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Cujbă L, Banc A, Drugan T, Coadă CA, Cristea AP, Stan C, Nicula C. Homonymous Hemiatrophy of Macular Ganglion Cell Layer as a Marker of Retrograde Neurodegeneration in Multiple Sclerosis-A Narrative Review. Diagnostics (Basel) 2024; 14:1255. [PMID: 38928670 PMCID: PMC11202963 DOI: 10.3390/diagnostics14121255] [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: 04/28/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Retrograde axonal neurodegeneration along the visual pathway-either direct or trans-synaptic-has already been demonstrated in multiple sclerosis (MS), as well as in compressive, vascular, or posttraumatic lesions of the visual pathway. Optical coherence tomography (OCT) can noninvasively track macular and optic nerve changes occurring as a result of this phenomenon. Our paper aimed to review the existing literature regarding hemimacular atrophic changes in the ganglion cell layer identified using OCT examination in MS patients without prior history of optic neuritis. Homonymous hemimacular atrophy has been described in post-chiasmal MS lesions, even in patients with normal visual field results. Temporal and nasal macular OCT evaluation should be performed separately in all MS patients, in addition to an optic nerve OCT evaluation and a visual field exam.
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Affiliation(s)
- Larisa Cujbă
- Medical Doctoral School, University of Oradea, 410087 Oradea, Romania;
| | - Ana Banc
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.B.); (C.S.)
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Camelia Alexandra Coadă
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andreea-Petra Cristea
- Department of Ophthalmology, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Cristina Stan
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (A.B.); (C.S.)
| | - Cristina Nicula
- Department of Maxillo-Facial Surgery and Radiology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
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Fahrenthold BK, Cavanaugh MR, Tamhankar M, Lam BL, Feldon SE, Johnson BA, Huxlin KR. Training in Cortically Blinded Fields Appears to Confer Patient-Specific Benefit Against Retinal Thinning. Invest Ophthalmol Vis Sci 2024; 65:29. [PMID: 38635245 PMCID: PMC11033601 DOI: 10.1167/iovs.65.4.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral hemifield, initiating a process of transsynaptic retrograde degeneration (TRD). Here, we examined retinal correlates of TRD using a new metric to account for global changes in inner retinal thickness and asked if perceptual training in the intact or blind field impacts its progression. Methods We performed a meta-analysis of optical coherence tomography data in 48 participants with unilateral V1 stroke and homonymous visual defects who completed clinical trial NCT03350919. After measuring the thickness of the macular ganglion cell and inner plexiform layer (GCL-IPL) and the peripapillary retinal nerve fiber layer (RNFL), we computed individual laterality indices (LI) at baseline and after ∼6 months of daily motion discrimination training in the intact or blind field. Increasingly positive LI denoted greater layer thinning in retinal regions affected versus unaffected by the cortical damage. Results Pretraining, the affected GCL-IPL and RNFL were thinner than their unaffected counterparts, generating LI values positively correlated with time since stroke. Participants trained in their intact field exhibited increased LIGCL-IPL. Those trained in their blind field had no significant change in LIGCL-IPL. LIRNFL did not change in either group. Conclusions Relative shrinkage of the affected versus unaffected macular GCL-IPL can be reliably measured at an individual level and increases with time post-V1 stroke. Relative thinning progressed during intact-field training but appeared to be halted by training within the blind field, suggesting a potentially neuroprotective effect of this simple behavioral intervention.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Madhura Tamhankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Steven E. Feldon
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, United States
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
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Fahrenthold BK, Cavanaugh MR, Tamhankar M, Lam BL, Feldon SE, Johnson BA, Huxlin KR. Training in cortically-blind fields confers patient-specific benefit against retinal thinning after occipital stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.19.23298260. [PMID: 38196617 PMCID: PMC10775322 DOI: 10.1101/2023.12.19.23298260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral hemifield, initiating a process of trans-synaptic retrograde degeneration (TRD). Here, we examined retinal correlates of TRD using a new metric to account for global changes in inner retinal thickness, and asked if perceptual training in the intact or blind field impacts its progression. Methods We performed a meta-analysis of optical coherence tomography (OCT) data in 48 participants with unilateral V1 stroke and homonymous visual defects, who completed clinical trial NCT03350919. After measuring the thickness of the macular ganglion cell and inner plexiform layers (GCL-IPL), and the peripapillary retinal nerve fiber layer (RNFL), we computed individual laterality indices (LI) at baseline and after ~6 months of daily motion discrimination training in the intact- or blind-field. Increasingly positive LI denoted greater layer thinning in retinal regions affected versus unaffected by the cortical damage. Results Pre-training, the affected GCL-IPL and RNFL were thinner than their unaffected counterparts, generating LI values positively correlated with time since stroke. Participants trained in their intact-field exhibited increased LIGCL-IPL. Those trained in their blind-field had no significant change in LIGCL-IPL. LIRNFL did not change in either group. Conclusions Relative shrinkage of the affected versus unaffected macular GCL-IPL can be reliably measured at an individual level and increases with time post-V1 stroke. Relative thinning progressed during intact-field training, but appeared to be halted by training within the blind field, suggesting a potentially neuroprotective effect of this simple behavioral intervention.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Madhura Tamhankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Steven E. Feldon
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
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Donaldson L, Chen M, Margolin E. Transsynaptic Ganglion Cell Degeneration in Adult Patients After Occipital Lobe Stroke. J Neuroophthalmol 2023; 43:243-247. [PMID: 35763809 DOI: 10.1097/wno.0000000000001657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Loss of retinal ganglion cells after occipital lobe damage is known to occur through transsynaptic retrograde degeneration in congenital lesions; however, studies of this phenomenon in acquired pathology, such as strokes affecting postgenicular visual pathway, are scant. We studied a cohort of adult patients with known onset of occipital lobe stroke to look for the presence, rate, and timing of macular ganglion cell loss on optical coherence tomography. METHODS Retrospective review of patients seen in tertiary neuro-ophthalmology practice with homonymous hemianopia secondary to occipital lobe stroke of known onset. Optical coherence tomography of the macular ganglion cell complex (GCC) was performed, and hemifields corresponding to the side of the visual field (VF) defect were compared with the control retinal hemifield. RESULTS Fifteen patients with homonymous VF defects were included in the study, and 8 of these (53.3%) demonstrated GCC hemifield thickness of less than 90% on the side corresponding to VF loss including 2/9 (22%) patients who had a stroke less than 2.5 years ago and 6/6 (100%) patients who had a stroke longer than 2.5 years ago. The amount of hemifield atrophy correlated to the logarithm of time since stroke onset ( P =0.030) but not age ( P = 0.95) or mean deviation on VF ( P = 0.19). Three patients with longitudinal data showed GCC thinning rates of 1.99, 5.13, and 5.68 µm per year. CONCLUSION Transsynaptic retrograde degeneration occurs after occipital lobe stroke as early as 5.5 months after injury and was observed in all patients 2.5 years after stroke.
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Affiliation(s)
- Laura Donaldson
- Department of Ophthalmology and Vision Sciences (LD, EM), Faculty of Medicine, University of Toronto, Toronto, Canada; University of Western Ontario (MC), London, Canada; and Department of Medicine (EM), Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Quantification of retinal ganglion cell loss in patients with homonymous visual field defect due to stroke. Neurol Sci 2023:10.1007/s10072-023-06675-2. [PMID: 36905449 DOI: 10.1007/s10072-023-06675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND To quantify the degree of ganglion cell degeneration through spectral domain optical coherence tomography (SD-OCT) in adult patients with post-stroke homonymous visual field defect. METHODS Fifty patients with acquired visual field defect due to stroke (mean age = 61 years) and thirty healthy controls (mean age = 58 years) were included. Mean deviation (MD) and pattern standard deviation (PSD), average peripapillary retinal nerve fibre layer thickness (pRNLF-AVG), average ganglion cell complex thickness (GCC-AVG), global loss volume (GLV) and focal loss volume (FLV) were measured. Patients were divided according to the damaged vascular territories (occipital vs. parieto-occipital) and stroke type (ischaemic vs. haemorrhagic). Group analysis was conducted with ANOVA and multiple regressions. RESULTS pRNFL-AVG was significantly decreased among patients with lesions in parieto-occipital territories compared to controls and to patients with lesions in occipital territories (p = .04), with no differences with respect to stroke type. GCC-AVG, GLV and FLV differed in stroke patients and controls, regardless of stroke type and involved vascular territories. Age and elapsed time from stroke had a significant effect on pRNFL-AVG and GCC-AVG (p < .01), but not on MD and PSD. CONCLUSIONS Reduction of SD-OCT parameters occurs following both ischaemic and haemorrhagic occipital stroke, but it is larger when the injury extends to parietal territories and increases as time since stroke increases. The size of visual field defect is unrelated to SD-OCT measurements. Macular GCC thinning appeared to be more sensitive than pRNFL in detecting retrograde retinal ganglion cell degeneration and its retinotopic pattern in stroke.
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Ganglion Cell Complex Analysis: Correlations with Retinal Nerve Fiber Layer on Optical Coherence Tomography. Diagnostics (Basel) 2023; 13:diagnostics13020266. [PMID: 36673076 PMCID: PMC9858609 DOI: 10.3390/diagnostics13020266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this review is to analyze the correlations between the changes in the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) on optical coherence tomography in different possible situations, especially in eyes with glaucoma. For glaucoma evaluation, several studies have suggested that in the early stages, GCC analysis, especially the thickness of the infero and that of the inferotemporal GCC layers, is a more sensitive examination than circumpapillary RNFL (pRNFL). In the moderate stages of glaucoma, inferior pRNFL thinning is better correlated with the disease than in advanced cases. Another strategy for glaucoma detection is to find any asymmetry of the ganglion cell-inner plexiform layers (GCIPL) between the two macular hemifields, because this finding is a valuable indicator for preperimetric glaucoma, better than the RNFL thickness or the absolute thickness parameters of GCIPL. In preperimetric and suspected glaucoma, GCC and pRNFL have better specificity and are superior to the visual field. In advanced stages, pRNFL and later, GCC reach the floor effect. Therefore, in this stage, it is more useful to evaluate the visual field for monitoring the progression of glaucoma. In conclusion, GCC and pRNFL are parameters that can be used for glaucoma diagnosis and monitoring of the progression of the disease, with each having a higher accuracy depending on the stage of the disease.
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Assessment the neurodegenaration process of post-geniculate optic pathway in thalamic tumors using optical coherence tomography: Post-geniculate optic pathway in thalamic tumors. Int Ophthalmol 2022; 43:1487-1499. [PMID: 36227400 DOI: 10.1007/s10792-022-02545-6] [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: 08/25/2022] [Accepted: 10/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the effect of thalamic tumors related to post-geniculate optic pathway and those of microsurgical removal on neurodegeneration process of visual pathway using OCT. METHODS This cross-sectional study included 30 eyes of 15 patients with thalamic tumors and data compiled from 45 eyes of 45 healthy participants. The analysis of variables was divided into ipsilateral and contralateral eye depends on the laterality of brain tumors. The data gained at baseline, postoperative 3rd and postoperative 6th month period was analyzed in One-Way Repeated Measures ANOVA. RESULTS The mean superior quadrant retinal nerve fiber layer (RNFL) thickness of ipsilateral eye was significantly thicker (p = 0.02), while inferior hemifield ganglion cell-inner plexiform layer (GC-IPL) thickness of contralateral eye was significantly higher compared to control groups (p = 0.02). Significant negative correlations were found between the mean preop. mean deviation (MD) and tumor volume and time interval between initial diagnosis and surgery (r = - 0.730, p = 0.002 and r = - 0.680, p = 0.005, respectively) in the ipsilateral eye. In repeated measure analysis, there was no unfavourable effect of thalamic microsurgery on peripapillary average RNFL thickness on both ipsilateral and contralateral eyes (Ipsilateral eye; f (1.5,21.7) 0.76 p = 0.51 and contralateral eye; f (1.4,20.4) 0.42 p = 0.59). CONCLUSION This study suggests that thalamic tumors affecting post-geniculate optic pathway may lead to significant increase in RNFL and GC-IPL thicknesses and changes in VF parameters. Timely intervention in thalamic tumors may prevent irreversible loss of retinal axons secondary to neurodegeneration process.
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Simmen CF, Fierz FC, Michels L, Aldusary N, Landau K, Piccirelli M, Traber GL. Lateral Geniculate Nucleus Volume Determined on MRI Correlates With Corresponding Ganglion Cell Layer Loss in Acquired Human Postgeniculate Lesions. Invest Ophthalmol Vis Sci 2022; 63:18. [PMID: 35960514 PMCID: PMC9396694 DOI: 10.1167/iovs.63.9.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To quantitatively assess lateral geniculate nucleus (LGN) volume loss in the presence of lesions in the postgeniculate pathway and its correlation with optical coherence tomography retinal parameters. Methods This was a case control study of patients recruited at the University Hospital Zurich, Switzerland. Nine patients who were suffering from lesions in the postgeniculate pathway acquired at least 3 months earlier participated. Retinal parameters were analyzed using spectral domain optical coherence tomography and a newly developed magnetic resonance imaging protocol with improved contrast to noise ratio was applied to measure LGN volume. Results The affected LGN volume in the patients (mean volume 73.89 ± 39.08 mm3) was significantly smaller compared with the contralateral unaffected LGN (mean volume 131.43 ± 12.75 mm3), as well as compared with healthy controls (mean volume 107 ± 24.4 mm3). Additionally, the ganglion cell layer thickness corresponding with the affected versus unaffected side within the patient group differed significantly (mean thickness 40.5 ± 4.11 µm vs 45.7 ± 4.79 µm) compared with other retinal parameters. A significant linear correlation could also be shown between relative LGN volume loss and ganglion cell layer thickness decrease. Conclusions Corresponding LGN volume reduction could be shown in patients with postgeniculate lesions using a newly developed magnetic resonance imaging protocol. LGN volume decrease correlated with ganglion cell layer thickness reduction as a sign of trans-synaptic retrograde neuronal degeneration.
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Affiliation(s)
- Cyril Fabian Simmen
- Department of Neurology, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Fabienne Catherine Fierz
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Njoud Aldusary
- Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Ghislaine Lieselotte Traber
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
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Donaldson L, Margolin E. Visual fields and optical coherence tomography (OCT) in neuro-ophthalmology: Structure-function correlation. J Neurol Sci 2021; 429:118064. [PMID: 34488042 DOI: 10.1016/j.jns.2021.118064] [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] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Visual field (VF) testing is an essential component of the neurological examination. The differential diagnosis of VF defects depends on relating this measure of afferent visual function to the structure of the visual pathway and optical coherence tomography (OCT) is an invaluable tool for detailed structural evaluation of the optic nerve and retina. This review describes the ways in which interpretation of VF and OCT can be used together to increase the accuracy of the localization of lesions along the visual pathway. Lesions of the anterior visual pathway (originating in ganglion cells or nerve fibre layer of the retina or optic nerve) will typically produce defects that respect the horizontal midline, reflecting the arcuate path of the ganglion cell axons as they travel to the optic nerve. OCT of peripapillary retinal nerve fibre layer and ganglion cell complex (GCC) will typically demonstrate irreversible thinning in compressive and demyelinating lesions affecting anterior visual pathway. Chiasmal lesions produce highly localizable VF defects (junctional scotoma and bitemporal hemianopia) which correspond to the thinning of nasal portion of GCC. Lesions of the optic tract result in incongruous homonymous hemianopia on VF with corresponding hemianopic thinning on GCC developing within months. Lesions affecting optic radiations usually produce more congruous homonymous VF defects and can also produce homonymous thinning on GCC, however, this takes much longer to develop as trans-synaptic degeneration at the lateral geniculate body must occur.
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Affiliation(s)
- Laura Donaldson
- University of Toronto, Faculty of Medicine, Department of Ophthalmology and Vision Sciences, Toronto, Ontario, Canada
| | - Edward Margolin
- University of Toronto, Faculty of Medicine, Department of Medicine, Division of Neurology, Toronto, Ontario, Canada.
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Abstract
First described in 1991 and introduced into clinical practice in 1996, optical coherence tomography (OCT) now has a very extensive role in many different areas of ophthalmological practice. It is non-invasive, cheap, highly reproducible, widely available and easy to perform. OCT also has a role in managing patients with neurological disorders, particularly idiopathic intracranial hypertension. This review provides an overview of the technology underlying OCT and the information it can provide that is relevant to the practising neurologist. Particular conditions discussed include papilloedema, optic disc drusen, multiple sclerosis and neuromyelitis optica, other optic neuropathies, compression of the anterior visual pathway and various neurodegenerative conditions.
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