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Zuroff LR, Green AJ. The Study of Remyelinating Therapies in Multiple Sclerosis: Visual Outcomes as a Window Into Repair. J Neuroophthalmol 2024; 44:143-156. [PMID: 38654413 DOI: 10.1097/wno.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Amelioration of disability in multiple sclerosis requires the development of complementary therapies that target neurodegeneration and promote repair. Remyelination is a promising neuroprotective strategy that may protect axons from damage and subsequent neurodegeneration. METHODS A review of key literature plus additional targeted search of PubMed and Google Scholar was conducted. RESULTS There has been a rapid expansion of clinical trials studying putative remyelinating candidates, but further growth of the field is limited by the lack of consensus on key aspects of trial design. We have not yet defined the ideal study population, duration of therapy, or the appropriate outcome measures to detect remyelination in humans. The varied natural history of multiple sclerosis, coupled with the short time frame of phase II clinical trials, requires that we develop and validate biomarkers of remyelination that can serve as surrogate endpoints in clinical trials. CONCLUSIONS We propose that the visual system may be the most well-suited and validated model for the study potential remyelinating agents. In this review, we discuss the pathophysiology of demyelination and summarize the current clinical trial landscape of remyelinating agents. We present some of the challenges in the study of remyelinating agents and discuss current potential biomarkers of remyelination and repair, emphasizing both established and emerging visual outcome measures.
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Affiliation(s)
- Leah R Zuroff
- Department of Neurology (LZ), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Neurology (AJG), University of California San Francisco, San Francisco, California
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Cerdá-Fuertes N, Stoessel M, Mickeliunas G, Pless S, Cagol A, Barakovic M, Maceski AM, Álvarez González C, D’ Souza M, Schaedlin S, Benkert P, Calabrese P, Gugleta K, Derfuss T, Sprenger T, Granziera C, Naegelin Y, Kappos L, Kuhle J, Papadopoulou A. Optical coherence tomography versus other biomarkers: Associations with physical and cognitive disability in multiple sclerosis. Mult Scler 2023; 29:1540-1550. [PMID: 37772490 PMCID: PMC10637109 DOI: 10.1177/13524585231198760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a biomarker of neuroaxonal loss in multiple sclerosis (MS). OBJECTIVE The objective was to assess the relative role of OCT, next to magnetic resonance imaging (MRI) and serum markers of disability in MS. METHODS A total of 100 patients and 52 controls underwent OCT to determine peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layers (GCIPL). Serum neurofilament light chain (sNfL), total lesion volume (TLV), and brain parenchymal fraction (BPF) were also assessed. The associations of OCT with disability were examined in linear regression models with correction for age, vision, and education. RESULTS In patients, pRNFL was associated with the Symbol Digit Modalities Test (SDMT; p = 0.030). In the multivariate analysis including sNfL and MRI measures, pRNFL (β = 0.19, p = 0.044) and TLV (β = -0.24, p = 0.023) were the only markers associated with the SDMT. pRNFL (p < 0.001) and GCIPL (p < 0.001) showed associations with the Expanded Disability Status Scale (EDSS). In the multivariate analysis, GCIPL showed the strongest association with the EDSS (β = -0.32, p < 0.001) followed by sNfL (β = 0.18, p = 0.024). CONCLUSION The associations of OCT measures with cognitive and physical disability were independent of serum and brain MRI markers of neuroaxonal loss. OCT can be an important tool for stratification in MS, while longitudinal studies using combinations of biomarkers are warranted.
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Affiliation(s)
- Nuria Cerdá-Fuertes
- Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Neurostatus AG, University Hospital of Basel, Basel, Switzerland
| | - Marc Stoessel
- Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
| | | | - Silvan Pless
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Faculty of Psychology and interdisciplinary Platform Psychology and Psychiatry, Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
| | | | | | - Marcus D’ Souza
- Neurostatus AG, University Hospital of Basel, Basel, Switzerland
| | - Sabine Schaedlin
- Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
| | - Pasquale Calabrese
- Faculty of Psychology and interdisciplinary Platform Psychology and Psychiatry, Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Konstantin Gugleta
- University Eye Clinic Basel, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Tobias Derfuss
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Till Sprenger
- Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Athina Papadopoulou
- Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
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Huang SC, Pisa M, Guerrieri S, Dalla Costa G, Comi G, Leocani L. Optical coherence tomography with voxel-based morphometry: a new tool to unveil focal retinal neurodegeneration in multiple sclerosis. Brain Commun 2023; 6:fcad249. [PMID: 38328398 PMCID: PMC10847824 DOI: 10.1093/braincomms/fcad249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/25/2023] [Accepted: 09/25/2023] [Indexed: 02/09/2024] Open
Abstract
Neurodegeneration is the main contributor to disability accumulation in multiple sclerosis. Previous studies in neuro-ophthalmology have revealed that neurodegeneration in multiple sclerosis also affects the neuro-retina. Optical coherence tomography has been used to measure thinning of retinal layers, which correlates with several other markers for axonal/neuronal loss in multiple sclerosis. However, the existing analytical tools have limitations in terms of sensitivity and do not provide topographical information. In this study, we aim to evaluate whether voxel-based morphometry can increase sensitivity in detecting neuroaxonal degeneration in the retina and offer topographical information. A total of 131 people with multiple sclerosis (41 clinically isolated syndrome, 53 relapsing-remitting and 37 progressive multiple sclerosis) and 50 healthy subjects were included. Only eyes with normal global peripapillary retinal nerve fibre layer thickness and no history of optic neuritis were considered. Voxel-based morphometry and voxel-wise statistical comparisons were performed on the following: (i) patients at different disease stages and 2) patients who experienced the first demyelination attack without subclinical optic neuritis, assessed by visual evoked potentials. Standard parameters failed to discern any differences; however, voxel-based morphometry-optical coherence tomography successfully detected focal macular atrophy of retinal nerve fibre layer and ganglion cell/inner plexiform layer, along with thickening of inner nuclear layer in patients who experienced the first demyelination attack (disease duration = 4.2 months). Notably, the atrophy pattern of the ganglion cell/inner plexiform layer was comparable across disease phenotypes. In contrast, the retinal nerve fibre layer atrophy spread from the optic nerve head to the fovea as the disease evolved towards the progressive phase. Furthermore, for patients who experienced the first neurological episode, the severity of retinal nerve fibre layer atrophy at entry could predict a second attack. Our results demonstrate that voxel-based morphometry-optical coherence tomography exhibits greater sensitivity than standard parameters in detecting focal retinal atrophy, even at clinical presentation, in eyes with no history of optic neuritis and with normal latency of visual evoked potentials. Thinning of the ganglion cell/inner plexiform layer primarily concentrated in nasal perifovea in all disease phenotypes, indicating selective vulnerability of retinal ganglion cells and their perifoveal axons. Conversely, the degree of retinal nerve fibre layer thinning seems to be related to the clinical course of multiple sclerosis. The findings suggest bidirectional neurodegeneration in the visual pathway. Voxel-based morphometry-optical coherence tomography shows potential as a valuable tool for monitoring neurodegeneration on a patient level and evaluating the efficacy of novel neuroprotective treatments.
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Affiliation(s)
- Su-Chun Huang
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Marco Pisa
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Simone Guerrieri
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Gloria Dalla Costa
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
| | - Giancarlo Comi
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
- Department of Neurorehabilitation Science, Casa di Cura Igea, Milan 20144, Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan 20132, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
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Antal SI, Kincses B, Veréb D, Király A, Tóth E, Bozsik B, Faragó P, Szabó N, Kocsis K, Bencsik K, Klivényi P, Kincses ZT. Evaluation of transorbital sonography measures of optic nerve diameter in the context of global and regional brain volume in multiple sclerosis. Sci Rep 2023; 13:5578. [PMID: 37019969 PMCID: PMC10076391 DOI: 10.1038/s41598-023-31706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
Transorbital sonography (TOS) could be a swift and convenient method to detect the atrophy of the optic nerve, possibly providing a marker that might reflect other quantitative structural markers of multiple sclerosis (MS). Here we evaluate the utility of TOS as a complementary tool for assessing optic nerve atrophy, and investigate how TOS-derived measures correspond to volumetric brain markers in MS. We recruited 25 healthy controls (HC) and 45 patients with relapsing-remitting MS and performed B-mode ultrasonographic examination of the optic nerve. Patients additionally underwent MRI scans to obtain T1-weighted, FLAIR and STIR images. Optic nerve diameters (OND) were compared between HC, MS patients with and without history of optic neuritis (non-ON) using a mixed-effects ANOVA model. The relationship between within-subject-average OND and global and regional brain volumetric measures was investigated using FSL SIENAX, voxel-based morphometry and FSL FIRST. OND was significantly different between HC-MS (HC = 3.2 ± 0.4 mm, MS = 3 ± 0.4 mm; p < 0.019) and we found significant correlation between average OND and normalised whole brain (β = 0.42, p < 0.005), grey matter (β = 0.33, p < 0.035), white matter (β = 0.38, p < 0.012) and ventricular cerebrospinal fluid volume (β = - 0.36, p < 0.021) in the MS group. History of ON had no impact on the association between OND and volumetric data. In conclusion, OND is a promising surrogate marker in MS, that can be simply and reliably measured using TOS, and its derived measures correspond to brain volumetric measures. It should be further explored in larger and longitudinal studies.
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Affiliation(s)
- Szabolcs István Antal
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Psychiatry, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Dániel Veréb
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - András Király
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bence Bozsik
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
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Rzepiński Ł, Kucharczuk J, Tkaczyńska M, Parisi V, Grzybowski A. Swept-Source Optical Coherence Tomography Thresholds in Differentiating Clinical Outcomes in a Real-World Cohort of Treatment-Naïve Multiple Sclerosis Patients. Brain Sci 2023; 13:brainsci13040591. [PMID: 37190556 DOI: 10.3390/brainsci13040591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
This study aimed to determine whether peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell–inner plexiform layer (GCIPL) thickness thresholds for single-time-point swept-source optical coherence tomography (SS-OCT) measures can differentiate the clinical outcomes of treatment-naïve people with multiple sclerosis (pwMS). A total of 275 patients with the clinically isolated syndrome (n = 23), benign MS (n = 8), relapsing–remitting MS (n = 185), secondary progressive MS (n = 28), primary progressive MS (n = 31), and with no history of optic neuritis were included. The mean Expanded Disability Status Scale (EDSS) score was 3.0 ± 1.6. The cut-off values of pRNFL (87 µm and 88 µm) and GCIPL (70 µm) thicknesses have been adopted from previous studies using spectral-domain OCT. PwMS with pRNFL ≤87 µm and ≤88 µm had a longer disease duration, more advanced disability, and more frequently progressive MS variants compared to those with greater pRNFL thicknesses. In distinguishing pwMS with disability greater than or equal to the mean EDSS score (EDSS ≥ 3) from those with less severe disability, GCIPL thickness <70 µm had the highest sensitivity, while pRNFL thickness ≤87 µm had the greatest specificity. The optimal cut-off values differentiating patients with EDSS ≥ 3 from those with less severe disability was 63 µm for GCIPL thickness and 93.5 µm for pRNFL thickness. In conclusion, pRNFL and GCIPL thickness thresholds for single-time-point SS-OCT measurements may be helpful in differentiating the disability status of treatment-naïve pwMS.
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Affiliation(s)
- Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland
- Sanitas—Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Jan Kucharczuk
- Department of Ophthalmology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland
| | - Magda Tkaczyńska
- Department of Surgery, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Mickiewicza 24/3B, 60-836 Poznan, Poland
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Davion JB, Jougleux C, Lopes R, Leclerc X, Outteryck O. Relation between retina, cognition and brain volumes in MS: a consequence of asymptomatic optic nerve lesions. J Neurol 2023; 270:240-249. [PMID: 36018381 DOI: 10.1007/s00415-022-11348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Asymptomatic optic nerve lesions are frequent in multiple sclerosis (MS) and their impact on cognition and/or brain volume has never been taken into account. PATIENTS AND METHODS We used the data from the cross-sectional Visual Ways in MS (VWIMS) study including relapsing remitting MS. All patients underwent brain and optic nerve Magnetic Resonance Imaging (MRI) including Double Inversion Recuperation (DIR) sequence, retinal OCT, and cognitive evaluation with the Brief International Cognitive Assessment in MS (BICAMS). We measured the association between OCT findings (thickness/volume of retinal layers) and extra-visual parameters (cerebral volumes and BICAMS scores) in optic nerves with and/or without the presence of DIR asymptomatic optic nerve hypersignal. RESULTS Between March and December 2017, we included 98 patients. Two patients were excluded. Over the 192 eyes, 73 had at least one clinical history of optic neuritis (ON-eyes) whereas 119 were asymptomatic (NON-eyes). Among the 119 NON-eyes, 58 had 3D-DIR optic nerve hypersignal (48.7%). We confirmed significant associations between some retinal OCT measures and some extra-visual parameters (cerebral volumes, cognitive scores) in NON-eyes. Unexpectedly, these associations were found when an asymptomatic optic nerve DIR-hypersignal was present on MRI, but not when it was absent. CONCLUSION Our study showed a relation between OCT measures and extra-visual parameters in NON-eyes MS patients. As a confusion factor, asymptomatic optic nerve lesions may be the explanation of the relation between OCT measures and extra-visual parameters. Retinal OCT seems to be far more a "window over the optic nerve" than a "window over the brain".
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Affiliation(s)
- Jean-Baptiste Davion
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Caroline Jougleux
- Department of Neurology, Multiple Sclerosis Center of Lille, Univ. Lille, 59000, Lille, France
| | - Renaud Lopes
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Xavier Leclerc
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Olivier Outteryck
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France.
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Long-Term Stability of Neuroaxonal Structure in Alemtuzumab-Treated Relapsing-Remitting Multiple Sclerosis Patients. J Neuroophthalmol 2021; 40:37-43. [PMID: 32045393 DOI: 10.1097/wno.0000000000000802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) experience progressive thinning in optical coherence tomography (OCT) measures of neuroaxonal structure regardless of optic neuritis history. Few prospective studies have investigated the effects of disease-modifying therapies on neuroaxonal degeneration in the retina. Alemtuzumab is a monoclonal antibody shown to be superior to interferon β-1a in treating relapsing-remitting MS (RRMS). The purpose of this study was to assess the effects of alemtuzumab and first-line injectable treatments on OCT measures of neuroaxonal structure including peripapillary retinal nerve fiber layer (RNFL) thickness and combined ganglion cell-inner plexiform (GCIP) layer volume in RRMS patients followed up over 5 years. METHODS In this retrospective pilot study with prospectively collected double cohort data, spectral domain OCT measures of RNFL thickness and GCIP volume were compared between alemtuzumab-treated RRMS patients (N = 24) and RRMS patients treated with either interferon-β or glatiramer acetate (N = 21). RESULTS Over a median of 60 months (range 42-60 months), the alemtuzumab cohort demonstrated a change in the mean RNFL thickness (thinning from baseline) of -0.88 μm (95% confidence interval [CI] -2.63 to 0.86; P = 0.32) and mean GCIP volume of +0.013 mm (95% CI -0.006 to 0.032; P = 0.18). Over the same time period, the first-line therapy-treated cohort demonstrated greater degrees of RNFL thinning (mean change in RNFL thickness was -3.65 μm [95% CI -5.40 to -1.89; P = 0.0001]). There was also more prominent GCIP volume loss relative to baseline in the first-line therapy group (-0.052 mm [95% CI -0.070 to -0.034; P < 0.0001]). CONCLUSIONS Alemtuzumab-treated patients with RRMS demonstrated relative stability of OCT-measured neuroaxonal structure compared with RRMS patients treated with either interferon-β or glatiramer acetate over a 5-year period. These findings, along with previous demonstration of improved brain atrophy rates, suggest that alemtuzumab may offer long-term preservation of neuroaxonal structure in patients with RRMS.
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Liu Y, Chen J, Huang L, Yan S, Bian Q, Yang F. Relationships Among Retinal Nerve Fiber Layer Thickness, Vascular Endothelial Growth Factor, and Cognitive Impairment in Patients with Schizophrenia. Neuropsychiatr Dis Treat 2021; 17:3597-3606. [PMID: 34916796 PMCID: PMC8668245 DOI: 10.2147/ndt.s336077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies have suggested retinal nerve fiber layer (RNFL) involvement in the pathogenesis of schizophrenia. Additionally, research has shown that vascular endothelial growth factor (VEGF) potentially contributes to the pathophysiology of psychiatric disorders. Therefore, this study aimed to investigate VEGF, RNFL, and correlations with cognitive impairments in schizophrenia patients. METHODS Patients with schizophrenia (n = 138) were compared to healthy controls (n = 160). RNFLs were measured with optical coherence tomography (OCT). The Stroop color and word test (SCWT) was used to evaluate neurocognition. Blood samples were collected to measure VEGF. SPSS 20.0 was used to perform analysis of covariance, t-tests, partial correlation analysis, and linear regression. RESULTS Thinner RNFLs were found in schizophrenia patients (p < 0.001). RNFL showed a significant correlation with SCWT scores (all p < 0.05). Serum level of VEGF was lower in patients with schizophrenia (p = 0.010). Total and inferior RNFL thicknesses of right eyes were positively correlated to VEGF level (RNFL total thickness p = 0.032, inferior thickness p = 0.014).Total RNFL thicknesses were shown to be reduced following a prolonged duration of illness (both p < 0.01). CONCLUSION These findings suggest that patients with schizophrenia have degeneration with RNFL thickness following illness duration, which may contribute to neurocognitive impairments observed in schizophrenia. VEGF is speculated to play some important role on RNFL degeneration with schizophrenia patients.
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Affiliation(s)
- Yanhong Liu
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Jingxu Chen
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Lvzhen Huang
- Ophthalmology Department, People's Hospital of Peking University, Beijing, People's Republic of China
| | - Shaoxiao Yan
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Qingtao Bian
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Fude Yang
- Huilongguan Clinical Medical School, Peking University, Beijing, People's Republic of China.,Beijing Huilongguan Hospital, Beijing, People's Republic of China
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9
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Eslami F, Ghiasian M, Khanlarzade E, Moradi E. Retinal Nerve Fiber Layer Thickness and Total Macular Volume in Multiple Sclerosis Subtypes and Their Relationship with Severity of Disease, a Cross-Sectional Study. Eye Brain 2020; 12:15-23. [PMID: 32021529 PMCID: PMC6974299 DOI: 10.2147/eb.s229814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/25/2019] [Indexed: 01/27/2023] Open
Abstract
Background Optic neuritis (ON) is an inflammatory demyelinating lesion in the optic nerve, which is strongly associated with multiple sclerosis (MS). Optical coherence tomography (OCT) is a noninvasive technique for the evaluation of the retinal layers. Our aim was to examine OCT metrics including retinal nerve fiber layer thickness (RNFLT), and total macular volume (TMV), in MS subtypes and their relationship with duration, first manifestation, and severity of disease. Material and Methods In this cross-sectional study, patients with a definite diagnosis of MS underwent complete ophthalmic and neurologic examination. OCT parameters including TMV and RNFLT were compared between MS subtypes and different first manifestations of MS. Their relationships were also studied with the duration and severity of disease based on the Expanded Disability Status Scale (EDSS) score. Results A total of 240 eyes were examined in 120 enrolled MS patients. The differences in RNFLT were not analytically meaningful between the subtypes of MS, but the differences in TMV values were statistically significant between the subtypes of MS (P: 0.39 and P: 0.04, respectively). The differences between RNFLT and TMV of eyes with and without ON were statistically significant between these two groups (P<0.001 and P<0.001). There was also an inverse correlation between EDSS disability score and RNFLT and TMV values (P: 0.00, r: −0.33 and P: 0.034, r: −0.11, respectively) and a significant inverse correlation between the duration of MS and RNFLT (P: 0.00, r: −0.47). The differences in RNFLT and TMV values were analytically meaningful between the categories of first manifestations of MS (P: 0.000 and P: 0.027, respectively). Conclusion RNFLT and TMV represent noninvasive parameters for assessment of neuroaxonal degeneration in the anterior visual pathway that correlate with the severity and duration of multiple sclerosis. The lowest RNFLT and TMV values were also seen in the perceptual category between the first manifestations of MS. Therefore, they may be useful in the evaluation of MS patients.
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Affiliation(s)
- Fatemeh Eslami
- Department of Ophthalmology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Ghiasian
- Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elham Khanlarzade
- Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ehsan Moradi
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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10
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Optical coherence tomography shows neuroretinal thinning in myelopathy of adrenoleukodystrophy. J Neurol 2019; 267:679-687. [PMID: 31720823 PMCID: PMC7035302 DOI: 10.1007/s00415-019-09627-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 02/01/2023]
Abstract
Background Progressive myelopathy is the main cause of disability in adrenoleukodystrophy (ALD). Development of therapies is hampered by a lack of quantitative outcome measures. In this study, we investigated whether myelopathy in ALD is associated with retinal neurodegeneration on optical coherence tomography (OCT), which could serve as a surrogate outcome measure. Methods Sixty-two patients (29 men and 33 women) and 70 age-matched and sex-matched controls (33 men and 37 women) were included in this cross-sectional study. We compared retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and peripapillary retinal nerve fiber layer (pRNFL) thickness between ALD patients and controls. In addition, we correlated these OCT measurements with clinical parameters of severity of myelopathy. Results Patients had significantly thinner RNFL (male group, p < 0.05) and pRNFL superior and temporal quadrant [both male (p < 0.005) and female (p < 0.05) groups] compared to controls. Comparing three groups (symptomatic patients, asymptomatic patients and controls), there were significant differences in RNFL thickness (total grid and peripheral ring) in the male group (p ≤ 0.002) and in pRNFL thickness (superior and temporal quadrant) in both male (p ≤ 0.02) and the female (p ≤ 0.02) groups. Neuroretinal layer thickness correlated moderately with severity of myelopathy in men (correlation coefficients between 0.29–0.55, p < 0.02), but not in women. Conclusions These results suggest that neurodegeneration of the spinal cord in ALD is reflected in the retina of patients with ALD. Therefore, OCT could be valuable as an outcome measure for the myelopathy of ALD. Additional longitudinal studies are ongoing. Electronic supplementary material The online version of this article (10.1007/s00415-019-09627-z) contains supplementary material, which is available to authorized users.
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11
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Caldito NG, Saidha S, Sotirchos ES, Dewey BE, Cowley NJ, Glaister J, Fitzgerald KC, Al-Louzi O, Nguyen J, Rothman A, Ogbuokiri E, Fioravante N, Feldman S, Kwakyi O, Risher H, Kimbrough D, Frohman TC, Frohman E, Balcer L, Crainiceanu C, Van Zijl PCM, Mowry EM, Reich DS, Oh J, Pham DL, Prince J, Calabresi PA. Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study. Brain 2018; 141:3115-3129. [PMID: 30312381 PMCID: PMC6202573 DOI: 10.1093/brain/awy245] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/03/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023] Open
Abstract
On average, African Americans with multiple sclerosis demonstrate higher inflammatory disease activity, faster disability accumulation, greater visual dysfunction, more pronounced brain tissue damage and higher lesion volume loads compared to Caucasian Americans with multiple sclerosis. Neurodegeneration is an important component of multiple sclerosis, which in part accounts for the clinical heterogeneity of the disease. Brain atrophy appears to be widespread, although it is becoming increasingly recognized that regional substructure atrophy may be of greater clinical relevance. Patient race (within the limitations of self-identified ancestry) is regarded as an important contributing factor. However, there is a paucity of studies examining differences in neurodegeneration and brain substructure volumes over time in African Americans relative to Caucasian American patients. Optical coherence tomography is a non-invasive and reliable tool for measuring structural retinal changes. Recent studies support its utility for tracking neurodegeneration and disease progression in vivo in multiple sclerosis. Relative to Caucasian Americans, African American patients have been found to have greater retinal structural injury in the inner retinal layers. Increased thickness of the inner nuclear layer and the presence of microcystoid macular pathology at baseline predict clinical and radiological inflammatory activity, although whether race plays a role in these changes has not been investigated. Similarly, assessment of outer retinal changes according to race in multiple sclerosis remains incompletely characterized. Twenty-two African Americans and 60 matched Caucasian Americans with multiple sclerosis were evaluated with brain MRI, and 116 African Americans and 116 matched Caucasian Americans with multiple sclerosis were monitored with optical coherence tomography over a mean duration of 4.5 years. Mixed-effects linear regression models were used in statistical analyses. Grey matter (-0.9%/year versus -0.5%: P =0.02), white matter (-0.7%/year versus -0.3%: P =0.04) and nuclear thalamic (-1.5%/year versus -0.7%/year: P =0.02) atrophy rates were approximately twice as fast in African Americans. African Americans also exhibited higher proportions of microcystoid macular pathology (12.1% versus 0.9%, P =0.001). Retinal nerve fibre layer (-1.1% versus -0.8%: P =0.02) and ganglion cell+ inner plexiform layer (-0.7%/year versus -0.4%/year: P =0.01) atrophy rates were faster in African versus Caucasian Americans. African Americans on average exhibited more rapid neurodegeneration than Caucasian Americans and had significantly faster brain and retinal tissue loss. These results corroborate the more rapid clinical progression reported to occur, in general, in African Americans with multiple sclerosis and support the need for future studies involving African Americans in order to identify individual differences in treatment responses in multiple sclerosis.
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Affiliation(s)
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Blake E Dewey
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Norah J Cowley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Glaister
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Omar Al-Louzi
- Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James Nguyen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alissa Rothman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Fioravante
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney Feldman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hunter Risher
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorlan Kimbrough
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Austin Dell Medical School, Austin TX, USA
| | - Elliot Frohman
- Department of Neurology, University of Texas Austin Dell Medical School, Austin TX, USA
| | - Laura Balcer
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | | | - Peter C M Van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University, Baltimore MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, MD, USA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Neurology, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada
| | - Dzung L Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jerry Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Chan VTT, Sun Z, Tang S, Chen LJ, Wong A, Tham CC, Wong TY, Chen C, Ikram MK, Whitson HE, Lad EM, Mok VCT, Cheung CY. Spectral-Domain OCT Measurements in Alzheimer's Disease: A Systematic Review and Meta-analysis. Ophthalmology 2018; 126:497-510. [PMID: 30114417 DOI: 10.1016/j.ophtha.2018.08.009] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023] Open
Abstract
TOPIC OCT is a noninvasive tool to measure specific retinal layers in the eye. The relationship of retinal spectral-domain (SD) OCT measurements with Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains unclear. Hence, we conducted a systematic review and meta-analysis to examine the SD OCT measurements in AD and MCI. CLINICAL RELEVANCE Current methods of diagnosing early AD are expensive and invasive. Retinal measurements of SD OCT, which are noninvasive, technically simple, and inexpensive, are potential biomarkers of AD. METHODS We conducted a literature search in PubMed and Excerpta Medica Database to identify studies published before December 31, 2017, that assessed the associations between AD, MCI, and measurements of SD OCT: ganglion cell-inner plexiform layer (GC-IPL), ganglion cell complex (GCC), macular volume, and choroidal thickness, in addition to retinal nerve fiber layer (RNFL) and macular thickness. We used a random-effects model to examine these relationships. We also conducted meta-regression and assessed heterogeneity, publication bias, and study quality. RESULTS We identified 30 eligible studies, involving 1257 AD patients, 305 MCI patients, and 1460 controls, all of which were cross-sectional studies. In terms of the macular structure, AD patients showed significant differences in GC-IPL thickness (standardized mean difference [SMD], -0.46; 95% confidence interval [CI], -0.80 to -0.11; I2 = 71%), GCC thickness (SMD, -0.84; 95% CI, -1.10 to -0.57; I2 = 0%), macular volume (SMD, -0.58; 95% CI, -1.03 to -0.14; I2 = 80%), and macular thickness of all inner and outer sectors (SMD range, -0.52 to -0.74; all P < 0.001) when compared with controls. Peripapillary RNFL thickness (SMD, -0.67; 95% CI, -0.95 to -0.38; I2 = 89%) and choroidal thickness (SMD range, -0.88 to -1.03; all P < 0.001) also were thinner in AD patients. CONCLUSIONS Our results confirmed the associations between retinal measurements of SD OCT and AD, highlighting the potential usefulness of SD OCT measurements as biomarkers of AD.
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Affiliation(s)
- Victor T T Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shumin Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore, Republic of Singapore; Department of Pharmacology, National University of Singapore, Singapore, Republic of Singapore
| | - M Kamran Ikram
- Departments of Neurology and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Heather E Whitson
- Duke University Medical Center, Durham, North Carolina; Geriatrics Research Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, North Carolina
| | | | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
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13
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Kim NH, Kim HJ, Park CY, Jeong KS, Cho JY. Optical Coherence Tomography versus Visual Evoked Potentials for Detecting Visual Pathway Abnormalities in Patients with Neuromyelitis Optica Spectrum Disorder. J Clin Neurol 2018; 14:200-205. [PMID: 29504295 PMCID: PMC5897203 DOI: 10.3988/jcn.2018.14.2.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 01/19/2023] Open
Abstract
Background and Purpose Optical coherence tomography (OCT) and visual evoked potentials (VEPs) can be used to detect optic neuritis (ON). However, the comparative sensitivities of OCT and VEPs for detecting ON in neuromyelitis optica spectrum disorder (NMOSD) are unclear, and so we assessed these sensitivities. Methods This cross-sectional study included 73 patients with aquaporin-4 antibody-seropositive NMOSD, and 101 eyes with ON. The clinical characteristics, visual acuity (VA), Expanded Disability Status Scale (EDSS) scores, OCT peripapillary retinal nerve fiber layer (RNFL) thickness, and VEPs of the patients were evaluated. Results OCT and VEPs were abnormal in 68% and 73% of eyes with a history of ON, respectively, and in 2% and 9% of eyes without ON. Test sensitivities were influenced by the number of ON episodes: the OCT RNFL thickness and VEPs were abnormal in 50% and 67% of the eyes with first-ever ON episode, respectively (p=0.041), with the combination of both tests detecting abnormalities in up to 75% of the eyes. The sensitivities of the OCT RNFL thickness and VEPs increased to 95% and 83%, respectively, after the second or subsequent ON episode (p=0.06), with the combination of both tests detecting abnormalities in 95% of cases. The OCT RNFL thickness and VEP latency/amplitude were correlated with EDSS scores and VA. Conclusions VEPs were superior for detecting subclinical or first-ever ON, while OCT was better for detecting eyes with multiple ON episodes. The correlations of OCT and VEPs with clinical disability measures indicate that these tests are potential markers of the disease burden in NMOSD.
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Affiliation(s)
- Nam Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Cheol Yong Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyoung Sook Jeong
- Department of Occupational and Environmental Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Joong Yang Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
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14
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Sinha PK, Joshi D, Singh VP, Deshmukh S, Singh U, Pathak A, Mishra VN, Chaurasia RN, Sharda V, Gupta G. Optical Coherence Tomography and Subclinical Optical Neuritis in Longitudinally Extensive Transverse Myelitis. Ann Indian Acad Neurol 2017; 20:358-362. [PMID: 29184337 PMCID: PMC5682738 DOI: 10.4103/aian.aian_170_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective The aim is to compare the retinal nerve fiber layer (RNFL) thickness of longitudinally extensive transverse myelitis (LETM) eyes without previous optic neuritis with that of healthy control subjects. Methods Over 20 LETM eyes and 20 normal control eyes were included in the study and subjected to optical coherence tomography to evaluate and compare the RNFL thickness. Result Significant RNFL thinning was observed at 8 o'clock position in LETM eyes as compared to the control eyes (P = 0.038). No significant differences were seen in other RNFL measurements. Conclusion Even in the absence of previous optic neuritis LETM can lead to subclinical axonal damage leading to focal RNFL thinning.
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Affiliation(s)
| | - Deepika Joshi
- Department of Neurology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | | | - Sujit Deshmukh
- Department of Ophthalmology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Usha Singh
- Department of Pathology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Neurology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | | | | | - Vivek Sharda
- Department of Neurology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Garima Gupta
- Department of Neurology, IMS, BHU, Varanasi, Uttar Pradesh, India
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15
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Chan VTT, Tso THK, Tang F, Tham C, Mok V, Chen C, Wong TY, Cheung CY. Using Retinal Imaging to Study Dementia. J Vis Exp 2017. [PMID: 29155753 DOI: 10.3791/56137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The retina offers a unique "window" to study pathophysiological processes of dementia in the brain, as it is an extension of the central nervous system (CNS) and shares prominent similarities with the brain in terms of embryological origin, anatomical features and physiological properties. The vascular and neuronal structure in the retina can now be visualized easily and non-invasively using retinal imaging techniques, including fundus photography and optical coherence tomography (OCT), and quantified semi-automatically using computer-assisted analysis programs. Studying the associations between vascular and neuronal changes in the retina and dementia could improve our understanding of dementia and, potentially, aid in diagnosis and risk assessment. This protocol aims to describe a method of quantifying and analyzing retinal vasculature and neuronal structure, which are potentially associated with dementia. This protocol also provides examples of retinal changes in subjects with dementia, and discusses technical issues and current limitations of retinal imaging.
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Affiliation(s)
- Victor T T Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Tiffany H K Tso
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Clement Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Vincent Mok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong; Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System; Department of Pharmacology, National University of Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong;
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16
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Abstract
BACKGROUND Although patients with acute optic neuritis (ON) recover high-contrast visual acuity (HCVA) to 20/40 or better in 95% of affected eyes, patients with a history of ON continue to note subjective abnormalities of vision. Furthermore, substantial and permanent thinning of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) is now known to occur early in the course of ON. We measured vision-specific quality of life (QOL) in patients with a history of acute ON and recovery of VA to 20/40 or better in their affected eyes to determine how these QOL scores relate to RNFL and GCL thickness and low-contrast letter acuity (LCLA) across the spectrum of visual recovery. METHODS Data from an ongoing collaborative study of visual outcomes in multiple sclerosis and ON were analyzed for this cross-sectional observational cohort. Patients and disease-free control participants completed the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement to the NEI-VFQ-25, as well as VA and LCLA testing for each eye separately and binocularly. Optical coherence tomography measures for each eye included peripapillary RNFL thickness and macular GCL + inner plexiform layer (GCL + IPL) thickness. RESULTS Patients with a history of acute ON and recovery to 20/40 or better VA (n = 113) had significantly reduced scores for the NEI-VFQ-25 (83.7 ± 15.4) and 10-Item Neuro-Ophthalmic Supplement (74.6 ± 17.4) compared with disease-free controls (98.2 ± 2.1 and 96.4 ± 5.2, P < 0.001, linear regression models, accounting for age and within-patient, intereye correlations). Most patients with 20/40 or better visual recovery (98/112, 88%) had monocular HCVA in their affected eye of 20/20 or better. Although patients with 20/50 or worse HCVA recovery demonstrated the worst performance on low-contrast acuity, affected eye RNFL and GCL + IPL thickness, and QOL scales, these measures were also significantly reduced among those with 20/40 or better HCVA recovery compared with controls. CONCLUSIONS Patients with a history of ON and "good" visual recovery, defined in the literature as 20/40 or better HCVA, are left with clinically meaningful reductions in vision-specific QOL. Such patient-observed deficits reflect the underlying significant degrees of retinal axonal and neuronal loss and visual dysfunction that are now known to characterize ON even in the setting of maximal HCVA recovery. There remains an unmet therapeutic need for patients with ON.
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17
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Chhablani PP, Ambiya V, Nair AG, Bondalapati S, Chhablani J. Retinal Findings on OCT in Systemic Conditions. Semin Ophthalmol 2017. [DOI: 10.1080/08820538.2017.1332233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Preeti Patil Chhablani
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vikas Ambiya
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Akshay G. Nair
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Jay Chhablani
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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18
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Nguyen CTO, Hui F, Charng J, Velaedan S, van Koeverden AK, Lim JKH, He Z, Wong VHY, Vingrys AJ, Bui BV, Ivarsson M. Retinal biomarkers provide "insight" into cortical pharmacology and disease. Pharmacol Ther 2017; 175:151-177. [PMID: 28174096 DOI: 10.1016/j.pharmthera.2017.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The retina is an easily accessible out-pouching of the central nervous system (CNS) and thus lends itself to being a biomarker of the brain. More specifically, the presence of neuronal, vascular and blood-neural barrier parallels in the eye and brain coupled with fast and inexpensive methods to quantify retinal changes make ocular biomarkers an attractive option. This includes its utility as a biomarker for a number of cerebrovascular diseases as well as a drug pharmacology and safety biomarker for the CNS. It is a rapidly emerging field, with some areas well established, such as stroke risk and multiple sclerosis, whereas others are still in development (Alzheimer's, Parkinson's, psychological disease and cortical diabetic dysfunction). The current applications and future potential of retinal biomarkers, including potential ways to improve their sensitivity and specificity are discussed. This review summarises the existing literature and provides a perspective on the strength of current retinal biomarkers and their future potential.
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Affiliation(s)
- Christine T O Nguyen
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia.
| | - Flora Hui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jason Charng
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Shajan Velaedan
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Anna K van Koeverden
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jeremiah K H Lim
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Zheng He
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Vickie H Y Wong
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Bang V Bui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Magnus Ivarsson
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
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Soltys J, Wang Q, Mao-Draayer Y. Optical coherence tomography and T cell gene expression analysis in patients with benign multiple sclerosis. Neural Regen Res 2017; 12:1352-1356. [PMID: 28966652 PMCID: PMC5607832 DOI: 10.4103/1673-5374.213558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Benign multiple sclerosis is a retrospective diagnosis based primarily on a lack of motor symptom progression. Recent findings that suggest patients with benign multiple sclerosis experience non-motor symptoms highlight the need for a more prospective means to diagnose benign multiple sclerosis early in order to help direct patient care. In this study, we present optical coherence tomography and T cell neurotrophin gene analysis findings in a small number of patients with benign multiple sclerosis. Our results demonstrated that retinal nerve fiber layer was mildly thinned, and T cells had a distinct gene expression profile that included upregulation of interleukin 10 and leukemia inhibitory factor, downregulation of interleukin 6 and neurotensin high affinity receptor 1 (a novel neurotrophin receptor). These findings add evidence for further investigation into optical coherence tomography and mRNA profiling in larger cohorts as a potential means to diagnose benign multiple sclerosis in a more prospective manner.
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Affiliation(s)
- John Soltys
- Present Address: University of Colorado Medical Scientist Training Program (MSTP), Aurora, CO, USA
| | - Qin Wang
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
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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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Schönfeldt-Lecuona C, Kregel T, Schmidt A, Pinkhardt EH, Lauda F, Kassubek J, Connemann BJ, Freudenmann RW, Gahr M. From Imaging the Brain to Imaging the Retina: Optical Coherence Tomography (OCT) in Schizophrenia. Schizophr Bull 2016; 42:9-14. [PMID: 26048298 PMCID: PMC4681543 DOI: 10.1093/schbul/sbv073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Optical Coherence Tomography (OCT) is a noninvasive imaging method, which provides an in vivo image of the retina. It allows for quantitative measurements of retinal and macular thickness, including single-layer analysis. Because the retinal nerve fibre layer comprises the first axons of the visual pathway and is unmyelinated, it can be considered a unique anatomical model, which may provide insight into the pathophysiological processes of diseases with a neurodegenerative character. In fact, past OCT studies have emphasized the role of the visual pathway as an ideal structure for exploring neurodegeneration and have demonstrated the potential of the method as an instrument for longitudinally monitoring structural changes in neurological disorders such as multiple sclerosis. Progress in signal processing and advancements to the OCT technique enables the illustration of structural changes in the retinal layers in a quick, reproducible, and objective manner with a spatial resolution comparable to those of histological slices.Findings from computer-based magnetic resonance imaging analyses and neuropathological studies support the hypothesis of a degenerative component of certain psychiatric disorders such as schizophrenia. Studies in schizophrenia incorporating OCT are currently rare and have yielded further heterogeneous results. This article elucidates the method of OCT and the retina's role as a "window to the brain". Furthermore, in delineating the degenerative components of schizophrenia, we discuss the possible applications of OCT in the schizophrenia population.
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Affiliation(s)
- Carlos Schönfeldt-Lecuona
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12-14, Ulm, Germany;
| | - Thomas Kregel
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany;,These authors contributed equally to this article
| | - Arno Schmidt
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
| | - Elmar H. Pinkhardt
- Department of Neurology, University Clinic Ulm, Oberer Eselsberg 45, Ulm, Germany
| | - Florian Lauda
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany;,Department of Neurology, University Clinic Ulm, Oberer Eselsberg 45, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University Clinic Ulm, Oberer Eselsberg 45, Ulm, Germany
| | - Bernhard J. Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
| | - Roland W. Freudenmann
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
| | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Leimgrubenweg 12–14, Ulm, Germany
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22
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Clinical trials to clinical use: using vision as a model for multiple sclerosis and beyond. J Neuroophthalmol 2015; 34 Suppl:S18-23. [PMID: 25133966 DOI: 10.1097/wno.0000000000000163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optical coherence tomography (OCT) has made possible the structure-function correlations that uniquely characterize the afferent visual pathway as a model for understanding multiple sclerosis (MS) and for developing new treatments. During the past decade, OCT measures of retinal nerve fiber layer (RNFL) and ganglion cell/inner plexiform layer (GCL + IPL) thickness have evolved from being a means to validate visual function tests, such as low-contrast letter acuity, to provide a window on the axonal and neuronal loss that are now widely recognized as contributors to permanent visual dysfunction in MS. Although acute optic neuritis (ON) leads to thinning of the RNFL by 20%-40% within 3 months after a single episode, thinning of the RNFL and GCL + IPL occur over time in MS eyes even in the absence of an acute ON history. As such, OCT and its functional and patient-reported correlates of low-contrast acuity and vision-specific quality of life (QOL) have now been incorporated into MS clinical trials. Results of an ongoing, phase 2 trial of a remyelinating agent that uses acute ON as a model for assessing therapeutic efficacy will define even further the important role for OCT in documenting structural changes as we move forward from clinical trials to clinical use.
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23
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Sineok EV, Malov IV, Vlasov YV. The early diagnosis of neurodegenerative changes in multiple sclerosis and clinically isolated syndrome based on optical coherence tomography of the retina. Zh Nevrol Psikhiatr Im S S Korsakova 2015. [DOI: 10.17116/jnevro2015115829-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Emberti Gialloreti L, Pardini M, Benassi F, Marciano S, Amore M, Mutolo MG, Porfirio MC, Curatolo P. Reduction in retinal nerve fiber layer thickness in young adults with autism spectrum disorders. J Autism Dev Disord 2014; 44:873-82. [PMID: 24014196 DOI: 10.1007/s10803-013-1939-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent years have seen an increase in the use of retinal nerve fiber layer (RNFL) evaluation as an easy-to-use, reproducible, proxy-measure of brain structural abnormalities. Here, we evaluated RNFL thickness in a group of subjects with high functioning autism (HFA) or with Asperger Syndrome (AS) to its potential as a tool to study autism pathophysiology. All subjects underwent high-resolution spectral domain optical coherence tomography to evaluate RNFL thickness. HFA subjects presented with reduced global RNFL thickness compared both to AS subjects and controls. AS subjects showed a reduced nasal quadrant RNFL thickness compared to controls. Verbal-IQ/performance-IQ discrepancy correlated with RNFL thickness. Our data suggest that RNFL evaluation could help in the development of biological markers of autism pathophysiology.
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Affiliation(s)
- Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy,
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Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that is pathologically characterized by inflammatory demyelination and neurodegeneration. Axonal damage, along with neuronal loss, occurs from disease onset and may lead to progressive and permanent disability. In contrast with the inflammatory pathways, the molecular mechanisms leading to MS neurodegeneration remain largely elusive. With improved understanding of these mechanisms, new potential therapeutic targets for neuroprotection have emerged. We review the current understanding of neurodegenerative processes at play in MS and discuss potential outcome measures and targets for neuroprotection trials.
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Affiliation(s)
- Amir-Hadi Maghzi
- Multiple Sclerosis Center, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, 2nd floor, Room 221F, Box 3206, 94158, San Francisco, CA, USA,
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26
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Analysis of the visual system in Friedreich ataxia. J Neurol 2013; 260:2362-9. [DOI: 10.1007/s00415-013-6978-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/20/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
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Kardys A, Weinstock-Guttman B, Dillon M, Masud MW, Weinstock N, Mahfooz N, Lang JK, Weinstock A, Lincoff N, Zivadinov R, Ramanathan M. Cholesterol affects retinal nerve fiber layer thickness in patients with multiple sclerosis with optic neuritis. Eur J Neurol 2013; 20:1264-71. [DOI: 10.1111/ene.12162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/28/2013] [Indexed: 11/26/2022]
Affiliation(s)
- A. Kardys
- Department of Pharmaceutical Sciences; State University of New York; Buffalo NY USA
| | | | - M. Dillon
- Department of Neurology; State University of New York; Buffalo NY USA
| | - M. W. Masud
- Department of Neurology; State University of New York; Buffalo NY USA
| | - N. Weinstock
- Department of Neurology; State University of New York; Buffalo NY USA
| | - N. Mahfooz
- Department of Neurology; State University of New York; Buffalo NY USA
| | - J. K. Lang
- Department of Neurology; State University of New York; Buffalo NY USA
| | - A. Weinstock
- Department of Neurology; State University of New York; Buffalo NY USA
| | - N. Lincoff
- Department of Neurology; State University of New York; Buffalo NY USA
| | - R. Zivadinov
- Department of Neurology; State University of New York; Buffalo NY USA
- Department of Neurology; Buffalo Neuroimaging Analysis Center; State University of New York; Buffalo NY USA
| | - M. Ramanathan
- Department of Pharmaceutical Sciences; State University of New York; Buffalo NY USA
- Department of Neurology; State University of New York; Buffalo NY USA
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28
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Oliveira C, Cestari DM, Rizzo JF. The use of fourth-generation optical coherence tomography in multiple sclerosis: a review. Semin Ophthalmol 2013; 27:187-91. [PMID: 23163274 DOI: 10.3109/08820538.2012.708808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optical coherence tomography (OCT) has been routinely used to obtain high spatial resolution images of the retina and choroid non-invasively. Within the past decade, a fourth-generation OCT device using Fourier domain (FD) analysis has been developed that provides higher velocity and higher axial resolution images with better reproducibility than the previous generation time domain (TD) OCT technology. This review addresses the use of fourth-generation, FD ocular OCT in patients with multiple sclerosis.
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Affiliation(s)
- Cristiano Oliveira
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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29
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Galetta KM, Balcer LJ. Measures of visual pathway structure and function in MS: Clinical usefulness and role for MS trials. Mult Scler Relat Disord 2013; 2:172-82. [PMID: 25877723 DOI: 10.1016/j.msard.2012.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/11/2012] [Indexed: 11/17/2022]
Abstract
Over the past decade, the visual pathway in multiple sclerosis (MS) has become an important system for assessing both patient function and disease burden. Abnormalities of low-contrast acuity, long recognized as important correlates of driving, facial recognition, and other activities of daily living, are now noted to be common among patients with MS, even among those with no history of acute optic neuritis (ON). Low-contrast letter acuity scores correlate well with brain MRI lesion burden, visual-evoked potential (VEP) amplitudes, health-related quality of life (QOL), and retinal nerve fiber layer (RNFL) axonal and neuronal loss as measured by optical coherence tomography (OCT). Axonal and neuronal degeneration in MS is likely to be an important cause of visual impairment and disability, particularly among patients with progressive MS subtypes. With the advent of OCT and the use of low-contrast letter acuity charts in MS research and clinical trials, the structure-function correlations afforded by the anterior visual pathway can be assessed and potentially harnessed as a model for testing new therapies. Recent advances in OCT, such as high resolution spectral-domain techniques and computerized algorithms for image analysis, have allowed for measurement of specific retinal layers, including the ganglion cell (GCL) neuronal layer and its intimately associated, thin layer of interneurons, the inner plexiform layer (IPL). Longitudinal collaborative studies of GCL+IPL thinning and RNFL axonal loss are providing an in vivo view into neuroretinal pathology, and are providing new insights into how the visual pathway may reflect overall mechanisms of disease in MS.
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Affiliation(s)
- Kristin M Galetta
- Departments of Neurology, KMG, LJB, Ophthalmology, LJB and Epidemiology, LJB, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Laura J Balcer
- Departments of Neurology, KMG, LJB, Ophthalmology, LJB and Epidemiology, LJB, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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30
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Pula JH, Kattah JC, Wang H, Marshall J, Eggenberger ER. Ability of a neuro-ophthalmologist to estimate retinal nerve fiber layer thickness. Clin Ophthalmol 2012; 6:1477-81. [PMID: 23055667 PMCID: PMC3460702 DOI: 10.2147/opth.s34573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Qualitative description of the optic disc has clinical value, but optical coherence tomography (OCT) has provided the ability to quantify retinal nerve fiber layer (RNFL) thickness. Methods We asked three neuro-ophthalmologists of at least 20 years’ experience to estimate the average OCT RNFL thickness of 37 eyes based on fundus photos. Results The overall correlation coefficient for RNFL thickness estimation variance between two physicians and between physician and OCT was 0.53. The likelihood that the RNFL thickness estimation between physicians, or between physician and OCT, was within 10 μm of each other was 47%–62%. All physicians had disparities in RNFL thickness estimation greater than 30 μm. Conclusion This study provides information on the ability of an experienced neuro-ophthalmologist to estimate the RNFL thickness based on fundus photos.
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Affiliation(s)
- John H Pula
- University of Illinois College of Medicine at Peoria, Illinois Neurologic Institute, Peoria, IL, USA
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31
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Serbecic N, Beutelspacher SC, Kircher K, Reitner A, Schmidt-Erfurth U. Interpretation of RNFLT values in multiple sclerosis-associated acute optic neuritis using high-resolution SD-OCT device. Acta Ophthalmol 2012; 90:540-5. [PMID: 21044275 DOI: 10.1111/j.1755-3768.2010.02013.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Optical coherence tomography (OCT) has emerged as the technique of choice in measuring the retinal nerve fibre layer (RNFL) quantitatively. It is suggested that RNFL reduction may correlate with lesion burden and diffuse axonal degeneration in the whole CNS of patients with multiple sclerosis (MS). However, RNFL changes because of optic neuritis (ON) must be taken into account. METHODS Twenty-three patients with acute ON (46 eyes) associated with clinical definite MS (23 ON eyes, 23 fellow eyes) and 23 sex- and age-matched healthy controls were studied. Retinal nerve fibre layer thickness (RNFLT) was measured at baseline, using a high-resolution spectral domain OCT (SD-OCT) applying circular, peripapillary OCT scans with a novel eye-tracking mechanism. RESULTS The internal OCT software was able to identify RNFL atrophy in three out of five of the acute ON eyes and one out of four of the fellow eyes with previous ON episodes. Retinal nerve fibre layer thickness of two ON (8.7%) and five fellow eyes (21.7%) was overestimated, thus located within the 95% and 5% confidence interval of the company standard values (not marked pathologic). In contrast, our comparison with age- and sex-matched controls revealed RNFL atrophy suggestive of prior, clinically silent RNFL loss in ON and fellow eyes (30.4%). CONCLUSION Retinal nerve fibre layer thickness measurements at a single time-point seem to have a limited role in detecting prior clinically silent optic nerve injury. Our data suggest that affected eyes should be compared with the fellow eyes and a sufficient number of age- and sex-matched controls to allow the detection of even subtle RNFL changes at baseline. The role of OCT for disease monitoring of MS must be evaluated in detail, as ON is often the initial symptom of MS.
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Affiliation(s)
- Nermin Serbecic
- Department of Ophthalmology, University Eye Hospital Vienna, Waehringer Guertel, Vienna, Austria.
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32
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Fjeldstad AS, Carlson NG, Rose JW. Optical coherence tomography as a biomarker in multiple sclerosis. ACTA ACUST UNITED AC 2012; 6:593-604. [DOI: 10.1517/17530059.2012.719496] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Wang XG, Peng Q, Wu Q. Comparison of central macular thickness between two spectral-domain optical coherence tomography in elderly non-mydriatic eyes. Int J Ophthalmol 2012; 5:354-9. [PMID: 22773987 PMCID: PMC3388407 DOI: 10.3980/j.issn.2222-3959.2012.03.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 05/04/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exams, and to investigate the relationship between CMT and possible influencing factors such as age, sex, eye (OD/OS), and operators in elderly non-mydriatic eyes. METHODS Seventy-two normal subjects were included. Every subject underwent CMT measurement twice using one of two SD-OCT (OSE-2000, Moptim, Shenzhen, China & 3-D OCT-1000, Topcon, Tokyo, Japan) instruments respectively where we randomly chose one eye in each patient for the test; these exams were performed by two operators over an hour period with a brief rest between sessions. Comparison of the OSE-2000 and 3-D OCT-1000 CMT measurements was based on paired-t test. The mean difference between the CMT measurements was calculated. General linear model analyzed the relationships among eye (OD/OS), operator, sex, and CMT values using age as co-variant. All tests were considered statistically significant at P<0.05. The main outcome measures included CMT. RESULTS When evaluated with general linear model analysis, CMT measurements were found to have high reproducibility across the two instruments between the two operators for the OSE-2000 single line scan and 3-D OCT-1000 macular scans (P=0.731; P=0.443). There was statistically significant difference in CMT values between the two instruments (P<0.001) and the mean difference was -46.83µm at 95% confidence limits (-49.15,-44.51). Age was positively correlated with CMT (beta coefficient = 0.516, P=0.001; beta coefficient = 0.453, P=0.009) and sex was correlated with CMT from the OSE-2000 (P=0.021) but not with the 3-D OCT-1000 (P=0.056). According to the actual thickness measurements, the CMT of the male was thicker than the female's but there was no statistical difference. There was interaction between sex and eye in OSE-2000 and not in 3-D OCT-1000 (P=0.02; P=0.374). No significant correlation was found between CMT and the influencing factor of eye in both of the instruments (P=0.884; P=0.492). CONCLUSION Reproducibility of CMT measurement using the two SD-OCTs is excellent in normal eyes according to the operator factor analysis. OSE-2000 has a different posterior retinal boundary of CMT measurement, which results in the CMT value differences, compared with the 3-D OCT-1000. Age is positively correlated with CMT measurement while sex is correlated with CMT in the OSE-2000 but not in the 3-D OCT-1000 and eye (OD/OS) had no correlation with CMT values. Mydriatic drops may not be necessary for CMT measurement using high scan rate SD-OCT in normal eyes in dark room.
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Affiliation(s)
- Xiao-Gang Wang
- Department of Ophthalmology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai 200233, China
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Patterns of retinal damage facilitate differential diagnosis between Susac syndrome and MS. PLoS One 2012; 7:e38741. [PMID: 22701702 PMCID: PMC3372471 DOI: 10.1371/journal.pone.0038741] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 05/09/2012] [Indexed: 11/19/2022] Open
Abstract
Susac syndrome, a rare but probably underdiagnosed combination of encephalopathy, hearing loss, and visual deficits due to branch retinal artery occlusion of unknown aetiology has to be considered as differential diagnosis in various conditions. Particularly, differentiation from multiple sclerosis is often challenging since both clinical presentation and diagnostic findings may overlap. Optical coherence tomography is a powerful and easy to perform diagnostic tool to analyse the morphological integrity of retinal structures and is increasingly established to depict characteristic patterns of retinal pathology in multiple sclerosis. Against this background we hypothesised that differential patterns of retinal pathology facilitate a reliable differentiation between Susac syndrome and multiple sclerosis. In this multicenter cross-sectional observational study optical coherence tomography was performed in nine patients with a definite diagnosis of Susac syndrome. Data were compared with age-, sex-, and disease duration-matched relapsing remitting multiple sclerosis patients with and without a history of optic neuritis, and with healthy controls. Using generalised estimating equation models, Susac patients showed a significant reduction in either or both retinal nerve fibre layer thickness and total macular volume in comparison to both healthy controls and relapsing remitting multiple sclerosis patients. However, in contrast to the multiple sclerosis patients this reduction was not distributed over the entire scanning area but showed a distinct sectorial loss especially in the macular measurements. We therefore conclude that patients with Susac syndrome show distinct abnormalities in optical coherence tomography in comparison to multiple sclerosis patients. These findings recommend optical coherence tomography as a promising tool for differentiating Susac syndrome from MS.
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Seigo MA, Sotirchos ES, Newsome S, Babiarz A, Eckstein C, Ford E, Oakley JD, Syc SB, Frohman TC, Ratchford JN, Balcer LJ, Frohman EM, Calabresi PA, Saidha S. In vivo assessment of retinal neuronal layers in multiple sclerosis with manual and automated optical coherence tomography segmentation techniques. J Neurol 2012; 259:2119-30. [PMID: 22418995 DOI: 10.1007/s00415-012-6466-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/24/2012] [Accepted: 02/21/2012] [Indexed: 01/22/2023]
Abstract
Macular optical coherence tomography (OCT) segmentation, enabling quantification of retinal axonal and neuronal subpopulations, may help elucidate the neuroretinal pathobiology of multiple sclerosis (MS). This study aimed to determine the agreement, reproducibility, and visual correlations of retinal layer thicknesses measured by different OCT segmentation techniques, on two spectral-domain OCT devices. Macular scans of 52 MS patients and 30 healthy controls from Spectralis OCT and Cirrus HD-OCT were segmented using fully manual (Spectralis), computer-aided manual (Spectralis and Cirrus), and fully automated (Cirrus) segmentation techniques. Letter acuity was recorded. Bland-Altman analyses revealed low mean differences across OCT segmentation techniques on both devices for ganglion cell + inner plexiform layers (GCIP; 0.76-2.43 μm), inner nuclear + outer plexiform layers (INL + OPL; 0.36-1.04 μm), and outer nuclear layers including photoreceptor segment (ONL + PR; 1.29-3.52 μm) thicknesses. Limits of agreement for GCIP and ONL + PR thicknesses were narrow. Results of fully manual and computer-aided manual segmentation were comparable to those of fully automated segmentation. MS patients demonstrated macular RNFL, GCIP, and ONL + PR thinning compared to healthy controls across OCT segmentation techniques, irrespective of device (p < 0.03 for all). Low-contrast letter acuity in MS correlated significantly and more strongly with GCIP than peripapillary RNFL thicknesses, regardless of the segmentation method or device. GCIP and ONL + PR thicknesses, measured by different OCT devices and segmentation techniques, are reproducible and agree at the individual and cohort levels. GCIP thinning in MS correlates with visual dysfunction. Significant ONL + PR thinning, detectable across OCT segmentation techniques and devices, strongly supports ONL pathology in MS. Fully automated, fully manual and computer-assisted manual OCT segmentation techniques compare closely, highlighting the utility of accurate and time-efficient automated segmentation outcomes in MS clinical trials.
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Affiliation(s)
- Michaela A Seigo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Nerve fiber layer and macular thinning measured with different imaging methods during the course of acute optic neuritis. Eur J Ophthalmol 2012; 21:473-83. [PMID: 21038310 DOI: 10.5301/ejo.2010.5844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2010] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare retinal nerve fiber layer thickness (RNFLT) and inner macula thickness changes measured with Fourier-domain optical coherence tomography (FD-OCT) and scanning laser polarimetry during the course of acute optic neuritis (ON). METHODS Nine eyes of 7 consecutive patients with multiple sclerosis (MS) were prospectively imaged from the onset of ON for 6 to 12 months. Nine healthy eyes were imaged for 12 to 19 months. RESULTS Retinal nerve fiber layer thickness measured with FD-OCT initially increased in all eyes with diffuse optic disc edema. Inner macula thickness and polarimetric RNFLT decreased already in the acute phase, in all eyes. All parameters stabilized at 2 to 5 months. The relative structural loss was different with the different methods. Poor image quality with polarimetry occurred in 2 eyes in the acute phase of ON. In the control eyes all parameters were stable. CONCLUSIONS Change of RNFLT and macular thickness during the course of acute ON in MS strongly depends on the method used for the measurement. Inner macula thickness, measured with FD-OCT, was especially useful for the follow-up, since it was not influenced by initial disc edema and had consistently high image quality.
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Vision in multiple sclerosis: the story, structure-function correlations, and models for neuroprotection. J Neuroophthalmol 2012; 31:362-73. [PMID: 22089500 DOI: 10.1097/wno.0b013e318238937f] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Visual dysfunction is one of the most common clinical manifestations of multiple sclerosis (MS). Just over a decade ago, MS clinical trials did not include visual outcomes, but experts recognized the need for more sensitive measures of visual function. Low-contrast letter acuity emerged as the leading candidate to measure visual disability in MS, and subsequent studies found low-contrast acuity testing to correlate well with brain MRI lesion burden, visual-evoked potentials, quality of life (QOL), and retinal nerve fiber layer (RNFL) loss, as measured by optical coherence tomography (OCT). OCT in MS has allowed for assessment of structure-function correlations that make the anterior visual pathway and acute optic neuritis (ON) ideal models for testing novel agents for neuroprotection and repair. New therapies that reduce axonal loss by neuroprotective or myelin repair mechanisms can now be assessed noninvasively by OCT and coupled with visual function data. Based on OCT studies in MS, RNFL thickness is reduced significantly among patients (92 μm) vs controls (105 μm) and is particularly reduced in MS eyes with a history of ON (85 μm). Worsening of visual function by a clinically significant ≥ 7 letters or approximately 1.5 lines for low-contrast acuity is associated with approximately 4.5 μm reductions in RNFL thickness in MS eyes. Longitudinal studies of OCT have also shown RNFL axonal loss over time that occurs even in the absence of acute ON and that correlates with clinically meaningful worsening of vision and QOL, even in patients with benign MS. The latest OCT investigations involve high-resolution spectral-domain (SD) OCT with segmentation and measurement of specific retinal layers using computerized algorithms. These methods allow quantitation of ganglion cell (neuronal) layer loss and axonal degeneration in MS in vivo. In this review, we examine the data from these studies and ongoing trials that highlight the entity of ON as a model to investigate neuroprotection and neurorepair. In doing so, we also present representative group data from studies that have examined visual function, OCT measures, and QOL scales in patients with MS and ON and disease-free controls. These data, and those from recent meta-analyses, may be used to provide reference values for the development of clinical trial protocols.
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Walter SD, Ishikawa H, Galetta KM, Sakai RE, Feller DJ, Henderson SB, Wilson JA, Maguire MG, Galetta SL, Frohman E, Calabresi PA, Schuman JS, Balcer LJ. Ganglion cell loss in relation to visual disability in multiple sclerosis. Ophthalmology 2012; 119:1250-7. [PMID: 22365058 DOI: 10.1016/j.ophtha.2011.11.032] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/04/2011] [Accepted: 11/22/2011] [Indexed: 01/28/2023] Open
Abstract
PURPOSE We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS). DESIGN Cross-sectional study. PARTICIPANTS A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment. METHODS The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined. MAIN OUTCOME MEASURES The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5% and 1.25% contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score. RESULTS Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (P<0.001 and P = 0.001) and in MS ON versus non-ON eyes (P<0.001 for both measures). Peripapillary RNFL, macular RNFL, GCL+IPL, and the combination of macular RNFL+GCL+IPL were significantly correlated with VA (P≤0.001), 2.5% LCLA (P<0.001), and 1.25% LCLA (P≤0.001). Among OCT measurements, reductions in GCL+IPL (P<0.001), macular RNFL (P = 0.006), and the combination (macular RNFL+GCL+IPL; P<0.001) were most strongly associated with lower (worse) NEI-VFQ-25 and 10-Item Supplement QOL scores; GCL+IPL thinning was significant even accounting for macular RNFL thickness (P = 0.03 for GCL+IPL, P = 0.39 for macular RNFL). CONCLUSIONS We demonstrated that GCL+IPL thinning is most significantly correlated with both visual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Scott D Walter
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Ziemann U, Wahl M, Hattingen E, Tumani H. Development of biomarkers for multiple sclerosis as a neurodegenerative disorder. Prog Neurobiol 2011; 95:670-85. [DOI: 10.1016/j.pneurobio.2011.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/07/2011] [Accepted: 04/10/2011] [Indexed: 01/24/2023]
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Comparison of retinal nerve fiber layer and central macular thickness measurements among five different optical coherence tomography instruments in patients with multiple sclerosis and optic neuritis. J Neuroophthalmol 2011; 31:110-6. [PMID: 21131852 DOI: 10.1097/wno.0b013e3181facbbd] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To compare the mean central macular thickness (CMT) and the mean average optic nerve retinal nerve fiber layer (RNFL) thickness in the eyes of patients with a history of optic neuritis and/or multiple sclerosis (MS) using 5 commercially available optical coherence tomography (OCT) instruments. METHODS Cross-sectional study including 46 patients (92 eyes) with a history of optic neuritis and/or MS. Both eyes were imaged on the same day with 5 OCT instruments: 1 time-domain OCT (Stratus) and 4 different Fourier-domain (spectral-domain) OCT (3D OCT-1000, Cirrus, RTVue-100, and Spectralis). RESULTS Twenty-five patients (50 eyes) were included in the final analysis after excluding patients with diabetes, glaucoma, ocular hypertension, or retinal pathology and inadequate scan quality. Randomized block analysis of variance revealed statistically significant differences across instruments (P < 0.001) for both eyes for mean CMT and mean average optic nerve RNFL. When testing for significant differences in measurements from instrument to instrument, some difference was noted between the right and left eyes. CONCLUSIONS Statistically significant differences exist among commercially available OCT instruments in measuring mean CMT and mean average RNFL thickness in patients with optic neuritis and/or MS. These findings likely result from the differences in data acquisition and segmentation algorithm software among OCT instruments. Awareness of these variations among OCT instruments will be important in using these instruments for clinical trials and management of patients with optic neuritis and/or MS.
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Warner CV, Syc SB, Stankiewicz AM, Hiremath G, Farrell SK, Crainiceanu CM, Conger A, Frohman TC, Bisker ER, Balcer LJ, Frohman EM, Calabresi PA, Saidha S. The impact of utilizing different optical coherence tomography devices for clinical purposes and in multiple sclerosis trials. PLoS One 2011; 6:e22947. [PMID: 21853058 PMCID: PMC3154907 DOI: 10.1371/journal.pone.0022947] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 07/01/2011] [Indexed: 11/18/2022] Open
Abstract
Optical coherence tomography (OCT) derived retinal measures, particularly peri-papillary retinal nerve fiber layer (RNFL) thickness, have been proposed as outcome measures in remyelinating and neuroprotective trials in multiple sclerosis (MS). With increasing utilization of multiple centers to improve power, elucidation of the impact of different OCT technologies is crucial to the design and interpretation of such studies. In this study, we assessed relation and agreement between RNFL thickness and total macular volume (in MS and healthy controls) derived from three commonly used OCT devices: Stratus time-domain OCT, and Cirrus HD-OCT and Spectralis, two spectral-domain (SD) OCT devices. OCT was performed on both Cirrus HD-OCT and Stratus in 229 participants and on both Cirrus HD-OCT and Spectralis in a separate cohort of 102 participants. Pearson correlation and Bland-Altman analyses were used to assess correlation and agreement between devices. All OCT retinal measures correlated highly between devices. The mean RNFL thickness was 7.4 µm lower on Cirrus HD-OCT than Stratus, indicating overall poor agreement for this measurement between these machines. Further, the limits of agreement (LOA) between Cirrus HD-OCT and Stratus were wide (−4.1 to 18.9 µm), indicating poor agreement at an individual subject level. The mean RNFL thickness was 1.94 µm (LOA: −5.74 to 9.62 µm) higher on Spectralis compared to Cirrus HD-OCT, indicating excellent agreement for this measurement across this cohort. Although these data indicate that these three devices agree poorly at an individual subject level (evidenced by wide LOA in both study cohorts) precluding their co-utilization in everyday practice, the small difference for mean measurements between Cirrus HD-OCT and Spectralis indicate pooled results from these two SD-devices could be used as outcome measures in clinical trials, provided patients are scanned on the same machine throughout the trial, similar to the utilization of multiple different MRI platforms in MS clinical trials.
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Affiliation(s)
- Christina V. Warner
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Stephanie B. Syc
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Aleksandra M. Stankiewicz
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Girish Hiremath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sheena K. Farrell
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ciprian M. Crainiceanu
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy Conger
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Teresa C. Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Esther R. Bisker
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Laura J. Balcer
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Elliot M. Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Peter A. Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (SS); (PAC)
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (SS); (PAC)
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Pula JH, Towle VL, Staszak VM, Cao D, Bernard JT, Gomez CM. Retinal Nerve Fibre Layer and Macular Thinning in Spinocerebellar Ataxia and Cerebellar Multisystem Atrophy. Neuroophthalmology 2011; 35:108-114. [PMID: 21866205 DOI: 10.3109/01658107.2011.580898] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The spinocerebellar ataxias, like all neurodegenerative diseases, lack objective disease- and stage-specific biomarkers. Based on reports of clinically evident optic disc atrophy or retinal disease in some ataxia patients, and the discovery that pre-symptomatic retinal thinning occurs in other neurologic diseases such as multiple sclerosis, we tested the hypothesis that subclinical neuronal or axonal loss in the retina could occur in the degenerative ataxias. Spectral domain optical coherence tomography was performed on 29 ataxia patients with genetically proven spinocerebellar ataxia (SCA) 1, 2, 3, or 6, or multisystem atrophy type C (MSA-C) and 27 age-matched normal subjects. Ataxia patients were assessed using the scale for assessment and rating of ataxia. Compared with normal control subjects, retinal nerve fibre layer (RNFL) thickness was reduced for patients with SCA2 and SCA3, and thickness in the macular region was reduced for all SCAs but SCA2.
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Affiliation(s)
- John H Pula
- Department of Neurology, University of Illinois College of Medicine, Peoria, Illinois, USA
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Keltner JL, Cello KE, Balcer LJ, Calabresi PA, Markowitz CE, Werner JS. Stratus OCT Quality Control in Two Multi-Centre Multiple Sclerosis Clinical Trials. Neuroophthalmology 2011; 35:57-64. [PMID: 30151022 DOI: 10.3109/01658107.2011.557760] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/20/2010] [Accepted: 10/21/2010] [Indexed: 11/13/2022] Open
Abstract
The University of California (UC) Davis Reading Center evaluated 19,961 scans from 981 subjects in two multiple sclerosis therapeutic trials with the aim of determining the influence of optical coherence tomography quality control procedures on error rates. There was no optical coherence tomography technician certification in Trial 1, and technicians had very limited monitoring and feedback during the trial in view of the fact that data were received retrospectively. However, technicians were certified in Trial 2 and submitted data in accordance with the protocol. Trial 2 scans had higher signal strengths, fewer errors, and more useable data than the scans in Trial 1. Thus, certified technicians and prompt transmission of data for ongoing quality control monitoring provided higher quality data in multiple sclerosis trials.
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Affiliation(s)
| | | | | | - Peter A Calabresi
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Clyde E Markowitz
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, USA
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Galetta KM, Calabresi PA, Frohman EM, Balcer LJ. Optical coherence tomography (OCT): imaging the visual pathway as a model for neurodegeneration. Neurotherapeutics 2011; 8:117-32. [PMID: 21274691 PMCID: PMC3075740 DOI: 10.1007/s13311-010-0005-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Axonal and neuronal degeneration are important features of multiple sclerosis (MS) and other neurologic disorders that affect the anterior visual pathway. Optical coherence tomography (OCT) is a non-invasive technique that allows imaging of the retinal nerve fiber layer (RNFL), a structure which is principally composed of ganglion cell axons that form the optic nerves, chiasm, and optic tracts. Since retinal axons are nonmyelinated until they penetrate the lamina cribrosa, the RNFL is an ideal structure (no other central nervous system tract has this unique arrangement) for visualizing the processes of neurodegeneration, neuroprotection and, potentially, even neuro-repair. OCT is capable of providing high-resolution reconstructions of retinal anatomy in a rapid and reproducible fashion and permits objective analysis of the RNFL (axons) as well as ganglion cells and other neurons in the macula. In a systematic OCT examination of multiple sclerosis (MS) patients, RNFL thickness and macular volumes are reduced when compared to disease-free controls. Conspicuously, these changes, which signify disorganization of retinal structural architecture, occur over time even in the absence of a history of acute demyelinating optic neuritis. RNFL axonal loss in MS is most severe in those eyes with a corresponding reduction in low-contrast letter acuity (a sensitive vision test involving the perception of gray letters on a white background) and in those patients who exhibit the greatest magnitude of brain atrophy, as measured by validated magnetic resonance imaging techniques. These unique structure-function correlations make the anterior visual pathway an ideal model for investigating the effects of standard and novel therapies that target axonal and neuronal degeneration. We provide an overview of the physics of OCT, its unique properties as a non-invasive imaging technique, and its potential applications toward understanding mechanisms of brain tissue injury in MS, other optic neuropathies, and neurologic disorders.
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Affiliation(s)
- Kristin M. Galetta
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania USA
| | - Peter A. Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Massachusetts USA
| | - Elliot M. Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Laura J. Balcer
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania USA
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania USA
- Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania USA
- 3 E. Gates–Neurology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104 USA
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Rebolleda G, García-García A, Won Kim HR, Muñoz-Negrete FJ. Comparison of retinal nerve fiber layer measured by time domain and spectral domain optical coherence tomography in optic neuritis. Eye (Lond) 2010; 25:233-8. [PMID: 21183940 DOI: 10.1038/eye.2010.206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To study the relationship between retinal nerve fiber layer (RNFL) thickness measurements from time domain (Stratus) and spectral domain (Cirrus HD) optical coherence tomography (OCT) in subjects with optic neuritis. METHODS A total of 18 patients who had suffered monocular acute optic neuritis were imaged by a single trained operator using the Stratus-OCT (fast RNFL scan mode) and Cirrus HD-OCT (optic disc cube mode) on the same day. The relationship between RNFL thickness measurements of the two OCTs (overall and by quadrants) were evaluated using intraclass correlation coefficient (ICC) and Bland-Altman plots. Comparisons between eyes having optic neuritis (ON-group) and fellow eyes (fellow-group) were assessed by a generalized estimating equation (GEE) regression model. RESULTS For Stratus-OCT, the median average RNFL was 86.3 and 102 μ in the ON-group and in the fellow-group, respectively. For Cirrus-OCT, the corresponding measurements were 81 and 93 μ. Average RNFL thickness as determined by the two OCT devices was well correlated in the ON-group (ρ = 0.906, P< 0.001) and in the fellow-group (ρ = 0.702, P = 0.001). The median signal strength was significantly higher with Cirrus-OCT. Bland-Altman plots showed that Stratus RNFL measurements were larger than Cirrus-OCT, but smaller when average RNFL thickness was very thin (≤ 56 μ). CONCLUSIONS Although the Cirrus-OCT and Stratus-OCT RNFL thickness measurements are well correlated in patients with optic neuritis, RNFL measurements cannot be directly compared. Clinicians should be aware that measurements are generally higher with Stratus- than with Cirrus-OCT.
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Affiliation(s)
- G Rebolleda
- Department of Ophthalmology, Glaucoma Unit, Hospital Ramón y Cajal, Madrid, Spain.
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Sättler MB, Bähr M. Future neuroprotective strategies. Exp Neurol 2010; 225:40-7. [DOI: 10.1016/j.expneurol.2009.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 08/18/2009] [Accepted: 08/19/2009] [Indexed: 12/27/2022]
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Talman LS, Bisker ER, Sackel DJ, Long DA, Galetta KM, Ratchford JN, Lile DJ, Farrell SK, Loguidice MJ, Remington G, Conger A, Frohman TC, Jacobs DA, Markowitz CE, Cutter GR, Ying GS, Dai Y, Maguire MG, Galetta SL, Frohman EM, Calabresi PA, Balcer LJ. Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis. Ann Neurol 2010; 67:749-60. [PMID: 20517936 DOI: 10.1002/ana.22005] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Cross-sectional studies of optical coherence tomography (OCT) show that retinal nerve fiber layer (RNFL) thickness is reduced in multiple sclerosis (MS) and correlates with visual function. We determined how longitudinal changes in RNFL thickness relate to visual loss. We also examined patterns of RNFL thinning over time in MS eyes with and without a prior history of acute optic neuritis (ON). METHODS Patients underwent OCT measurement of RNFL thickness at baseline and at 6-month intervals during a mean follow-up of 18 months at 3 centers. Low-contrast letter acuity (2.5%, 1.25% contrast) and visual acuity (VA) were assessed. RESULTS Among 299 patients (593 eyes) with >or=6 months follow-up, eyes with visual loss showed greater RNFL thinning compared to eyes with stable vision (low-contrast acuity, 2.5%: p < 0.001; VA: p = 0.005). RNFL thinning increased over time, with average losses of 2.9microm at 2 to 3 years and 6.1microm at 3 to 4.5 years (p < 0.001 vs 0.5-1-year follow-up interval). These patterns were observed for eyes with or without prior history of ON. Proportions of eyes with RNFL loss greater than test-retest variability (>or=6.6microm) increased from 11% at 0 to 1 year to 44% at 3 to 4.5 years (p < 0.001). INTERPRETATION Progressive RNFL thinning occurs as a function of time in some patients with MS, even in the absence of ON, and is associated with clinically significant visual loss. These findings are consistent with subclinical axonal loss in the anterior visual pathway in MS, and support the use of OCT and low-contrast acuity as methods to evaluate the effectiveness of putative neuroprotection protocols.
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Affiliation(s)
- Lauren S Talman
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Syc SB, Warner CV, Hiremath GS, Farrell SK, Ratchford JN, Conger A, Frohman T, Cutter G, Balcer LJ, Frohman EM, Calabresi PA. Reproducibility of high-resolution optical coherence tomography in multiple sclerosis. Mult Scler 2010; 16:829-39. [PMID: 20530512 DOI: 10.1177/1352458510371640] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Optical coherence tomography (OCT) is a non-invasive method to quantify neurodegeneration as an outcome in multiple sclerosis clinical trials; however, no data exist on Cirrus spectral domain optical coherence tomography (SD-OCT) reproducibility in patients with multiple sclerosis. The objective of this study was to determine the protocol for achieving optimal inter-visit, inter-rater, and intra-rater reproducibility for studies performed on healthy controls and multiple sclerosis patients utilizing novel high-definition SD-OCT. This is a prospective study of inter-visit, inter-rater, and intra-rater reproducibility in multiple sclerosis patients (n = 58) and healthy controls (n = 32) on Cirrus-HD SD-OCT. Excellent reproducibility of average and quadrantic retinal nerve fiber layer (RNFL) thickness values, average macular thickness (AMT), and total macular volume (TMV) [measured by intraclass correlation coefficient (ICC)] was found for inter-visit (healthy controls: mean RNFL = 0.97, quadrant range = 0.92-0.97, AMT = 0.97, TMV = 0.92), inter-rater (MS: mean RNFL = 0.97, quadrant = 0.94-0.98, AMT = 0.99, TMV = 0.96; healthy controls: mean RNFL = 0.97, quadrant = 0.94-0.97, AMT = 0.98, TMV = 0.99), and intra-rater (MS patients: mean RNFL = 0.99, quadrant = 0.83-0.99, AMT = 0.97, TMV = 0.98) reproducibility. The reproducibility of retinal measures derived by Cirrus HD-OCT, especially quadrantic values, is excellent. Specific procedures for OCT acquisition and analysis of retinal imaging metrics using SD-OCT technology may improve the application of this novel technology in multiple sclerosis.
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Affiliation(s)
- Stephanie B Syc
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Keltner JL, Johnson CA, Cello KE, Dontchev M, Gal RL, Beck RW. Visual field profile of optic neuritis: a final follow-up report from the optic neuritis treatment trial from baseline through 15 years. ACTA ACUST UNITED AC 2010; 128:330-7. [PMID: 20212204 DOI: 10.1001/archophthalmol.2010.16] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate visual field abnormalities after an episode of optic neuritis among participants in the Optic Neuritis Treatment Trial. METHODS Three readers independently evaluated 10 443 visual fields from 454 patients and classified visual field abnormalities into 21 different monocular categories representing 3 general types of visual loss: diffuse, localized, and artifactual. Classification frequency was determined and reader agreement was evaluated. The association of visual field abnormality classifications with mean deviation, pattern standard deviation, visual acuity, and foveal threshold was assessed. RESULTS At baseline, diffuse loss accounted for 66.2% of the abnormalities in the affected eyes but only 6.2% of the abnormalities in the fellow eyes. During years 1 through 15, the affected and fellow eyes exhibited predominantly localized loss in the nerve fiber bundle region (partial arcuate, paracentral, and arcuate defects). At year 1, 35.7% of the abnormalities in the affected eyes and 34.4% in the fellow eyes consisted of localized defects. At year 15, 39.5% of abnormalities in the affected eyes and 26.3% in the fellow eyes consisted of localized defects. Foveal threshold was highly correlated with visual acuity and contrast sensitivity in the affected eye at baseline (-0.82 vs 0.79, respectively), 6 months (-0.84 vs 0.81), and 1 year (-0.84 vs 0.79). CONCLUSIONS Diffuse and central loss were more predominant in the affected eye at baseline, and nerve fiber bundle defects (partial arcuate, paracentral, and arcuate) were the most predominant localized abnormalities in both the affected and fellow eyes during the study.
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Affiliation(s)
- John L Keltner
- Department of Ophthalmology and Vision Science, University of California, Davis, 4860 Y St, Ste 2400, Sacramento, CA 95817, USA.
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[Comparison of three optical coherence tomography devices, one time-domain and two fourier-domain, for the estimation of the retinal nerve fibre layer thickness]. ACTA ACUST UNITED AC 2010; 85:165-73. [PMID: 23010520 DOI: 10.1016/s0365-6691(10)55002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 06/18/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess agreement between one system of time-domain optical coherence tomography (OCT) (Stratus) and two systems of fourier-domain OCT (Cirrus and 3D OCT-1000) for the measurement of the retinal nerve fibre layer thickness (RNFL). METHODS Fifty eyes from 25 patients with neuro-ophthalmological disorders of the afferent visual pathway were included. A triple RNFL thickness OCT examination with Stratus, Cirrus and 3D OCT-1000 was performed on both eyes of every patient, on the same day and by the same technician. The average RNFL thickness by quadrants and clock sectors were compared with the Lin´s concordance correlation coefficient (CCC) and Bland-Altman plots. RESULTS The average RNFL thickness, the temporal and nasal quadrants and corresponding clock sectors, was higher by 3D OCT-1000 (mean 90.02 microns), nevertheless, RNFL thickness of the superior and inferior quadrants and corresponding clock hours was higher when measured by Stratus device. The CCC agreement between Stratus and Cirrus was high (0.820), between Stratus and 3D OCT-1000 was moderate (mean 0.573) and between Cirrus and 3D OCT-1000 was moderate with a mean of 0.564 but too low in the nasal and temporal quadrants (0.362 and 0.347 respectively). CONCLUSIONS The RNFL thickness measurements by Stratus, Cirrus and 3D OCT-1000 OCT are not equivalent. Although the agreement between Stratus and Cirrus was high, it was too low between 3D OCT-1000 and Stratus or Cirrus.
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