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Bsteh G, Hegen H, Altmann P, Auer M, Berek K, Di Pauli F, Kornek B, Krajnc N, Leutmezer F, Macher S, Rommer PS, Zebenholzer K, Zulehner G, Zrzavy T, Deisenhammer F, Pemp B, Berger T. Diagnostic Performance of Adding the Optic Nerve Region Assessed by Optical Coherence Tomography to the Diagnostic Criteria for Multiple Sclerosis. Neurology 2023; 101:e784-e793. [PMID: 37400245 PMCID: PMC10449446 DOI: 10.1212/wnl.0000000000207507] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/24/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The optic nerve has been recommended as an additional region for demonstrating dissemination in space (DIS) in diagnostic criteria for multiple sclerosis (MS). The aim of this study was to investigate whether adding the optic nerve region as determined by optical coherence tomography (OCT) as part of the DIS criteria improves the 2017 diagnostic criteria. METHODS From a prospective observational study, we included patients with a first demyelinating event who had complete information to assess DIS and a spectral domain OCT scan obtained within 180 days. Modified DIS criteria (DIS + OCT) were constructed by adding the optic nerve to the current DIS regions based on validated thresholds for OCT intereye differences. Time to second clinical attack was the primary endpoint. RESULTS We analyzed 267 patients with MS (mean age 31.3 years [SD 8.1], 69% female) during a median observation period of 59 months (range: 13-98). Adding the optic nerve as a fifth region improved the diagnostic performance by increasing accuracy (DIS + OCT 81.2% vs DIS 65.6%) and sensitivity (DIS + OCT 84.2% vs DIS 77.9%) without lowering specificity (DIS + OCT 52.2% vs DIS 52.2%). Fulfilling DIS + OCT criteria (≥2 of 5 DIS + OCT regions involved) indicated a similar risk of a second clinical attack (hazard ratio [HR] 3.6, CI 1.4-14.5) compared with a 2.5-fold increased risk when fulfilling DIS criteria (HR 2.5, CI 1.2-11.8). When the analysis was conducted according to topography of the first demyelinating event, DIS + OCT criteria performed similarly in both optic neuritis and nonoptic neuritis. DISCUSSION Addition of the optic nerve, assessed by OCT, as a fifth region in the current DIS criteria improves diagnostic performance by increasing sensitivity without lowering specificity. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that adding the optic nerve as determined by OCT as a fifth DIS criterion to the 2017 McDonald criteria improves diagnostic accuracy.
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Affiliation(s)
- Gabriel Bsteh
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria.
| | - Harald Hegen
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Patrick Altmann
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Michael Auer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Klaus Berek
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Franziska Di Pauli
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Barbara Kornek
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Nik Krajnc
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Fritz Leutmezer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Stefan Macher
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Paulus Stefan Rommer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Karin Zebenholzer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Gudrun Zulehner
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Tobias Zrzavy
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Florian Deisenhammer
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Berthold Pemp
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
| | - Thomas Berger
- From the Department of Neurology (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Comprehensive Center for Clinical Neurosciences and Mental Health (G.B., P.A., B.K., N.K., F.L., S.M., P.S.R., K.Z., G.Z., T.Z., T.B.), Medical University of Vienna; Department of Neurology (H.H., M.A., K.B., F.D.P., F.D.), Medical University of Innsbruck; and Department of Ophthalmology (B.P.), Medical University of Vienna, Austria
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Huang-Link Y, Yang G, Gustafsson G, Gauffin H, Landtblom AM, Mirabelli P, Link H. The Importance of Optical Coherence Tomography in the Diagnosis of Atypical or Subclinical Optic Neuritis: A Case Series Study. J Clin Med 2023; 12:jcm12041309. [PMID: 36835847 PMCID: PMC9961647 DOI: 10.3390/jcm12041309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Background: Optic neuritis (ON) is an inflammatory condition of the optic nerve. ON is associated with development of demyelinating diseases of the central nervous system (CNS). CNS lesions visualized by magnetic resonance imaging (MRI) and the finding of oligoclonal IgG bands (OB) in the cerebrospinal fluid (CSF) are used to stratify the risk of MS after a "first" episode of ON. However, the diagnosis of ON in absence of typical clinical manifestations can be challenging. Methods and Materials: Here we present three cases with changes in the optic nerve and ganglion cell layer in the retina over the disease course. (1) A 34-year-old female with a history of migraine and hypertension had suspect amaurosis fugax (transient vision loss) in the right eye. This patient developed MS four years later. Optical coherence tomography (OCT) showed dynamic changes of the thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) over time. (2) A 29-year-old male with spastic hemiparesis and lesions in the spinal cord and brainstem. Six years later he showed bilateral subclinical ON identified using OCT, visual evoked potentials (VEP) and MRI. The patient fulfilled diagnosis criteria of seronegative neuromyelitis optica (NMO). (3) A 23-year-old female with overweight and headache had bilateral optic disc swelling. With OCT and lumbar puncture, idiopathic intracranial hypertension (IIH) was excluded. Further investigation showed positive antibody for myelin oligodendrocyte glycoprotein (MOG). Conclusions: These three cases illustrate the importance of using OCT to facilitate quick, objective and accurate diagnosis of atypical or subclinical ON, and thus proper therapy.
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Affiliation(s)
- Yumin Huang-Link
- Division of Neurology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
- Correspondence: ; Tel.: +46-72-463-8760
| | - Ge Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Greta Gustafsson
- Division of Neurophysiology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Helena Gauffin
- Division of Neurology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Anne-Marie Landtblom
- Division of Neurology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
- Division of Neurology, Department of Medical Sciences, Uppsala University, 752 36 Uppsala, Sweden
| | - Pierfrancesco Mirabelli
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Hans Link
- Department of Neurosciences, Karolinska Institutet, 171 77 Stockholm, Sweden
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Chang S, Zwueste D, Ambros B, Norton J, Leis ML. Comparison of the effect of sedation and general anesthesia on pattern and flash visual evoked potentials in normal dogs. BMC Vet Res 2022; 18:272. [PMID: 35831819 PMCID: PMC9277965 DOI: 10.1186/s12917-022-03375-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Visual evoked potentials (VEPs) can provide objective functional assessment of the post-retinal visual pathway. This study compared the effects of sedation (butorphanol and dexmedetomidine) and general anesthesia (propofol and sevoflurane) on pattern and flash VEPs. Dogs (n = 13) underwent sedation or anesthesia and VEPs were obtained from 3 subcutaneous recording electrodes placed on the head (O1, Oz, O2). Results Pattern VEPs could only be recorded under sedation and a maximum of 3 peaks were identified (N75, P100, N135). Flash VEPs could be recorded under both sedation and anesthesia and a maximum of 5 peaks were identified (N1, P1, N2, P2, N3). The latency of the N1 peak and the baseline-N1 amplitude were significantly longer under general anesthesia. Conclusion Visual evoked potentials should be preferentially recorded in dogs sedated with dexmedetomidine and butorphanol, regardless of the stimulus. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-022-03375-5.
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Affiliation(s)
- Stephanie Chang
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada
| | - Danielle Zwueste
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada
| | - Barbara Ambros
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada
| | - Jonathan Norton
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Marina L Leis
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada.
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Masala A, Mola ID, Cellerino M, Pera V, Vagge A, Uccelli A, Christian C, Traverso CE, Iester M. Choroidal Thickness in Multiple Sclerosis: An Optical Coherence Tomography Study. J Clin Neurol 2022; 18:334-342. [PMID: 35589321 PMCID: PMC9163936 DOI: 10.3988/jcn.2022.18.3.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose To identify changes in the choroidal thickness (CT) in multiple sclerosis (MS) patients with and without optic neuritis (ON) using enhanced-depth-imaging optical coherence tomography (EDI-OCT). Methods This cross-sectional study included 96 eyes with MS and 28 eyes of healthy controls. All participants underwent an ophthalmologic examination and EDI-OCT scanning (Spectralis, Heidelberg Engineering, Germany) to assess the CT and the retinal nerve fiber layer (RNFL) thickness. MS patients were divided into two groups: 1) with and 2) without a history of ON. The CT was evaluated in the fovea and at six horizontal and six vertical points at 500, 1,000, and 1,500 µm from the fovea. Paired t-tests were used to compare the groups, and p-value<0.05 was considered as significant. Results At all 13 measurements points, the CT was thicker in MS patients than in the healthy controls and was thinner in eyes with ON than in the contralateral eyes, but these differences were not statistically significant. However, the CT was always larger in all points in eyes with a history of ON than in the control eyes. The RNFL was significantly thinner (p<0.05) in both MS and ON eyes than in the control eyes. Conclusions The CT did not differ between MS and control eyes, but it was significantly larger in patients with a history of ON, in whom the RNFL was thinner. Further studies are necessary to establish the possible role of the choroid in MS.
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Affiliation(s)
- Alessandro Masala
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,San Martino IRCCS Policlinic Hospital, Genoa, Italy
| | - Ilaria Di Mola
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,San Martino IRCCS Policlinic Hospital, Genoa, Italy
| | - Maria Cellerino
- Neurologic Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Valentina Pera
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,San Martino IRCCS Policlinic Hospital, Genoa, Italy
| | - Aldo Vagge
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,San Martino IRCCS Policlinic Hospital, Genoa, Italy
| | - Antonio Uccelli
- San Martino IRCCS Policlinic Hospital, Genoa, Italy.,Neurologic Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Cordano Christian
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Carlo E Traverso
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,San Martino IRCCS Policlinic Hospital, Genoa, Italy
| | - Michele Iester
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,San Martino IRCCS Policlinic Hospital, Genoa, Italy.
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Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, España-Gregori E, Casanova B. Dyschromatopsia in multiple sclerosis reflects diffuse chronic neurodegeneration beyond anatomical landmarks. Acta Neurol Belg 2021; 121:1767-1775. [PMID: 33044738 DOI: 10.1007/s13760-020-01516-x] [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: 04/16/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
To formulate and validate a dyschromatopsia linear regression model in patients with multiple sclerosis (MS). 64 MS patients (50 to formulate the model and 14 for its validation) underwent neurological (Expanded Disability Status Scale, EDSS), color vision (Farnsworth D15 test), and peripapillary retinal nerve fiber layer (pRNFL) and retinal evaluation with spectral-domain optical coherence tomography (SD-OCT). Neuroradiological examination permitted to obtain brain parenchymal fraction (BPF) and cervical spinal cord volume (SC). Ophthalmic parameters were calculated as the average of both non-optic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. The influence of sex, age, disease duration, and history of disease-modifying treatment (first- or second-line DMT) was tested as covariables that could influence color perception. Color confusion index (log CCI) correlated with pRNFL (r = - 0.322, p = 0.009), ganglion cell layer (GCL, r = - 0.321, p = 0.01), BPF (r = - 0.287, p = 0.021), SC volume (r = - 0.33, p = 0.008), patients' age (r = 0.417, p = 0.001), disease duration (r = 0.371, p = 0.003), and EDSS (r = 0.44, p = 0.001). The following CCI equation was obtained: log (CCI) = 0.316-0.224 BPF - 0.187 SC volume (mm3) + 0.226 age (years) + 0.012 disease duration (years) - 0.372 GCL (µm). CCI correlates with MS clinical and paraclinical established biomarkers suggesting chronic diffuse neurodegeneration in MS operates at brain, SC, and retina linking all three compartments. Color vision outcome can be calculated through the aforementioned variables for clinical and research purposes.
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Affiliation(s)
- Antonio Barreiro-González
- Ophthalmology Department, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Maria T Sanz
- Departamento de Didáctica de La Matemática, Universidad de Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Carmen Alcalá
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique España-Gregori
- Ophthalmology Department, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
- Surgery Department, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Bonaventura Casanova
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
- Medicine Department, Faculty of Medicine, University of Valencia, Valencia, Spain
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Özbilen KT, Gündüz T, Çukurova Kartal SN, Gedik AC, Eraksoy M, Kürtüncü M. Bruch's membrane opening-minimum rim width: An alternative OCT biomarker study for multiple sclerosis. Eur J Ophthalmol 2021; 31:2141-2149. [PMID: 33601900 DOI: 10.1177/1120672121996638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Bruch's membrane opening-minimum rim width (BMO-MRW) and RNFL measured using anatomic positioning system (APS-RNFL) are novel OCT methods and remained unexplored in MS patients.To investigate the novel parameters of spectral-domain OCT as an alternative biomarker in patients with multiple sclerosis (MS). METHODS Retrospective cohort study; participants consisted of relapsing-remitting MS (RRMS) patients and healthy controls (HC). Eyes were classified according to the presence of MS and previous optic neuritis (ON). Measurements of standard peripapillary RNFL (S-RNFL), BMO-MRW, and APS-RNFL were performed. RESULT A total of 244 eyes of 122 participants (MS-patients: 63, HC: 59) were included in the study. Fifty-one eyes had a history of previous ON. In almost all measured parameters, neuroretinal rim thicknesses were observed the thinnest in eyes with ON history between all subgroups. S-RNFL and APS-RNFL techniques showed the difference in neuroretinal rim thickness in all three subjects (ON+, ON-, and HC). However, BMO-MRW, on the other hand, could not distinguish between ON(-) patients and HC. The relationship between OCT parameters and EDSS were observed only in eyes with an ON history in all three techniques. A meaningful model with 78% accuracy was obtained by using only the OCT parameters as risk factors. In the ROC analysis, no parameters were found to have acceptable high sensitivity and specificity. BMO-MRW was statistically weaker in every aspect than other RNFL techniques. CONCLUSION The novel APS-RNFL technique appears to be a bit more reliable alternative to S-RNFL technique to support therapeutic decision-making in MS. BMO-MRW has not been found as a successful alternative to S-RNFL.
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Affiliation(s)
- Kemal Turgay Özbilen
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ali Ceyhun Gedik
- Lüleburgaz State Hospital, Ophthalmology Clinic, Kırklareli, Turkey
| | - Mefküre Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Vidal-Jordana A, Rovira A, Arrambide G, Otero-Romero S, Río J, Comabella M, Nos C, Castilló J, Galan I, Cabello S, Moncho D, Rahnama K, Thonon V, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Auger C, Sastre-Garriga J, Montalban X, Tintoré M. Optic Nerve Topography in Multiple Sclerosis Diagnosis: The Utility of Visual Evoked Potentials. Neurology 2020; 96:e482-e490. [PMID: 33328323 PMCID: PMC7905792 DOI: 10.1212/wnl.0000000000011339] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. Methods From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non–optic neuritis). Results The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non–optic neuritis CIS. Conclusion The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
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Affiliation(s)
- Angela Vidal-Jordana
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada.
| | - Alex Rovira
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Georgina Arrambide
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Susana Otero-Romero
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jordi Río
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Manuel Comabella
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Carlos Nos
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Joaquin Castilló
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ingrid Galan
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Sergio Cabello
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Dulce Moncho
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Kimia Rahnama
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Vanessa Thonon
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Breogan Rodríguez-Acevedo
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ana Zabalza
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Luciana Midaglia
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Cristina Auger
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jaume Sastre-Garriga
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Xavier Montalban
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Mar Tintoré
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
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Schmidt MF, Pihl-Jensen G, Frederiksen JL. Functional–structural assessment of the optic pathways in patients with optic neuritis. Doc Ophthalmol 2019; 140:159-168. [DOI: 10.1007/s10633-019-09728-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 10/09/2019] [Indexed: 01/26/2023]
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Anssari N, Vosoughi R, Mullen K, Mansouri B. Selective Colour Vision Deficits in Multiple Sclerosis at Different Temporal Stages. Neuroophthalmology 2019; 44:16-23. [PMID: 32076444 DOI: 10.1080/01658107.2019.1615960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022] Open
Abstract
Multiple sclerosis (MS) without optic neuritis causes color-vision deficit but the evidence for selective color deficits in parvocellular-Red/Green (PC-RG) and koniocellular-Blue/Yellow (KC-BY) pathways is inconclusive. We investigated selective color-vision deficits at different MS stages. Thirty-one MS and twenty normal participants were tested for achromatic, red-green and blue-yellow sinewave-gratings (0.5 and 2 cycles-per-degree (cpd)) contrast orientation discrimination threshold. Red-green mean threshold at 0.5cpd in established-MS and blue-yellow mean threshold in all MS participants were abnormal. These findings show blue-yellow versus red-green color test is useful in differentiating MS chronicity, which helps to better understand the mechanism of colour-vision involvement in MS.
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Affiliation(s)
- Neda Anssari
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Reza Vosoughi
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Kathy Mullen
- Department of Ophthlmology, McGill University, Montreal, Canada
| | - Behzad Mansouri
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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