1
|
Cujbă L, Banc A, Stan C, Drugan T, Nicula C. Macular OCT's Proficiency in Identifying Retrochiasmal Visual Pathway Lesions in Multiple Sclerosis-A Pilot Study. Diagnostics (Basel) 2024; 14:1221. [PMID: 38928637 PMCID: PMC11202879 DOI: 10.3390/diagnostics14121221] [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: 04/29/2024] [Revised: 06/01/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive imaging technique based on the principle of low-coherence interferometry that captures detailed images of ocular structures. Multiple sclerosis (MS) is a neurodegenerative disease that can lead to damage of the optic nerve and retina, which can be depicted by OCT. The purpose of this pilot study is to determine whether macular OCT can be used as a biomarker in the detection of retrochiasmal lesions of the visual pathway in MS patients. We conducted a prospective study in which we included 52 MS patients and 27 healthy controls. All participants underwent brain MRI, visual field testing, and OCT evaluation of the thicknesses of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer (GCL), and macular inner plexiform layer (IPL). OCT measurements were adjusted for optic neuritis (ON). VF demonstrated poor capability to depict a retrochiasmal lesion identified by brain MRI (PPV 0.50). In conclusion, the OCT analysis of the macula appears to excel in identifying retrochiasmal MS lesions compared to VF changes. The alterations in the GCL and IPL demonstrate the most accurate detection of retrochiasmal visual pathway changes in MS patients.
Collapse
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
| | - Cristina Stan
- Department of Ophthalmology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Cristina Nicula
- Department of Maxillo-Facial Surgery and Radiology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| |
Collapse
|
2
|
Ciociola EC, Patel K, Blahnik T, Ghosh A, Klifto MR, Fleischman D. A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease. J Curr Glaucoma Pract 2023; 17:126-133. [PMID: 37920375 PMCID: PMC10618602 DOI: 10.5005/jp-journals-10078-1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/02/2023] [Indexed: 11/04/2023] Open
Abstract
Aim To investigate the limitations of diagnosing glaucoma in patients with coexistent neurodegenerative disease (NDD) by collecting information on demographics, examination findings, optical coherence tomography (OCT), and visual field (VF) tests. Materials and methods Retrospective cohort study of patients with primary open-angle glaucoma and coexistent dementia, multiple sclerosis (MS), Parkinson's disease (PD), or cerebrovascular accident (CVA) from 2014 to 2020. We included patients with a minimum of 3 years of follow-up. Demographics, ophthalmic exam, OCT, and VF findings were reported and compared across NDD groups using the Chi-squared and analysis of variance tests. Results We included 199 patients with glaucoma and coexistent NDD, including dementia (51.3%), CVA (11.2%), PD (18.1%), and MS (19.6%). Cupping, neuroretinal rim thinning, pallor, and peripapillary atrophy of the optic nerve were most frequently observed. There was a high number of missing values from OCT to VF tests, and zero patients had a complete OCT or VF test. Additionally, 67.8 and 77.4% of patients received <1 OCT and VF/year, respectively. Retinal nerve fiber layer (RNFL) thinning was observed most frequently in the superior (33.2% OD and 30.7% OS) and inferior (25.6% OD and 30.2% OS) quadrants, with the most significant thinning seen in CVA patients compared to other NDDs (p < 0.05). Glaucoma hemifield tests (GHTs) were abnormal in 23.1% OD and 22.6% OS, and the average mean deviation was -7.43 [standard deviation (SD) 8.23] OD and -8.79 (SD 7.99) OS. Conclusion The OCT and VF tests are frequently unavailable and may be confounded in patients with coexistent glaucoma and NDDs, complicating glaucoma diagnosis and management. Clinical significance Diagnosing and managing glaucoma in patients with coexistent NDD is difficult, given the lack of available and reliable OCT and VF testing data. Providers may be forced to rely on intraocular pressure (IOP) and other imperfect measures. How to cite this article Ciociola EC, Patel K, Blahnik T, et al. A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease. J Curr Glaucoma Pract 2023;17(3):126-133.
Collapse
Affiliation(s)
- Elizabeth C Ciociola
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Kush Patel
- Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Tyler Blahnik
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Arko Ghosh
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Meredith R Klifto
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - David Fleischman
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| |
Collapse
|
3
|
Montolío A, Martín-Gallego A, Cegoñino J, Orduna E, Vilades E, Garcia-Martin E, Palomar APD. Machine learning in diagnosis and disability prediction of multiple sclerosis using optical coherence tomography. Comput Biol Med 2021; 133:104416. [PMID: 33946022 DOI: 10.1016/j.compbiomed.2021.104416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system, especially the brain, spinal cord, and optic nerve. Diagnosis of this disease is a very complex process and generally requires a lot of time. In addition, treatments are applied without any information on the disability course in each MS patient. For these two reasons, the objective of this study was to improve the MS diagnosis and predict the long-term course of disability in MS patients based on clinical data and retinal nerve fiber layer (RNFL) thickness, measured by optical coherence tomography (OCT). MATERIAL AND METHODS A total of 104 healthy controls and 108 MS patients, 82 of whom had a 10-year follow-up, were enrolled. Classification algorithms such as multiple linear regression (MLR), support vector machines (SVM), decision tree (DT), k-nearest neighbours (k-NN), Naïve Bayes (NB), ensemble classifier (EC) and long short-term memory (LSTM) recurrent neural network were tested to develop two predictive models: MS diagnosis model and MS disability course prediction model. RESULTS For MS diagnosis, the best result was obtained using EC (accuracy: 87.7%; sensitivity: 87.0%; specificity: 88.5%; precision: 88.7%; AUC: 0.8775). In line with this good performance, the accuracy was 85.4% using k-NN and 84.4% using SVM. And, for long-term prediction of MS disability course, LSTM recurrent neural network was the most appropriate classifier (accuracy: 81.7%; sensitivity: 81.1%; specificity: 82.2%; precision: 78.9%; AUC: 0.8165). The use of MLR, SVM and k-NN also showed a good performance (AUC ≥ 0.8). CONCLUSIONS This study demonstrated that machine learning techniques, using clinical and OCT data, can help establish an early diagnosis and predict the course of MS. This advance could help clinicians select more specific treatments for each MS patient. Therefore, our findings underscore the potential of RNFL thickness as a reliable MS biomarker.
Collapse
Affiliation(s)
- Alberto Montolío
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain; Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - Alejandro Martín-Gallego
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain; Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - José Cegoñino
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain; Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - Elvira Orduna
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
| | - Elisa Vilades
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
| | - Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
| | - Amaya Pérez Del Palomar
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain; Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain.
| |
Collapse
|
4
|
Visual field impairment captures disease burden in multiple sclerosis. J Neurol 2016; 263:695-702. [DOI: 10.1007/s00415-016-8034-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
|
5
|
Soufi G, AitBenhaddou E, Hajji Z, Tazrout S, Benomar A, Soufi M, Boulanouar A, Abouqal R, Yahyaoui M, Berraho A. Evaluation of retinal nerve fiber layer thickness measured by optical coherence tomography in Moroccan patients with multiple sclerosis. J Fr Ophtalmol 2015; 38:497-503. [DOI: 10.1016/j.jfo.2014.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/13/2014] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
|
6
|
Huseyinoglu N, Ekinci M, Ozben S, Buyukuysal C. Relationship between Structural and Functional Assessment of the Visual System in Mildly Disabled Relapsing-Remitting Multiple Sclerosis Patients. Neuroophthalmology 2014; 38:1-7. [PMID: 27928266 DOI: 10.3109/01658107.2013.855242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/01/2013] [Indexed: 01/21/2023] Open
Abstract
Studies that explored the anterior visual pathway in the patients with multiple sclerosis (MS) have demonstrated contradictory results about the correlation between structural and functional status of optic nerve and retina. We aimed to investigate the functional and structural findings in our cohort of mildly disabled relapsing-remitting MS patients. A total of 134 eyes (80 eyes of the patients with MS and 54 eyes of the control group) were investigated. Eyes of MS patients were divided into two groups-as eyes with history of optic neuritis (ON group) and without history of optic neuritis (NON group). Ophthalmological investigation including visual evoked potentials, standard automated perimetry, and optical coherence tomography were performed for all participants. Retinal and macular thicknesses were significantly decreased in ON and NON groups compared with controls. Also, visual evoked potential latencies and visual field loss were worse in the both MS groups compared with control group. We did not find any correlation between visual evoked potentials and retinal or macular thickness values but visual field parameters were correlated between retinal and macular layer loss in the NON group. According to our results and some previous studies, although both functional and structural changes were detected in patients with MS, functional status markers do not always show parallelism (or synchrony) with structural changes, especially in eyes with history of optic neuritis.
Collapse
Affiliation(s)
| | - Metin Ekinci
- Department of Ophthalmology, Kafkas University Medical Faculty Kars Turkey
| | - Serkan Ozben
- Department of Neurology, Kafkas University Medical Faculty Kars Turkey
| | - Cagatay Buyukuysal
- Department of Biostatistics, Bülent Ecevit University Medical Faculty Zonguldak Turkey
| |
Collapse
|
7
|
Güler M, Türkçüoğlu P, Yılmaz T, Yoldaş TK, Channa R. Comparison of Visual Field Parameters in Early and Advanced Stages of Multiple Sclerosis Patients Without a History of Optic Neuritis. Neuroophthalmology 2013; 37:58-62. [DOI: 10.3109/01658107.2013.767356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/03/2012] [Accepted: 12/03/2012] [Indexed: 11/13/2022] Open
|
8
|
|
9
|
Gelfand JM, Goodin DS, Boscardin WJ, Nolan R, Cuneo A, Green AJ. Retinal axonal loss begins early in the course of multiple sclerosis and is similar between progressive phenotypes. PLoS One 2012; 7:e36847. [PMID: 22666330 PMCID: PMC3359324 DOI: 10.1371/journal.pone.0036847] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/16/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To determine whether retinal axonal loss is detectable in patients with a clinically isolated syndrome (CIS), a first clinical demyelinating attack suggestive of multiple sclerosis (MS), and examine patterns of retinal axonal loss across MS disease subtypes. METHODOLOGY/PRINCIPAL FINDINGS Spectral-domain Optical Coherence Tomography was performed in 541 patients with MS, including 45 with high-risk CIS, 403 with relapsing-remitting (RR)MS, 60 with secondary-progressive (SP)MS and 33 with primary-progressive (PP)MS, and 53 unaffected controls. Differences in retinal nerve fiber layer (RNFL) thickness and macular volume were analyzed using multiple linear regression and associations with age and disease duration were examined in a cross-sectional analysis. In eyes without a clinical history of optic neuritis (designated as "eyes without optic neuritis"), the total and temporal peripapillary RNFL was thinner in CIS patients compared to controls (temporal RNFL by -5.4 µm [95% CI -0.9 to--9.9 µm, p = 0.02] adjusting for age and sex). The total (p = 0.01) and temporal (p = 0.03) RNFL was also thinner in CIS patients with clinical disease for less than 1 year compared to controls. In eyes without optic neuritis, total and temporal RNFL thickness was nearly identical between primary and secondary progressive MS, but total macular volume was slightly lower in the primary progressive group (p<0.05). CONCLUSIONS/SIGNIFICANCE Retinal axonal loss is increasingly prominent in more advanced stages of disease--progressive MS>RRMS>CIS--with proportionally greater thinning in eyes previously affected by clinically evident optic neuritis. Retinal axonal loss begins early in the course of MS. In the absence of clinically evident optic neuritis, RNFL thinning is nearly identical between progressive MS subtypes.
Collapse
Affiliation(s)
- Jeffrey M. Gelfand
- University of California, San Francisco Department of Neurology, Multiple Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - Douglas S. Goodin
- University of California, San Francisco Department of Neurology, Multiple Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - W. John Boscardin
- Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Rachel Nolan
- University of California, San Francisco Department of Neurology, Multiple Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - Ami Cuneo
- University of California, San Francisco Department of Neurology, Multiple Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - Ari J. Green
- University of California, San Francisco Department of Neurology, Multiple Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|
10
|
Chatziralli IP, Moschos MM, Brouzas D, Kopsidas K, Ladas ID. Evaluation of retinal nerve fibre layer thickness and visual evoked potentials in optic neuritis associated with multiple sclerosis. Clin Exp Optom 2012; 95:223-8. [PMID: 22329676 DOI: 10.1111/j.1444-0938.2012.00706.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim was to compare the retinal nerve fibre layer (RNFL) thickness and visual evoked potentials (VEP) among eyes with multiple sclerosis (MS)-associated optic neuritis, unaffected eyes of the same patients and eyes of disease-free controls. Changes in RNFL thickness, visual acuity (VA) and VEP over time are evaluated in MS-associated optic neuritis. METHODS Forty-six eyes of 23 patients (six male and 17 female), who suffer from MS and were diagnosed with unilateral or bilateral optic neuritis, participated in the study. Forty eyes of 20 age- and gender-matched controls were tested. VA measurement, optical coherence tomography and VEP were performed in all patients at presentation and at one, three and six months thereafter. RESULTS There was a statistically significant difference in VA between MS eyes with optic neuritis and controls (p < 0.0001), as well as between MS eyes with and without optic neuritis (p < 0.005). VA improved over time. Average RNFL thickness was reduced in MS eyes with or without optic neuritis in comparison to control eyes. This reduction in RNFL thickness was more marked over time. The amplitude of P(100) was significantly decreased in MS eyes with optic neuritis in comparison to controls (p < 0.0001) and there was a statistically significant delay in peak time of P(100) in MS eyes with optic neuritis versus the eyes of normal subjects (p < 0.0001), which improved over time. CONCLUSION The present study suggests that there is a progressive decrease in RNFL over time in eyes with optic neuritis associated with MS. The amplitude and latency of P(100) in VEP examination returned to normal ranges over time.
Collapse
Affiliation(s)
- Irini P Chatziralli
- 1st Department of Ophthalmology, University of Athens, Medical School, Athens, Greece
| | | | | | | | | |
Collapse
|
11
|
Costello FE, Klistorner A, Kardon R. Optical Coherence Tomography in the Diagnosis and Management of Optic Neuritis and Multiple Sclerosis. Ophthalmic Surg Lasers Imaging Retina 2011; 42 Suppl:S28-40. [DOI: 10.3928/15428877-20110627-03] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/18/2011] [Indexed: 01/30/2023]
|
12
|
Alpay A, Guney T, Unal A, Ugurbas SH. Comparison of retinal nerve fibre layer thickness with visual evoked potential and visual field in patients with multiple sclerosis. Clin Exp Ophthalmol 2011; 40:e25-31. [PMID: 21668781 DOI: 10.1111/j.1442-9071.2011.02619.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate retinal nerve fibre layer thickness and to compare results with visual evoked potentials and visual field in patients with multiple sclerosis. DESIGN A prospective, case-control study, university hospital setting. PARTICIPANTS Seventy-three eyes of 37 multiple sclerosis patients and 74 eyes of 37 healthy subjects. METHODS All patients underwent a complete neurological and ophthalmological examination and peri-papillary retinal nerve fibre layer thickness was evaluated using scanning laser polarimetry (GDx). Furthermore, visual evoked potential and visual field testing were performed. MAIN OUTCOME MEASURES The χ(2) test, Student's t-test, Mann-Whitney U-test and Pearson's correlation coefficient analysis of the GDx, visual evoked potential and visual field testing parameters. RESULTS GDx measurements showed significantly more retinal nerve fibre layer damage in the patients than in the control groups. Comparison of the GDx parameters between patients with optic neuritis and non-optic neuritis demonstrated a statistically significant difference in symmetry (P = 0.046) and superior/nasal parameters (P = 0.009). A correlation was found between the number, superior and inferior ratio parameters, and P100 amplitude obtained with visual evoked potential in patients with non-optic neuritis. Additionally, there was a correlation between the number, inferior ratio and superior/nasal parameters, and the mean deviation of visual field in the non-optic neuritis group. CONCLUSIONS For retinal nerve fibre layer thickness measurements in multiple sclerosis patients, the GDx, along with other techniques, such as visual evoked potential, can be used as a diagnostic and follow-up criterion, particularly in patients without optic neuritis.
Collapse
Affiliation(s)
- Atilla Alpay
- Department of Ophthalmology, the School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.
| | | | | | | |
Collapse
|