Francisco, CA, USA
| | | | - Shiv Saidha
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Timm Oberwahrenbrock
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité University Medicine and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité University Medicine and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | - Clare Fraser
- Save Sight Institute, University of Sydney, NSW, Australia
| | | | | | - Teresa Frohman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Irati Zubizarreta
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Magi Andorra
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Albert Saiz
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Axel Petzold
- VU Medical Center, Amsterdam, Netherlands; Moorfields Eye Hospital, London, UK
| | | | | | - Orhan Aktas
- University of Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | - Friedemann Paul
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité University Medicine and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | - Elliot Frohman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laura J Balcer
- University of Pennsylvania, Philadelphia, PA, USA; New York University, New York, NY, USA
| | - Ari J Green
- University of California, San Francisco, CA, USA
| | | | - Pablo Villoslada
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; University of California, San Francisco, CA, USA.
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128
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Abstract
PURPOSE To determine and describe the contribution of Neurodiagnostic (ND) technologists in achieving better patient outcomes. METHODS An online survey was distributed to ND services leadership (administrators, laboratory managers, supervisors, team leads, service owners, and Medical Directors) in the United States (U.S.) to assess the impact of ND professionals and credentialing on improved patient care. The 9-question internet survey addressed three sections: 1) Participant demographics; 2) Quality improvement with credentialing; 3) Value in obtaining credentials. Responses were anonymous. SURVEY RESULTS The survey response rate was 27% (152 of 564 respondents). Approximately 74% of all survey respondents acknowledge direct observation of quality improvement in EEG procedures by credentialed technologists; 85% agree that credentialed technologists are better able to identify and recognize abnormalities in the EEG and alert physicians for timely interpretation and patient health management; 45.6% observe improved patient outcomes with credentialed technologists; 72.8% percent agree credentialed technologists provide better quality of recording and data acquisition; and an overwhelming 96% of all participants express the view that technologists obtaining credentials in their modality of practice is valuable. CONCLUSION Our survey data support the positive impact that credentialed Neurodiagnostic Technologists have on the quality improvement of EEG procedures and patient care as observed by ND leadership nationwide. Furthermore, survey data support and demonstrate that ND leaders in the U.S. promote and endorse credentialing for their technologists as evidence of ample knowledge and competency, elevating the level of professionalism and providing neurodiagnostic services of the highest quality.
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129
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Abstract
PURPOSE To evaluate longitudinal changes of visual function in relapsing-remitting multiple sclerosis (RRMS). METHODS Multifocal visual evoked potential (mfVEP), contrast sensitivity (CS), and Humphrey visual fields (HVFs) were obtained at two visits (mean follow-up, 1.5 [±0.9] years) in both eyes of 57 RRMS patients (53 eyes with optic neuritis [ON]: 14 ON within 6 months of first visit [ON < 6 months] and 39 ON ≥ 6 months; 57 non-ON). Longitudinal changes were assessed using mfVEP amplitude (log signal-to-noise ratio [logSNR]), latency, CS, and HVF mean deviation based on established 95% tolerance limits of test-retest variability. RESULTS A significant percentage of eyes in the ON < 6 months group exceeded 95% tolerance limits for mfVEP logSNR (21%, p < 0.05), latency (35%, p < 0.01), and CS (31% p < 0.001); more improved than worsened over time (14% vs. 7% for logSNR, 21% vs. 14% for latency, and 31% vs. 0% for CS). Multifocal visual evoked potential latency decreased in 11% of non-ON eyes and in 10% of eyes in the ON ≥ 6 months group, and increased in 21% and 10%, respectively (p < 0.01 for all). Latency changes correlated negatively with baseline latency (r = -0.43 and -0.45 for non-ON and ON ≥ 6 months; p = 0.0008). Although a nonsignificant percentage of non-ON and ON ≥ 6 months eyes exceeded tolerance limits for logSNR, CS, or HVF, logSNR and latency changes correlated, and both measures correlated with changes in CS (r = 0.47 to 0.79, p < 0.01). CONCLUSIONS Multifocal visual evoked potential, particularly latency, is potentially useful for assessing neuroprotective and remyelinating strategies in RRMS.
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130
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Álvarez-Cermeño JC, Muñoz-Negrete FJ, Costa-Frossard L, Sainz de la Maza S, Villar LM, Rebolleda G. Intrathecal lipid-specific oligoclonal IgM synthesis associates with retinal axonal loss in multiple sclerosis. J Neurol Sci 2016; 360:41-4. [DOI: 10.1016/j.jns.2015.11.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/03/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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131
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Qureshi SS, Frohman EM. Acute optic neuritis: a clinical paradigm for evaluation of neuroprotective and restorative strategies? Neural Regen Res 2015; 10:1599-601. [PMID: 26692855 PMCID: PMC4660751 DOI: 10.4103/1673-5374.165286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sara S Qureshi
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
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132
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Saidha S, Calabresi PA. Optical coherence tomography should be part of the routine monitoring of patients with multiple sclerosis: yes. Mult Scler 2015; 20:1296-8. [PMID: 25160122 DOI: 10.1177/1352458514541509] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Peter A Calabresi
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, USADivision of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, USA
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133
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Loughran-Fjeldstad AS, Carlson NG, Husebye CD, Cook LJ, Rose JW. Retinal nerve fiber layer sector-specific compromise in relapsing and remitting multiple sclerosis. eNeurologicalSci 2015; 1:30-37. [PMID: 29445776 PMCID: PMC5808615 DOI: 10.1016/j.ensci.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 01/12/2023] Open
Abstract
Objective To evaluate quadrant and sector retinal nerve fiber layer (RNFL) thickness and total macular volume (TMV) in relapsing–remitting multiple sclerosis (RR-MS) patients. Methods Optical coherence tomography measures of RNFL and TMV were studied in 321 eyes without prior optic neuritis (ON) (MS unaffected), 151 eyes with prior ON (MS affected), and 148 healthy control eyes. Results Mean RNFL thickness was significantly lower in the MS affected and MS unaffected groups relative to the control group (p < 0.0001). RNFL thicknesses in the superior, inferior, and temporal quadrants were significantly reduced in MS unaffected (113 ± 15 μm, 119 ± 17 μm, 63 ± 13 μm) (p < 0.001) and MS affected groups (99 ± 19 μm, 103 ± 21 μm, 51 ± 13 μm) (p < 0.0001) compared with that in controls (120 ± 14 μm, 128 ± 15 μm, 69 ± 8 μm, respectively). TMV was significantly reduced in both the MS affected and MS unaffected groups compared with that in the controls (p < 0.0001). Conclusion Quadrant, sector, and PMB RNFL thicknesses are significant individual measures in RR-MS for both affected and unaffected eyes and may prove valuable in future investigations including biomarker and outcomes research. We detailed RNFL quadrant and sector segmentation analysis in multiple sclerosis. RNFL sector thicknesses were lower in 2 affected eyes relative to 1 affected eye. PMB thickness distinguishes MS affected and MS unaffected groups from controls. TMV thickness distinguishes MS affected and MS unaffected groups from controls. EDSS correlated with RNFL for unaffected group and TMV for affected group.
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Affiliation(s)
| | - Noel G Carlson
- Neurovirology Research, VA SLC HCS, GRECC, 500 Foothill Drive, Salt Lake City, UT 84148, USA.,Department of Neurobiology & Anatomy, University of Utah, 20 North 1900 East, Salt Lake City, UT 84132 USA
| | - Cassandra D Husebye
- Department of Neurology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - John W Rose
- Department of Neurology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA.,Neurovirology Research, VA SLC HCS, GRECC, 500 Foothill Drive, Salt Lake City, UT 84148, USA
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134
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Saidha S, Al-Louzi O, Ratchford JN, Bhargava P, Oh J, Newsome SD, Prince JL, Pham D, Roy S, van Zijl P, Balcer LJ, Frohman EM, Reich DS, Crainiceanu C, Calabresi PA. Optical coherence tomography reflects brain atrophy in multiple sclerosis: A four-year study. Ann Neurol 2015; 78:801-13. [PMID: 26190464 DOI: 10.1002/ana.24487] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this work was to determine whether atrophy of specific retinal layers and brain substructures are associated over time, in order to further validate the utility of optical coherence tomography (OCT) as an indicator of neuronal tissue damage in patients with multiple sclerosis (MS). METHODS Cirrus high-definition OCT (including automated macular segmentation) was performed in 107 MS patients biannually (median follow-up: 46 months). Three-Tesla magnetic resonance imaging brain scans (including brain-substructure volumetrics) were performed annually. Individual-specific rates of change in retinal and brain measures (estimated with linear regression) were correlated, adjusting for age, sex, disease duration, and optic neuritis (ON) history. RESULTS Rates of ganglion cell + inner plexiform layer (GCIP) and whole-brain (r = 0.45; p < 0.001), gray matter (GM; r = 0.37; p < 0.001), white matter (WM; r = 0.28; p = 0.007), and thalamic (r = 0.38; p < 0.001) atrophy were associated. GCIP and whole-brain (as well as GM and WM) atrophy rates were more strongly associated in progressive MS (r = 0.67; p < 0.001) than relapsing-remitting MS (RRMS; r = 0.33; p = 0.007). However, correlation between rates of GCIP and whole-brain (and additionally GM and WM) atrophy in RRMS increased incrementally with step-wise refinement to exclude ON effects; excluding eyes and then patients (to account for a phenotype effect), the correlation increased to 0.45 and 0.60, respectively, consistent with effect modification. In RRMS, lesion accumulation rate was associated with GCIP (r = -0.30; p = 0.02) and inner nuclear layer (r = -0.25; p = 0.04) atrophy rates. INTERPRETATION Over time GCIP atrophy appears to mirror whole-brain, and particularly GM, atrophy, especially in progressive MS, thereby reflecting underlying disease progression. Our findings support OCT for clinical monitoring and as an outcome in investigative trials.
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Affiliation(s)
- Shiv Saidha
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Omar Al-Louzi
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - John N Ratchford
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Pavan Bhargava
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD.,Department of Computer Science, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD
| | - Dzung Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.,Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Snehashis Roy
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.,Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Peter van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD
| | - Laura J Balcer
- Department of Neurology, New York University Langone Medical Center, New York, NY
| | - Elliot M Frohman
- Department of Neurology and Ophthalmology, University of Texas Southwestern, Dallas, TX
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University, Baltimore, MD.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD.,Department of Biostatistics, Johns Hopkins University, Baltimore, MD.,Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
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135
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Oberwahrenbrock T, Weinhold M, Mikolajczak J, Zimmermann H, Paul F, Beckers I, Brandt AU. Reliability of Intra-Retinal Layer Thickness Estimates. PLoS One 2015; 10:e0137316. [PMID: 26349053 PMCID: PMC4562656 DOI: 10.1371/journal.pone.0137316] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 08/15/2015] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Measurement of intra-retinal layer thickness using optical coherence tomography (OCT) has become increasingly prominent in multiple sclerosis (MS) research. Nevertheless, the approaches used for determining the mean layer thicknesses vary greatly. Insufficient data exist on the reliability of different thickness estimates, which is crucial for their application in clinical studies. This study addresses this lack by evaluating the repeatability of different thickness estimates. METHODS Studies that used intra-retinal layer segmentation of macular OCT scans in patients with MS were retrieved from PubMed. To investigate the repeatability of previously applied layer estimation approaches, we generated datasets of repeating measurements of 15 healthy subjects and 13 multiple sclerosis patients using two OCT devices (Cirrus HD-OCT and Spectralis SD-OCT). We calculated each thickness estimate in each repeated session and analyzed repeatability using intra-class correlation coefficients and coefficients of repeatability. RESULTS We identified 27 articles, eleven of them used the Spectralis SD-OCT, nine Cirrus HD-OCT, two studies used both devices and two studies applied RTVue-100. Topcon OCT-1000, Stratus OCT and a research device were used in one study each. In the studies that used the Spectralis, ten different thickness estimates were identified, while thickness estimates of the Cirrus OCT were based on two different scan settings. In the simulation dataset, thickness estimates averaging larger areas showed an excellent repeatability for all retinal layers except the outer plexiform layer (OPL). CONCLUSIONS Given the good reliability, the thickness estimate of the 6mm-diameter area around the fovea should be favored when OCT is used in clinical research. Assessment of the OPL was weak in general and needs further investigation before OPL thickness can be used as a reliable parameter.
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Affiliation(s)
- Timm Oberwahrenbrock
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Maria Weinhold
- Optics and Laser Technology Laboratory, Beuth University of Applied Sciences, Berlin, Germany
| | - Janine Mikolajczak
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité–Universitätsmedizin, Berlin, Germany
| | - Ingeborg Beckers
- Optics and Laser Technology Laboratory, Beuth University of Applied Sciences, Berlin, Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
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136
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Droby A, Panagoulias M, Albrecht P, Reuter E, Duning T, Hildebrandt A, Wiendl H, Zipp F, Methner A. A novel automated segmentation method for retinal layers in OCT images proves retinal degeneration after optic neuritis. Br J Ophthalmol 2015; 100:484-90. [PMID: 26307452 DOI: 10.1136/bjophthalmol-2014-306015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/01/2015] [Indexed: 12/15/2022]
Abstract
AIM The evaluation of inner retinal layer thickness can serve as a direct biomarker for monitoring the course of inflammatory diseases of the central nervous system such as multiple sclerosis (MS). Using optical coherence tomography (OCT), thinning of the retinal nerve fibre layer and changes in deeper retinal layers have been observed in patients with MS. Here, we first compare a novel method for automated segmentation of OCT images with manual segmentation using two cohorts of patients with MS. Using this method, we also aimed to reproduce previous findings showing retinal degeneration following optic neuritis (ON) in MS. METHODS Based on a 5×5 expansion of the Prewitt operator to efficiently calculate the gradient of image intensity, we introduce an automated algorithm for the segmentation of intraretinal layers. We evaluated this algorithm by comparison to manually segmented two-dimensional OCT images at the macular level for 125 patients from two separate cohorts of patients with MS. Of these patients, 52 had suffered from unilateral ON+ within 6 months prior to measurement. RESULTS When comparing ON+ eyes with ON- eyes, both manual and automated segmentation demonstrated a significant inter-eye thinning in the ganglion cell layer in ON+ eyes. We also observed an increased thickness of the inner nuclear (INL) and the outer segment-retinal pigment epithelium (OS-RPE) layers of ON+ eyes in both cohorts. These findings corroborate previous data, thus demonstrating the validity of our approach. CONCLUSIONS The algorithm presented here was found to be a valid tool for replacing cumbersome manual segmentation methods in the quantification of inner retinal layers in OCT. The observed increases in thickness of INL and OS-RPE may be attributed to primary retinal inflammation, repair and/or plasticity mechanisms following the immune attack.
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Affiliation(s)
- Amgad Droby
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Michail Panagoulias
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Albrecht
- Medical Faculty, Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - Eva Reuter
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital, Münster, Germany
| | - Andreas Hildebrandt
- Department of Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital, Münster, Germany
| | - Frauke Zipp
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Axel Methner
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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137
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Ringelstein M, Albrecht P, Kleffner I, Bühn B, Harmel J, Müller AK, Finis D, Guthoff R, Bergholz R, Duning T, Krämer M, Paul F, Brandt A, Oberwahrenbrock T, Mikolajczak J, Wildemann B, Jarius S, Hartung HP, Aktas O, Dörr J. Retinal pathology in Susac syndrome detected by spectral-domain optical coherence tomography. Neurology 2015. [DOI: 10.1212/wnl.0000000000001852] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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138
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Bennett JL, Nickerson M, Costello F, Sergott RC, Calkwood JC, Galetta SL, Balcer LJ, Markowitz CE, Vartanian T, Morrow M, Moster ML, Taylor AW, Pace TWW, Frohman T, Frohman EM. Re-evaluating the treatment of acute optic neuritis. J Neurol Neurosurg Psychiatry 2015; 86:799-808. [PMID: 25355373 PMCID: PMC4414747 DOI: 10.1136/jnnp-2014-308185] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/28/2014] [Indexed: 12/28/2022]
Abstract
Clinical case reports and prospective trials have demonstrated a reproducible benefit of hypothalamic-pituitary-adrenal (HPA) axis modulation on the rate of recovery from acute inflammatory central nervous system (CNS) demyelination. As a result, corticosteroid preparations and adrenocorticotrophic hormones are the current mainstays of therapy for the treatment of acute optic neuritis (AON) and acute demyelination in multiple sclerosis.Despite facilitating the pace of recovery, HPA axis modulation and corticosteroids have failed to demonstrate long-term benefit on functional recovery. After AON, patients frequently report visual problems, motion perception difficulties and abnormal depth perception despite 'normal' (20/20) vision. In light of this disparity, the efficacy of these and other therapies for acute demyelination require re-evaluation using modern, high-precision paraclinical tools capable of monitoring tissue injury.In no arena is this more amenable than AON, where a new array of tools in retinal imaging and electrophysiology has advanced our ability to measure the anatomic and functional consequences of optic nerve injury. As a result, AON provides a unique clinical model for evaluating the treatment response of the derivative elements of acute inflammatory CNS injury: demyelination, axonal injury and neuronal degeneration.In this article, we examine current thinking on the mechanisms of immune injury in AON, discuss novel technologies for the assessment of optic nerve structure and function, and assess current and future treatment modalities. The primary aim is to develop a framework for rigorously evaluating interventions in AON and to assess their ability to preserve tissue architecture, re-establish normal physiology and restore optimal neurological function.
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Affiliation(s)
- Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - Molly Nickerson
- Department of Medical Affairs, Questcor Pharmaceuticals, Inc., Hayward, California, USA
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Hotchkiss Brain Institute, Alberta, Canada
| | - Robert C Sergott
- Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA
| | | | - Steven L Galetta
- Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA
| | - Laura J Balcer
- Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA
| | - Clyde E Markowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy Vartanian
- Rockefeller University and Memorial Sloan-Kettering Hospital, Weill Cornell Medical College, New York, USA
| | - Mark Morrow
- Department of Neurology, Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Mark L Moster
- Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA
| | - Andrew W Taylor
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thaddeus W W Pace
- College of Nursing at the University of Arizona, Tucson, Arizona, USA
| | - Teresa Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elliot M Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
Although visual processing impairments are common in schizophrenia, it is not clear to what extent these originate in the eye vs. the brain. This review highlights potential contributions, from the retina and other structures of the eye, to visual processing impairments in schizophrenia and high-risk states. A second goal is to evaluate the status of retinal abnormalities as biomarkers for schizophrenia. The review was motivated by known retinal changes in other disorders (e.g., Parkinson’s disease, multiple sclerosis), and their relationships to perceptual and cognitive impairments, and disease progression therein. The evidence reviewed suggests two major conclusions. One is that there are multiple structural and functional disturbances of the eye in schizophrenia, all of which could be factors in the visual disturbances of patients. These include retinal venule widening, retinal nerve fiber layer thinning, dopaminergic abnormalities, abnormal ouput of retinal cells as measured by electroretinography (ERG), maculopathies and retinopathies, cataracts, poor acuity, and strabismus. Some of these are likely to be illness-related, whereas others may be due to medication or comorbid conditions. The second conclusion is that certain retinal findings can serve as biomarkers of neural pathology, and disease progression, in schizophrenia. The strongest evidence for this to date involves findings of widened retinal venules, thinning of the retinal nerve fiber layer, and abnormal ERG amplitudes. These data suggest that a greater understanding of the contribution of retinal and other ocular pathology to the visual and cognitive disturbances of schizophrenia is warranted, and that retinal changes have untapped clinical utility.
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Silverstein SM, Thompson JL. A vision science perspective on schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:39-41. [PMID: 26345386 PMCID: PMC4560247 DOI: 10.1016/j.scog.2015.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Huang-Link YM, Fredrikson M, Link H. Benign Multiple Sclerosis is Associated with Reduced Thinning of the Retinal Nerve Fiber and Ganglion Cell Layers in Non-Optic-Neuritis Eyes. J Clin Neurol 2015; 11:241-7. [PMID: 26022460 PMCID: PMC4507378 DOI: 10.3988/jcn.2015.11.3.241] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose It is exceedingly difficult to differentiate benign multiple sclerosis (BMS) from relapsing-remitting multiple sclerosis (RRMS) based on clinical characteristics, neuroimaging, and cerebrospinal fluid tests. Optical coherence tomography (OCT) allows quantification of retinal structures, such as the retinal nerve fiber layer (RNFL) thickness, at the optic disc and the ganglion cell layer (GCL) at the macula, on a micrometer scale. It can also be used to trace minor alterations and the progression of neurodegeneration, help predict BMS, and influence the choice of therapy. To utilize OCT to detect the extent of changes of the optic disk and macular microstructure in patients with BMS and RRMS compared to healthy controls (HCs), with special focus on changes related to the presence/absence of optic neuritis (ON). Methods Spectral-domain OCT was applied to examine eyes from 36 patients with multiple sclerosis (MS), comprising 11 with BMS and 25 with RRMS, and 34 HCs. Results The RNFL and GCL were significantly thinner in eyes previously affected by ON, irrespective of the type of MS (i.e., BMS or RRMS), than in HCs. Significant thinning of the GCL was also observed in non-ON RRMS (and not non-ON BMS) compared to HCs. Correspondingly, a significant association between disease duration and thinning rates of the RNFL and GCL was observed only in non-ON RRMS (-0.54±0.24 and -0.43±0.21 µm/year, mean±SE; p<0.05 for both), and not in non-ON BMS (-0.11±0.27 and -0.24±0.24 µm/year). Conclusions The RNFL and GCL were thinner in both ON- and non-ON MS, but the change was more pronounced in ON MS, irrespective of the MS subtype studied herein. GCL thinning and the thinning rate of both the GCL and RNFL were less pronounced in non-ON BMS than in non-ON RRMS. These findings may help to predict the course of BMS.
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Affiliation(s)
- Yu Min Huang-Link
- Division of Neurology, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden. yumin.link@ regionostergotland.se
| | - Mats Fredrikson
- Department of Occupational and Environmental Medicine and Linkoping Academic Research Center (LARC), Linköping University, Linköping, Sweden
| | - Hans Link
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Freedman MS, Abdoli M. Evaluating response to disease-modifying therapy in relapsing multiple sclerosis. Expert Rev Neurother 2015; 15:407-23. [DOI: 10.1586/14737175.2015.1023711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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143
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Gabilondo I, Martínez-Lapiscina EH, Fraga-Pumar E, Ortiz-Perez S, Torres-Torres R, Andorra M, Llufriu S, Zubizarreta I, Saiz A, Sanchez-Dalmau B, Villoslada P. Dynamics of retinal injury after acute optic neuritis. Ann Neurol 2015; 77:517-28. [PMID: 25559267 DOI: 10.1002/ana.24351] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 12/26/2014] [Accepted: 12/26/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We set out to assess the dynamics of retinal injury after acute optic neuritis (ON) and their association with clinical visual outcomes. METHODS Thirty-one consecutive patients with acute ON were prospectively analyzed over a 6-month follow-up period. Each month, we used optical coherence tomography (OCT) to assess the thickness of peripapillary retinal nerve fiber layer (pRNFL) and segmented macular layers, as well as high-contrast visual acuity, low-contrast visual acuity (LCVA), color visual acuity (CVA), and visual fields (VF). RESULTS In this prospective study, we found that 6 months after clinical onset, ON eyes suffered a reduction in pRNFL (-45.3 μm) and macular thickness (-17.3 μm). Macular atrophy was due to the decrease of macular RNFL thickness (-7.8 μm) and that of the ganglion cell layer and inner plexiform layer (GCIP, -11.3 μm), whereas the thickness of the outer retinal layers increased slightly. The macular RNFL and GCIP thickness decreased in parallel, yet it always occurred more rapidly and more severely for the GCIP. The change in the GCIP thickness in the first month predicted the visual impairment by month 6; a decrease ≥ of 4.5 μm predicted poor LCVA (sensitivity of 93% and specificity of 88%), and a decrease of ≥ 7 μm predicted poor VF and CVA (sensitivity of 78% and 100% and specificity of 63% and 66%, respectively). INTERPRETATION Retinal axonal and neuronal damage develops quickly after ON onset. Assessment of ganglion cell layer thickness by OCT after ON onset can be used as an imaging marker of persistent visual disability.
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Affiliation(s)
- Iñigo Gabilondo
- Center of Neuroimmunology and Department of Neurology, August Pi Sunyer Institute of Biomedical Research, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Oh J, Sotirchos ES, Saidha S, Whetstone A, Chen M, Newsome SD, Zackowski K, Balcer LJ, Frohman E, Prince J, Diener-West M, Reich DS, Calabresi PA. Relationships between quantitative spinal cord MRI and retinal layers in multiple sclerosis. Neurology 2015; 84:720-8. [PMID: 25609766 DOI: 10.1212/wnl.0000000000001257] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess relationships between spinal cord MRI (SC-MRI) and retinal measures, and to evaluate whether these measures independently relate to clinical disability in multiple sclerosis (MS). METHODS One hundred two patients with MS and 11 healthy controls underwent 3-tesla brain and cervical SC-MRI, which included standard T1- and T2-based sequences and diffusion-tensor and magnetization-transfer imaging, and optical coherence tomography with automated segmentation. Clinical assessments included visual acuity (VA), Expanded Disability Status Scale, MS functional composite, vibration sensation threshold, and hip-flexion strength. Regions of interest circumscribing SC cross-sections at C3-4 were used to obtain cross-sectional area (CSA), fractional anisotropy (FA), perpendicular diffusivity (λ⊥), and magnetization transfer ratio. Multivariable regression assessed group differences and SC, retinal, and clinical relationships. RESULTS In MS, there were correlations between SC-CSA, SC-FA, SC-λ⊥, and peripapillary retinal nerve fiber layer (pRNFL) (p = 0.01, p = 0.002, p = 0.001, respectively) after adjusting for age, sex, prior optic neuritis, and brain atrophy. In multivariable clinical models, when SC-CSA, pRNFL, and brain atrophy were included simultaneously, SC-CSA and pRNFL retained independent relationships with low-contrast VA (p = 0.04, p = 0.002, respectively), high-contrast VA (p = 0.06, p = 0.008), and vibration sensation threshold (p = 0.01, p = 0.05). SC-CSA alone retained independent relationships with Expanded Disability Status Scale (p = 0.001), hip-flexion strength (p = 0.001), and MS functional composite (p = 0.004). CONCLUSIONS In this cross-sectional study of patients with MS, correlations exist between SC-MRI and retinal layers, and both exhibit independent relationships with clinical dysfunction. These findings suggest that the SC and optic nerve reflect ongoing global pathologic processes that supplement measures of whole-brain atrophy, highlighting the importance of combining measures from unique compartments to facilitate a thorough examination of regional and global disease processes that contribute to clinical disability in MS.
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Affiliation(s)
- Jiwon Oh
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD.
| | - Elias S Sotirchos
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Shiv Saidha
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Anna Whetstone
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Min Chen
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Scott D Newsome
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Kathy Zackowski
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Laura J Balcer
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Elliot Frohman
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Jerry Prince
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Marie Diener-West
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Daniel S Reich
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Peter A Calabresi
- From the Departments of Neurology (J.O., E.S.S., S.S., A.W., S.D.N., K.Z., D.S.R., P.A.C.), Electrical and Computer Engineering (M.C., J.P.), Computer Science (J.P.), Physical Medicine and Rehabilitation (K.Z.), Biostatistics (M.C., M.D.-W., D.S.R.), and Radiology and Radiological Science (D.S.R.), Johns Hopkins University, Baltimore, MD; Division of Neurology (J.O.), Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Motion Analysis Laboratory (K.Z.), Kennedy Krieger Institute, Baltimore, MD; Department of Neurology (L.J.B.), University of Pennsylvania School of Medicine, Philadelphia; Departments of Neurology and Ophthalmology (E.F.), University of Texas Southwestern Medical Center at Dallas; and Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD.
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Kimbrough DJ, Sotirchos ES, Wilson JA, Al-Louzi O, Conger A, Conger D, Frohman TC, Saidha S, Green AJ, Frohman EM, Balcer LJ, Calabresi PA. Retinal damage and vision loss in African American multiple sclerosis patients. Ann Neurol 2015; 77:228-36. [PMID: 25382184 DOI: 10.1002/ana.24308] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 10/12/2014] [Accepted: 11/06/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine whether African American (AA) multiple sclerosis (MS) patients exhibit more retinal damage and visual impairment compared to Caucasian American (CA) MS patients. METHODS A total of 687 MS patients (81 AAs) and 110 healthy control (HC) subjects (14 AAs) were recruited at 3 academic hospitals between 2008 and 2012. Using mixed effects regression models, we compared high- and low-contrast visual acuity (HCVA and LCVA) and high-definition spectral domain optical coherence tomography measures of retinal architecture between MS patients of self-identified AA and CA ancestry. RESULTS In HCs, baseline peripapillary retinal nerve fiber layer (RNFL) thickness was 6.1µm greater in AAs (p = 0.047), whereas ganglion cell/inner plexiform layer (GCIP) thickness did not differ by race. In MS patients, baseline RNFL did not differ by race, and GCIP was 3.98µm thinner in AAs (p = 0.004). AAs had faster RNFL and GCIP thinning rates compared to CAs (p = 0.004 and p = 0.046, respectively). AA MS patients had lower baseline HCVA (p = 0.02) and worse LCVA per year of disease duration (p = 0.039). Among patients with an acute optic neuritis (AON) history, AAs had greater loss of HCVA than CA patients (p = 0.012). INTERPRETATION This multicenter investigation provides objective evidence that AA MS patients exhibit accelerated retinal damage compared to CA MS patients. Self-identified AA ancestry is associated with worse MS-related visual disability, particularly in the context of an AON history, suggesting a more aggressive inflammatory disease course among AA MS patients or a subpopulation therein.
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146
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Lang A, Carass A, Al-Louzi O, Bhargava P, Ying HS, Calabresi PA, Prince JL. Longitudinal graph-based segmentation of macular OCT using fundus alignment. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9413:94130M. [PMID: 26023248 PMCID: PMC4443705 DOI: 10.1117/12.2077713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Segmentation of retinal layers in optical coherence tomography (OCT) has become an important diagnostic tool for a variety of ocular and neurological diseases. Currently all OCT segmentation algorithms analyze data independently, ignoring previous scans, which can lead to spurious measurements due to algorithm variability and failure to identify subtle changes in retinal layers. In this paper, we present a graph-based segmentation framework to provide consistent longitudinal segmentation results. Regularization over time is accomplished by adding weighted edges between corresponding voxels at each visit. We align the scans to a common subject space before connecting the graphs by registering the data using both the retinal vasculature and retinal thickness generated from a low resolution segmentation. This initial segmentation also allows the higher dimensional temporal problem to be solved more efficiently by reducing the graph size. Validation is performed on longitudinal data from 24 subjects, where we explore the variability between our longitudinal graph method and a cross-sectional graph approach. Our results demonstrate that the longitudinal component improves segmentation consistency, particularly in areas where the boundaries are difficult to visualize due to poor scan quality.
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Affiliation(s)
- Andrew Lang
- Department of Electrical and Computer Engineering, The Johns Hopkins University
| | - Aaron Carass
- Department of Electrical and Computer Engineering, The Johns Hopkins University ; Department of Computer Science, The Johns Hopkins University
| | - Omar Al-Louzi
- Department of Neurology, The Johns Hopkins University School of Medicine
| | - Pavan Bhargava
- Department of Neurology, The Johns Hopkins University School of Medicine
| | - Howard S Ying
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine
| | - Peter A Calabresi
- Department of Neurology, The Johns Hopkins University School of Medicine
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, The Johns Hopkins University
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147
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Lang A, Carass A, Swingle EK, Al-Louzi O, Bhargava P, Saidha S, Ying HS, Calabresi PA, Prince JL. Automatic segmentation of microcystic macular edema in OCT. BIOMEDICAL OPTICS EXPRESS 2015; 6:155-69. [PMID: 25657884 PMCID: PMC4317118 DOI: 10.1364/boe.6.000155] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/29/2014] [Accepted: 12/04/2014] [Indexed: 05/11/2023]
Abstract
Microcystic macular edema (MME) manifests as small, hyporeflective cystic areas within the retina. For reasons that are still largely unknown, a small proportion of patients with multiple sclerosis (MS) develop MME-predominantly in the inner nuclear layer. These cystoid spaces, denoted pseudocysts, can be imaged using optical coherence tomography (OCT) where they appear as small, discrete, low intensity areas with high contrast to the surrounding tissue. The ability to automatically segment these pseudocysts would enable a more detailed study of MME than has been previously possible. Although larger pseudocysts often appear quite clearly in the OCT images, the multi-frame averaging performed by the Spectralis scanner adds a significant amount of variability to the appearance of smaller pseudocysts. Thus, simple segmentation methods only incorporating intensity information do not perform well. In this work, we propose to use a random forest classifier to classify the MME pixels. An assortment of both intensity and spatial features are used to aid the classification. Using a cross-validation evaluation strategy with manual delineation as ground truth, our method is able to correctly identify 79% of pseudocysts with a precision of 85%. Finally, we constructed a classifier from the output of our algorithm to distinguish clinically identified MME from non-MME subjects yielding an accuracy of 92%.
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Affiliation(s)
- Andrew Lang
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218,
USA
| | - Aaron Carass
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218,
USA
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD 21218,
USA
| | - Emily K. Swingle
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210,
USA
| | - Omar Al-Louzi
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD 21287,
USA
| | - Pavan Bhargava
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD 21287,
USA
| | - Shiv Saidha
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD 21287,
USA
| | - Howard S. Ying
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Baltimore, MD 21287,
USA
| | - Peter A. Calabresi
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD 21287,
USA
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218,
USA
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148
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Volpe NJ, Simonett J, Fawzi AA, Siddique T. Ophthalmic Manifestations of Amyotrophic Lateral Sclerosis (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2015; 113:T12. [PMID: 26877563 PMCID: PMC4731009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine if clinical and histopathologic findings were present in the eyes of patients with amyotrophic lateral sclerosis (ALS) and explore correlations to an animal model of ALS. METHODS Two patients with ALS were studied histopathologically as well as the retinas of ALS/dementia transgenic mice with dysfunctional ubiquilin2, UBQLN2(P497H). Clinical study 1, an observational, cross-sectional study, was performed using optical coherence tomography (OCT) to obtain and compare mean total macular thickness and average and quadrant specific peripapillary retinal nerve fiber layer (pRNFL) scans from 16 patients with ALS to controls. Correlation analysis was performed to evaluate the association with disease duration. Clinical study 2 consisted of measuring visual acuity, color vision, contrast sensitivity, and quality of life in 12 patients. RESULTS Histopathologic studies demonstrated intraretinal inclusions in one patient and loss of ganglion cell axons in another. Mouse eyes had intraretinal inclusions in the inner plexiform layers. Total macular volume was thinner in patients compared to controls (P<.05), and 37.5% of patients with ALS had an average pRNFL below the 1st percentile. Total macular and pRNFL thickness correlated inversely with disease duration. CONCLUSIONS Histopathologic analysis of ALS eyes and mice with the UBQLN2(P497H) mutation, as well as OCT measurements, supports involvement of the anterior visual pathway. We identified pathologies, including intraretinal deposits and axonal loss. pRNFL and total macular thinning found on OCT correlated with disease duration. A pattern of vision loss specific for ALS was not identified. This study confirms ocular involvement in patients and transgenic animals with ALS/dementia.
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Affiliation(s)
- Nicholas J Volpe
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joseph Simonett
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Teepu Siddique
- Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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149
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Balcer LJ, Miller DH, Reingold SC, Cohen JA. Vision and vision-related outcome measures in multiple sclerosis. Brain 2015; 138:11-27. [PMID: 25433914 PMCID: PMC4285195 DOI: 10.1093/brain/awu335] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/14/2014] [Accepted: 10/29/2014] [Indexed: 12/22/2022] Open
Abstract
Visual impairment is a key manifestation of multiple sclerosis. Acute optic neuritis is a common, often presenting manifestation, but visual deficits and structural loss of retinal axonal and neuronal integrity can occur even without a history of optic neuritis. Interest in vision in multiple sclerosis is growing, partially in response to the development of sensitive visual function tests, structural markers such as optical coherence tomography and magnetic resonance imaging, and quality of life measures that give clinical meaning to the structure-function correlations that are unique to the afferent visual pathway. Abnormal eye movements also are common in multiple sclerosis, but quantitative assessment methods that can be applied in practice and clinical trials are not readily available. We summarize here a comprehensive literature search and the discussion at a recent international meeting of investigators involved in the development and study of visual outcomes in multiple sclerosis, which had, as its overriding goals, to review the state of the field and identify areas for future research. We review data and principles to help us understand the importance of vision as a model for outcomes assessment in clinical practice and therapeutic trials in multiple sclerosis.
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Affiliation(s)
- Laura J Balcer
- 1 Departments of Neurology, Ophthalmology and Population Health, New York University School of Medicine, NY 10016, USA
| | - David H Miller
- 2 Queen Square MS Centre, UCL Institute of Neurology, London, WC1N 3BG, UK
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150
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Zimmermann H, Oberwahrenbrock T, Brandt AU, Paul F, Dörr J. Optical coherence tomography for retinal imaging in multiple sclerosis. Degener Neurol Neuromuscul Dis 2014; 4:153-162. [PMID: 32669908 PMCID: PMC7337265 DOI: 10.2147/dnnd.s73506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 12/12/2022] Open
Abstract
Visual disturbances caused by inflammatory and demyelinating processes of the visual system, mainly in the optic nerve, are a common symptom in multiple sclerosis (MS). Optical coherence tomography (OCT) is a tool that is increasingly used for quantifying retinal damage in MS and other neurologic diseases. Based on spectral interferometry, it uses low-coherent infrared light to generate high-resolution spatial images of the retina. The retinal nerve fiber layer (RNFL) consists of unmyelinated axons that form the optic nerve, and thus represents a part of the central nervous system. OCT allows for noninvasive measurements of RNFL thickness in micrometer resolution. With the help of OCT, researchers have managed to demonstrate that eyes of MS patients show distinct RNFL thinning after an event of acute optic neuritis in MS, and even subclinical damage in eyes with no previous optic neuritis. OCT is also a useful tool in terms of providing a differential diagnosis of MS toward, for example, neuromyelitis optica, a disease that usually shows stronger retinal thinning, or Susac syndrome, which is characterized by distinct patchy thinning of the inner retinal layers. RNFL thinning is associated with magnetic resonance imaging-derived measurements of the brain, such as whole-brain atrophy, gray and white matter atrophy, and optic radiation damage. These features suggest that OCT-derived retinal measurements are a complement for measuring central nervous system neurodegeneration in the context of clinical trials – for example, with neuroprotective substances.
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Affiliation(s)
| | | | | | - Friedemann Paul
- NeuroCure Clinical Research Center.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center.,Clinical and Experimental Multiple Sclerosis Research Center
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