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Al-Nosairy KO, Duscha A, Buhr H, Lipp A, Desel C, Hegelmaier T, Thieme H, Haghikia A, Hoffmann MB. Functional and structural readouts for early detection of retinal involvement in multiple sclerosis. Front Integr Neurosci 2023; 17:1158148. [PMID: 37138797 PMCID: PMC10150010 DOI: 10.3389/fnint.2023.1158148] [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: 02/03/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The retina, a window into the brain, allows for the investigation of many disease-associated inflammatory and neurodegenerative changes affecting the central nervous system (CNS). Multiple sclerosis (MS), an autoimmune disease targeting the CNS, typically impacts on the visual system including the retina. Hence, we aimed to establish innovative functional retinal measures of MS-related damage, e.g., spatially resolved non-invasive retinal electrophysiology, backed by established morphological retinal imaging markers, i.e., optical coherence tomography (OCT). Methods 20 healthy controls (HC) and 37 people with MS [17 without history of optic neuritis (NON) and 20 with (HON) history of optic neuritis] were included. In this work, we differentially assessed photoreceptor/bipolar cells (distal retina) and retinal ganglion cell (RGC, proximal retina) function besides structural assessment (OCT). We compared two multifocal electroretinography-based approaches, i.e., the multifocal pattern electroretinogram (mfPERG) and the multifocal electroretinogram to record photopic negative response (mfERG PhNR ). Structural assessment utilized peripapillary retinal nerve fiber layer thickness (pRNFL) and macular scans to calculate outer nuclear thickness (ONL) and macular ganglion cell inner plexiform layer thickness (GCIPL). One eye was randomly selected per subject. Results In NON, photoreceptor/bipolar cell layer had dysfunctional responses evidenced by reduced mfERG PhNR -N1 peak time of the summed response, but preserved structural integrity. Further, both NON and HON demonstrated abnormal RGC responses as evidenced by the photopic negative response of mfERG PhNR (mfPhNR) and mfPERG indices (P < 0.05). Structurally, only HON had thinned retina at the level of RGCs in the macula (GCIPL, P < 0.01) and the peripapillary area (pRNFL, P < 0.01). All three modalities showed good performance to differentiate MS-related damage from HC, 71-81% area under curve. Conclusion In conclusion, while structural damage was evident mainly for HON, functional measures were the only retinal read-outs of MS-related retinal damage that were independent of optic neuritis, observed for NON. These results indicate retinal MS-related inflammatory processes in the retina prior to optic neuritis. They highlight the importance of retinal electrophysiology in MS diagnostics and its potential as a sensitive biomarker for follow-up in innovative interventions.
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Affiliation(s)
- Khaldoon O. Al-Nosairy
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
- *Correspondence: Khaldoon O. Al-Nosairy,
| | - Alexander Duscha
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Henrike Buhr
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
| | - Antonia Lipp
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christiane Desel
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Tobias Hegelmaier
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Hagen Thieme
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Michael B. Hoffmann
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
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Ciapă MA, Șalaru DL, Stătescu C, Sascău RA, Bogdănici CM. Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process. Curr Issues Mol Biol 2022; 44:3959-3979. [PMID: 36135184 PMCID: PMC9497878 DOI: 10.3390/cimb44090272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis is a central nervous system inflammatory demyelinating disease with a wide range of clinical symptoms, ocular involvement being frequently marked by the presence of optic neuritis (ON). The emergence and progression of ON in multiple sclerosis is based on various pathophysiological mechanisms, disease progression being secondary to inflammation, demyelination, or axonal degeneration. Early identification of changes associated with axonal degeneration or further investigation of the molecular processes underlying remyelination are current concerns of researchers in the field in view of the associated therapeutic potential. This article aims to review and summarize the scientific literature related to the main molecular mechanisms involved in defining ON as well as to analyze existing data in the literature on remyelination strategies in ON and their impact on long-term prognosis.
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Affiliation(s)
| | - Delia Lidia Șalaru
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Correspondence:
| | - Cristian Stătescu
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Radu Andy Sascău
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Camelia Margareta Bogdănici
- Department of Surgical Specialties (II), University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Ophthalmology Clinic, Saint Spiridon Hospital, Iași 700111, Romania
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Lee G, Park K, Oh SY, Min J, Kim BJ. Peripapillary and parafoveal microvascular changes in eyes with optic neuritis and their fellow eyes measured by optical coherence tomography angiography: an Exploratory Study. Acta Ophthalmol 2021; 99:288-298. [PMID: 32833336 DOI: 10.1111/aos.14577] [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: 10/19/2019] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aimed to evaluate parafoveal and peripapillary microvascular alterations in eyes with optic neuritis (ON) along with their fellow eyes compared to healthy control eyes using optical coherence tomography angiography (OCT-A). METHODS We included 31 ON-affected eyes and 31 fellow eyes of 31 patients who had experienced unilateral ON and 33 eyes of 33 healthy controls in this exploratory retrospective cross-sectional study. Optical coherence tomography angiography (OCT-A) was used to generate microvascular structural images and quantify the vessel density of the superficial retinal capillary plexus (SRCP), the deep retinal capillary plexus (DRCP) and radial peripapillary capillary (RPC) segments. We used the Kruskal-Wallis test for the comparison of OCT-A results between the three groups and generalized estimating equation models for the pairwise comparisons. RESULTS There were significant differences of SRCP (p = 0.0003) and RPC segment (p < 0.0001) vessel densities between the three groups. Specifically, there was a reduction in parafoveal and peripapillary vessel density in the ON-affected eyes compared to fellow eyes (SRCP, estimates, -1.97, 95% confidence interval [CI], -3.07, -0.87; RPC, -6.95, 95% CI, -8.70, -5.19) and controls (SRCP, -3.15, 95% CI, -4.61, -1.69; RPC, -8.66, 95% CI, -10.55, -6.76). The superior sector of the RPC segments vessel density in the fellow eyes was decreased compared to the controls (-4.93, 95% CI, -8.07, -1.80). CONCLUSIONS The results of this study suggest that microvascular changes occur in both the affected eye and unaffected fellow eye after a unilateral ON episode. Future studies are needed to clarify the clinical implications of these findings.
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Affiliation(s)
- Ga‐In Lee
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Kyung‐Ah Park
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Sei Yeul Oh
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Ju‐Hong Min
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Byoung Joon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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Al-Nosairy KO, Horbrügger M, Schippling S, Wagner M, Haghikia A, Pawlitzki M, Hoffmann MB. Structure-Function Relationship of Retinal Ganglion Cells in Multiple Sclerosis. Int J Mol Sci 2021; 22:ijms22073419. [PMID: 33810342 PMCID: PMC8037992 DOI: 10.3390/ijms22073419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
The retinal ganglion cells (RGC) may be considered an easily accessible pathophysiological site of degenerative processes in neurological diseases, such as the RGC damage detectable in multiple sclerosis (MS) patients with (HON) and without a history of optic neuritis (NON). We aimed to assess and interrelate RGC functional and structural damage in different retinal layers and retinal sites. We included 12 NON patients, 11 HON patients and 14 healthy controls for cross-sectional multifocal pattern electroretinography (mfPERG) and optical coherence tomography (OCT) measurements. Amplitude and peak times of the mfPERG were assessed. Macula and disc OCT scans were acquired to determine macular retinal layer and peripapillary retinal nerve fiber layer (pRNFL) thickness. In both HON and NON patients the foveal N2 amplitude of the mfPERG was reduced compared to controls. The parafoveal P1 peak time was significantly reduced in HON only. For OCT, parafoveal (pfGCL) and perifoveal (pGCL) ganglion cell layer thicknesses were decreased in HON vs. controls, while pRNFL in the papillomacular bundle sector (PMB) showed reductions in both NON and HON. As the mfPERG derived N2 originates from RGC axons, these findings suggest foveal axonal dysfunction not only in HON, but also in NON patients.
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Affiliation(s)
- Khaldoon O. Al-Nosairy
- Department of Ophthalmology, University Hospital Magdeburg, 39120 Magdeburg, Germany; (K.O.A.-N.); (M.W.)
| | - Marc Horbrügger
- Department of Dermatology, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Sven Schippling
- Multimodal Imaging in Neuro-Immunological Diseases (MINDS), University of Zurich, 8057 Zurich, Switzerland;
- Center for Neuroscience Zurich (ZNZ), ETH Zurich, 8057 Zurich, Switzerland
| | - Markus Wagner
- Department of Ophthalmology, University Hospital Magdeburg, 39120 Magdeburg, Germany; (K.O.A.-N.); (M.W.)
| | - Aiden Haghikia
- Department of Neurology, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Marc Pawlitzki
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany;
| | - Michael B. Hoffmann
- Department of Ophthalmology, University Hospital Magdeburg, 39120 Magdeburg, Germany; (K.O.A.-N.); (M.W.)
- Center for Behavioral Brain Sciences, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-391-6713585
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Zafeiropoulos P, Katsanos A, Kitsos G, Stefaniotou M, Asproudis I. The contribution of multifocal visual evoked potentials in patients with optic neuritis and multiple sclerosis: a review. Doc Ophthalmol 2021; 142:283-292. [PMID: 33381858 PMCID: PMC8116218 DOI: 10.1007/s10633-020-09799-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/02/2020] [Indexed: 01/07/2023]
Abstract
Purpose To review the evidence on the usefulness of the multifocal visual evoked potential (mfVEP) test in patients with optic neuritis (ON) and/or multiple sclerosis (MS). Methods We critically review key published evidence on the use of mfVEP in ON/MS patients and its association with other functional and structural tests. Results Multifocal VEP tests are useful in detecting abnormality in patients with ON/MS and monitor the progression of lesions (remyelination, atrophy). In addition, mfVEP has good correlation with conventional visual evoked potential (VEP), standard automated perimetry, optical coherence tomography and magnetic resonance imaging. In patients with ON, mfVEP might be useful in predicting the risk of conversion to MS.
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Affiliation(s)
| | - Andreas Katsanos
- University Ophthalmology Clinic, Stavros Niarchos Avenue, 45500, Ioannina, Greece
| | - George Kitsos
- University Ophthalmology Clinic, Stavros Niarchos Avenue, 45500, Ioannina, Greece
| | - Maria Stefaniotou
- University Ophthalmology Clinic, Stavros Niarchos Avenue, 45500, Ioannina, Greece
| | - Ioannis Asproudis
- University Ophthalmology Clinic, Stavros Niarchos Avenue, 45500, Ioannina, Greece
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Pihl-Jensen G, Wanscher B, Frederiksen JL. Predictive value of optical coherence tomography, multifocal visual evoked potentials, and full-field visual evoked potentials of the fellow, non-symptomatic eye for subsequent multiple sclerosis development in patients with acute optic neuritis. Mult Scler 2020; 27:391-400. [PMID: 32507033 DOI: 10.1177/1352458520917924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diagnosis of multiple sclerosis (MS) may sometimes be ascertained at the time of optic neuritis (ON) but other times require the advent of new disease activity. OBJECTIVES The aim of this study was to examine the predictive value of optical coherence tomography (OCT) and visual evoked potential (VEP) measurements of the non-symptomatic, fellow eye of ON patients, for conversion to MS. METHODS This is a prospective cohort study in patients with acute ON. OCT thickness measurements of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell layer-inner plexiform layer (GCLIPL), and multifocal (mf) VEP and full-field (ff) VEP, were performed. Univariate and multivariate Cox regression examined the value of predictors for the conversion to MS. RESULTS A total of 79 unilateral, acute ON patients, with no MS diagnosis or prior demyelination, were included. Of which, 28 patients developed MS during follow-up. Inferonasal GCLIPL, mean GCLIPL, and pRNFL thickness significantly predicted MS development in multivariate analysis (hazard ratio (HR) = 0.922-0.939, p = 0.0172-0.021). MfVEP mean latency (HR = 1.052, p = 0.006) only predicted MS conversion in univariate analysis. No significant predictive value was shown for the other parameters (p > 0.2). CONCLUSION While both mfVEP and OCT are useful tools in the evaluation of acute ON patients, only OCT measurements of fellow eyes may serve as an independent predictor of MS development.
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Affiliation(s)
- Gorm Pihl-Jensen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet-Glostrup, Glostrup, Denmark/University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Wanscher
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet-Glostrup, Glostrup, Denmark/University of Copenhagen, Copenhagen, Denmark
| | - Jette Lautrup Frederiksen
- Department of Clinical Neurophysiology, Rigshospitalet-Glostrup, Glostrup, Denmark/Department of Neurology, Slagelse Hospital, Slagelse, Denmark
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Visual Evoked Potentials as a Biomarker in Multiple Sclerosis and Associated Optic Neuritis. J Neuroophthalmol 2020; 38:350-357. [PMID: 30106802 DOI: 10.1097/wno.0000000000000704] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
: ABSTRACT:: Multiple sclerosis (MS) is an inflammatory, degenerative disease of the central nervous system (CNS) characterized by progressive neurological decline over time. The need for better "biomarkers" to more precisely capture and track the effects of demyelination, remyelination, and associated neuroaxonal injury is a well-recognized challenge in the field of MS. To this end, visual evoked potentials (VEPs) have a role in assessing the extent of demyelination along the optic nerve, as a functionally eloquent CNS region. Moreover, VEPs testing can be used to predict the extent of recovery after optic neuritis (ON) and capture disabling effects of clinical and subclinical demyelination events in the afferent visual pathway. In this review, the evolving role of VEPs in the diagnosis of patients with ON and MS and the utility of VEPs testing in determining therapeutic benefits of emerging MS treatments is discussed.
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Wicki CA, Manogaran P, Simic T, Hanson JVM, Schippling S. Bilateral retinal pathology following a first-ever clinical episode of autoimmune optic neuritis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/2/e671. [PMID: 31969471 PMCID: PMC7051214 DOI: 10.1212/nxi.0000000000000671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This longitudinal study aimed to assess changes in retinal structure and visual function following a first-ever episode of acute optic neuritis (ON). METHODS Clinical and optical coherence tomography (OCT) data obtained over a period of 12 months were retrospectively analyzed in 41 patients with a first-ever clinical episode of acute ON. OCT scans, high-contrast visual acuity (HCVA), and low-contrast visual acuity (LCVA) were acquired at baseline and at 1, 3, 6, and 12 months thereafter. Macular ganglion cell and inner plexiform layer (GCIP), peripapillary retinal nerve fiber layer (pRNFL), and macular inner nuclear layer (INL) thicknesses were assessed by OCT. Linear mixed-effects models were used to analyze OCT variables of ipsilateral ON and contralateral non-ON (NON) eyes over time. RESULTS The mean change of GCIP thickness in ON eyes was significant at all follow-up time points, with nearly 75% of the total reduction having occurred by month 1. In ON eyes, thinner GCIP thickness at month 1 correlated with lower LCVA at month 3. Mean pRNFL thickness in ON eyes differed significantly from NON eyes at all postbaseline time points. INL thickness was significantly increased in ON eyes (month 1) but also in contralateral NON eyes (month 12). CONCLUSIONS Retinal structural damage develops rapidly following acute ON and is associated with subsequent functional visual deficits. Our results also suggest bilateral retinal pathology following unilateral ON, possibly caused by subclinical involvement of the contralateral NON eyes. Moreover, our data may assist in clinical trial planning in studies targeting tissue damage in acute ON.
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Affiliation(s)
- Carla A Wicki
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich.
| | - Praveena Manogaran
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
| | - Tanja Simic
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
| | - James V M Hanson
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
| | - Sven Schippling
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
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Lambe J, Saidha S, Bermel RA. Optical coherence tomography and multiple sclerosis: Update on clinical application and role in clinical trials. Mult Scler 2019; 26:624-639. [PMID: 32412377 DOI: 10.1177/1352458519872751] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Optical coherence tomography (OCT) has emerged as a fast, non-invasive, inexpensive, high-resolution imaging technique in multiple sclerosis (MS). Retinal layer quantification by OCT facilitates a 'window' into not only local retinal pathology but also global neurodegenerative processes, recognised to be the principal substrates of disability accumulation in MS. While OCT measures in MS have been demonstrated to reflect visual function, inflammatory activity outside of the visual pathways, disability measures including the prediction of disability progression, whole brain atrophy, and the differential neuroprotective effects of disease-modifying therapies, debate continues regarding the clinical utility of OCT in everyday practice. This review presents an overview of the evidence supporting OCT, with particular focus on its application in the MS clinic. We will also discuss the role of OCT in MS clinical trials to develop novel neuroprotective and potential remyelinating therapies.
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Affiliation(s)
- Jeffrey Lambe
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio, USA
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Empirical mode decomposition processing to improve multifocal-visual-evoked-potential signal analysis in multiple sclerosis. PLoS One 2018; 13:e0194964. [PMID: 29677200 PMCID: PMC5909914 DOI: 10.1371/journal.pone.0194964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/12/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To study the performance of multifocal-visual-evoked-potential (mfVEP) signals filtered using empirical mode decomposition (EMD) in discriminating, based on amplitude, between control and multiple sclerosis (MS) patient groups, and to reduce variability in interocular latency in control subjects. Methods MfVEP signals were obtained from controls, clinically definitive MS and MS-risk progression patients (radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS)). The conventional method of processing mfVEPs consists of using a 1–35 Hz bandpass frequency filter (XDFT). The EMD algorithm was used to decompose the XDFT signals into several intrinsic mode functions (IMFs). This signal processing was assessed by computing the amplitudes and latencies of the XDFT and IMF signals (XEMD). The amplitudes from the full visual field and from ring 5 (9.8–15° eccentricity) were studied. The discrimination index was calculated between controls and patients. Interocular latency values were computed from the XDFT and XEMD signals in a control database to study variability. Results Using the amplitude of the mfVEP signals filtered with EMD (XEMD) obtains higher discrimination index values than the conventional method when control, MS-risk progression (RIS and CIS) and MS subjects are studied. The lowest variability in interocular latency computations from the control patient database was obtained by comparing the XEMD signals with the XDFT signals. Even better results (amplitude discrimination and latency variability) were obtained in ring 5 (9.8–15° eccentricity of the visual field). Conclusions Filtering mfVEP signals using the EMD algorithm will result in better identification of subjects at risk of developing MS and better accuracy in latency studies. This could be applied to assess visual cortex activity in MS diagnosis and evolution studies.
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Alshowaeir D, Yiannikas C, Fraser C, Klistorner A. Mechanism of delayed conduction of fellow eyes in patients with optic neuritis. Int J Ophthalmol 2018; 11:329-332. [PMID: 29487827 DOI: 10.18240/ijo.2018.02.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022] Open
Abstract
To test the hypothesis that latency delay in the fellow eyes of optic neuritis (ON) patients and to compensate for delayed transmission of visual information, latency change of multi-focal visual evoked potential (mfVEP) traces in fellow eyes of 15 ON patients were analyzed. Patients with low risk (LR) for developing multiple sclerosis (MS) were examined separately from MS patients to isolate effect of cortical plasticity from potential pathological changes in disseminated disease. The small increase in latency in fellow eyes of LR group was statistically not significant. In MS patients, the latency was significantly delayed (P<0.02). The magnitude of the latency change in the fellow eyes did not correlate with the severity of latency delay in the affected eyes (R2<0.02, P=0.3). The differences between ON patients with and without MS, reported here, suggest that the presence of disseminated disease plays critical role in latency delay of the fellow eye.
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Affiliation(s)
- Daniah Alshowaeir
- Department of Ophthalmology, University of Sydney, Sydney 2000, Australia.,Department of Ophthalmology, King Saud University, Riyadh 11411, Saudi Arabia
| | - Con Yiannikas
- Department of Neurology, Concord Hospital, Sydney 2139, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Clare Fraser
- Department of Ophthalmology, University of Sydney, Sydney 2000, Australia
| | - Alexander Klistorner
- Department of Ophthalmology, University of Sydney, Sydney 2000, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney 2109, Australia
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Pihl-Jensen G, Schmidt MF, Frederiksen JL. Multifocal visual evoked potentials in optic neuritis and multiple sclerosis: A review. Clin Neurophysiol 2017; 128:1234-1245. [PMID: 28531809 DOI: 10.1016/j.clinph.2017.03.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/21/2022]
Abstract
Multifocal visual evoked potential (mf-VEP) represents a new approach to the classical full field (ff-)VEP with separate responses from up to 60 sectors of the visual field. A thorough literature survey of the use of mf-VEP in optic neuritis (ON) and multiple sclerosis (MS) is presented (38 published studies were retrieved). Mf-VEP provides direct topographical information of specific lesions and facilitates investigations on structural-functional correlations thus providing new methods for exploring the interplay between demyelination, atrophy and remyelination in MS. Good correlation was shown between mf-VEP and OCT, ff-VEP, MRI (MTR, DTI), 30-2 standard automated perimetry and low-contrast-visual acuity. All but one study showed superior sensitivity and specificity compared to ff-VEP, especially with regards to small, peripheral lesions or lesions of the upper visual field. Mf-VEP has shown superior sensitivity and specificity than established methods in diagnosing optic nerve lesions and tracking functional recovery following lesions. Abnormal mf-VEP responses in the fellow, non-ON afflicted eye may predict MS risk in ON patients. No standardization currently exists and no direct comparisons in ON and MS between at least 5 different commercially available mf-VEP systems have so far been published. Despite these limitations, mf-VEP is a promising new tool of diagnostic and prognostic value of mf-VEP in ON and MS.
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Affiliation(s)
- Gorm Pihl-Jensen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Mathias Falck Schmidt
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Jette Lautrup Frederiksen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
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Graham SL, Klistorner A. Afferent visual pathways in multiple sclerosis: a review. Clin Exp Ophthalmol 2016; 45:62-72. [DOI: 10.1111/ceo.12751] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Stuart L Graham
- Faculty of Medicine and Human Science; Macquarie University; Sydney New South Wales Australia
- Save Sight Institute; Sydney University; Sydney New South Wales Australia
| | - Alexander Klistorner
- Faculty of Medicine and Human Science; Macquarie University; Sydney New South Wales Australia
- Save Sight Institute; Sydney University; Sydney New South Wales Australia
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De Santiago L, Ortiz del Castillo M, Blanco R, Barea R, Rodríguez-Ascariz J, Miguel-Jiménez J, Sánchez-Morla E, Boquete L. A signal-to-noise-ratio-based analysis of multifocal visual-evoked potentials in multiple sclerosis risk assessment. Clin Neurophysiol 2016; 127:1574-1580. [DOI: 10.1016/j.clinph.2015.09.129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
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Jayaraman M, Gandhi RA, Ravi P, Sen P. Multifocal visual evoked potential in optic neuritis, ischemic optic neuropathy and compressive optic neuropathy. Indian J Ophthalmol 2015; 62:299-304. [PMID: 24088641 PMCID: PMC4061667 DOI: 10.4103/0301-4738.118452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To investigate the effect of optic neuritis (ON), ischemic optic neuropathy (ION) and compressive optic neuropathy (CON) on multifocal visual evoked potential (mfVEP) amplitudes and latencies, and to compare the parameters among three optic nerve disorders. Materials and Methods: mfVEP was recorded for 71 eyes of controls and 48 eyes of optic nerve disorders with subgroups of optic neuritis (ON, n = 21 eyes), ischemic optic neuropathy (ION, n = 14 eyes), and compressive optic neuropathy (CON, n = 13 eyes). The size of defect in mfVEP amplitude probability plots and relative latency plots were analyzed. The pattern of the defect in amplitude probability plot was classified according to the visual field profile of optic neuritis treatment trail (ONTT). Results: Median of mfVEP amplitude (log SNR) averaged across 60 sectors were reduced in ON (0.17 (0.13-0.33)), ION (0.14 (0.12-0.21)) and CON (0.21 (0.14-0.30)) when compared to controls. The median mfVEP relative latencies compared to controls were significantly prolonged in ON and CON group of 10.53 (2.62-15.50) ms and 5.73 (2.67-14.14) ms respectively compared to ION group (2.06 (-4.09-13.02)). The common mfVEP amplitude defects observed in probability plots were diffuse pattern in ON, inferior altitudinal defect in ION and temporal hemianopia in CON eyes. Conclusions: Optic nerve disorders cause reduction in mfVEP amplitudes. The extent of delayed latency noted in ischemic optic neuropathy was significantly lesser compared to subjects with optic neuritis and compressive optic neuropathy. mfVEP amplitudes can be used to objectively assess the topography of the visual field defect.
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Affiliation(s)
| | | | | | - Parveen Sen
- Department of Vitreoretina Consultant, Sankara Nethralaya, 18 College Road, Chennai, India
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Alshowaeir D, Yannikas C, Garrick R, Van Der Walt A, Graham SL, Fraser C, Klistorner A. Multifocal VEP assessment of optic neuritis evolution. Clin Neurophysiol 2014; 126:1617-23. [PMID: 25481337 DOI: 10.1016/j.clinph.2014.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/27/2014] [Accepted: 11/11/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate multifocal visual evoked potentials (mfVEP) changes in optic neuritis (ON) and fellow eyes during first year after the attack. METHODS Eighty-seven patients and twenty-five controls were examined. Patients were classified as multiple sclerosis (MS) group, high risk (HR) or low risk (LR) groups for conversion to MS. mfVEP recordings and retinal nerve fiber layer (RNFL) thickness were analyzed. RESULTS Recovery of amplitude and shortening of latency was fastest within the first 3months. The largest amplitude reduction and longest latency delay of the ON eye were recorded in the MS group. This was accompanied by deterioration of both parameters in fellow eyes (p<0.03). mfVEP remained stable in fellow eyes of the LR group. Inter-eye asymmetry showed similar amount of amplitude reduction and latency delay in all three groups. RNFL thickness strongly correlated with mfVEP amplitude as early as 3 months after ON (R(2)=0.6, p=0.001). CONCLUSION mfVEP amplitude is an early predictor of post-ON axonal loss. The apparent more severe involvement of ON eyes in the MS subgroup may be due to subclinical inflammation along the visual pathway. SIGNIFICANCE Severity of amplitude reduction and latency delay after episode of ON is not MS-related. Retro-chiasmal demyelination is a possible factor contributing to amplitude and latency differences between MS and non-MS patients.
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Affiliation(s)
- Daniah Alshowaeir
- Department of Ophthalmology, University of Sydney, Sydney, Australia; Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia.
| | - Con Yannikas
- Concord Hospital, Sydney, Australia; Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Raymond Garrick
- Department of Neurology, St Vincent Hospital, Sydney, Australia
| | | | - Stuart L Graham
- Department of Ophthalmology, Macquarie University, Sydney, Australia
| | - Clare Fraser
- Department of Ophthalmology, University of Sydney, Sydney, Australia
| | - Alexander Klistorner
- Department of Ophthalmology, University of Sydney, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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Martínez-Lapiscina EH, Sanchez-Dalmau B, Fraga-Pumar E, Ortiz-Perez S, Tercero-Uribe AI, Torres-Torres R, Villoslada P. The visual pathway as a model to understand brain damage in multiple sclerosis. Mult Scler 2014; 20:1678-85. [PMID: 25013155 DOI: 10.1177/1352458514542862] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients with multiple sclerosis (MS) almost always experience effects in the visual pathway; and thus, visual dysfunction is not only common but also highly relevant. The visual pathway represents a model of acute focal central nervous system (CNS) damage, through acute optic neuritis and retinal periphlebitis, as well as a model of chronic, diffuse CNS damage through chronic retinopathy and optic neuropathy. The optic pathway can be accurately evaluated in detail, due to the availability of highly sensitive imaging techniques (e.g. magnetic resonance imaging or optical coherent tomography) or electrophysiological tests (multifocal visual evoked potentials or electroretinography). These techniques allow the interactions between the different processes at play to be evaluated, such as inflammation, demyelination, axonal damage and neurodegeneration. Moreover, these features mean that the visual pathway can be used as a model to test new neuroprotective or regenerative therapies.
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Affiliation(s)
- E H Martínez-Lapiscina
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
| | - B Sanchez-Dalmau
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
| | - E Fraga-Pumar
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
| | - S Ortiz-Perez
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
| | - A I Tercero-Uribe
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
| | - R Torres-Torres
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
| | - P Villoslada
- Center of Neuroimmunology, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain/Hospital Clinic of Barcelona, Spain
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Hardmeier M, Hatz F, Naegelin Y, Hight D, Schindler C, Kappos L, Seeck M, Michel CM, Fuhr P. Improved characterization of visual evoked potentials in multiple sclerosis by topographic analysis. Brain Topogr 2013; 27:318-27. [PMID: 24085573 PMCID: PMC3921459 DOI: 10.1007/s10548-013-0318-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 09/20/2013] [Indexed: 11/09/2022]
Abstract
In multiple sclerosis (MS), the combination of visual, somatosensory and motor evoked potentials (EP) has been shown to be highly correlated with the Expanded Disability Severity Scale (EDSS) and to predict the disease course. In the present study, we explored whether the significance of the visual EP (VEP) can be improved with multichannel recordings (204 electrodes) and topographic analysis (tVEP). VEPs were analyzed in 83 MS patients (median EDSS 2.0; 52 % with history of optic neuritis; hON) and 47 healthy controls (HC). TVEP components were automatically defined on the basis of spatial similarity between the scalp potential fields (topographic maps) of single subjects’ VEPs and reference maps generated from HC. Non-ambiguous measures of latency, amplitude and configuration were derived from the maps reflecting the P100 component. TVEP was compared to conventional analysis (cVEP) with respect to reliability in HC, validity using descriptors of logistic regression models, and sensitivity derived from receiver operating characteristics curves. In tVEP, reliability tended to be higher for measurement of amplitude (p = 0.06). Regression models on diagnosis (MS vs. HC) and hON were more favorable using tVEP- versus cVEP-predictors. Sensitivity was increased in tVEP versus cVEP: 72 % versus 60 % for diagnosis, and 88 % versus 77 % for hON. The advantage of tVEP was most pronounced in pathological VEPs, in which cVEPs were often ambiguous. TVEP is a reliable, valid, and sensitive method of objectively quantifying pathological VEP in particular. In combination with other EP modalities, tVEP may improve the monitoring of disease course in MS.
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Affiliation(s)
- Martin Hardmeier
- Department of Neurology, Hospital of the University of Basel, Petersgraben 4, 4031, Basel, Switzerland,
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Wang J, Cheng H, Hu YS, Tang RA, Frishman LJ. The photopic negative response of the flash electroretinogram in multiple sclerosis. Invest Ophthalmol Vis Sci 2012; 53:1315-23. [PMID: 22273726 DOI: 10.1167/iovs.11-8461] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To use the photopic electroretinogram (ERG) to evaluate retinal function in eyes of multiple sclerosis (MS) patients with and without a history of optic neuritis (ON) and to compare the functional and structural status of the inner retina. METHODS Full-field ERG responses to brief red flashes (0.04-2.8 cd · s/m²) on a rod-saturating blue background were recorded from 51 MS patients and 33 age-matched control subjects. In patients, perimetry was performed and peripapillary retinal nerve fiber layer thickness (RNFLT) was assessed by optical coherence tomography (OCT) and scanning laser polarimetry (SLP). MS eyes were separated into groups: "ON >6" months (n = 25), "ON <6" months (n = 29), and "no ON" (n = 33) based on positive or negative history of ON and time since the last episode. Thirteen ON<6 eyes were re-evaluated 1 year later. RESULTS PhNR amplitudes were lower in ON>6, ON<6, and no-ON eyes (mean ± SD, 17.3 ± 7.6, 16.0 ± 6.5, and 23.8 ± 9.3 μV, respectively), than in control eyes (29.8 ± 6.5 μV; P < 0.001) for a standard stimulus of 1.42 cd · s/m²; a- and b-wave amplitudes were unaffected. PhNR amplitudes correlated with visual fields mean deviation (MD) in ON>6 (r² = 0.43; P < 0.001) and no-ON eyes (r² = 0.10; P < 0.05), with similar results for weaker stimuli. PhNR amplitudes correlated with RNFLT in ON>6 eyes: OCT (r² = 0.52; P < 0.0001) and SLP (r² = 0.51; P < 0.01); and in no-ON eyes, OCT (r² = 0.21; P < 0.01) and SLP (r² = 0.17; P < 0.05). ON<6 amplitudes did not correlate significantly with other measures, but increased after 1 year by 5.1 ± 3.1 μV (P < 0.001), visual fields MD increased by 1.8 ± 2.3 dB (P < 0.05), and RNFL loss persisted. CONCLUSIONS Photopic ERG PhNR amplitudes in MS patients are significantly reduced in eyes with and without a history of ON.
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Affiliation(s)
- Jing Wang
- College of Optometry, University of Houston, Houston, Texas, USA
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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]
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Dockstader C, Gaetz W, Rockel C, Mabbott DJ. White matter maturation in visual and motor areas predicts the latency of visual activation in children. Hum Brain Mapp 2011; 33:179-91. [PMID: 21432944 DOI: 10.1002/hbm.21203] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/31/2010] [Accepted: 10/20/2010] [Indexed: 11/09/2022] Open
Abstract
In humans, white matter maturation is important for the improvement of cognitive function and performance with age. Across studies the variables of white matter maturity and age are highly correlated; however, the unique contributions of white matter to information processing speed remain relatively unknown. We investigated the relations between the speed of the visually-evoked P100m response and the biophysical properties of white matter in 11 healthy children performing a simple, visually-cued finger movement. We found that: (1) the latency of the early, visually-evoked response was related to the integrity of white matter in both visual and motor association areas and (2) white matter maturation in these areas accounted for the variations in visual processing speed, independent of age. Our study is a novel investigation of spatial-temporal dynamics in the developing brain and provides evidence that white matter maturation accounts for age-related decreases in the speed of visual response. Developmental models of cortical specialization should incorporate the unique role of white matter maturation in mediating changes in performance during tasks involving visual processing.
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Affiliation(s)
- Colleen Dockstader
- The Hospital for Sick Children Psychology, 555 University Ave, Toronto, Ontario, Canada
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Frohman TC, Graves J, Balcer LJ, Galetta SL, Frohman EM. THE NEURO-OPHTHALMOLOGY OF MULTIPLE SCLEROSIS. Continuum (Minneap Minn) 2010; 16:122-46. [DOI: 10.1212/01.con.0000389938.07532.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Laron M, Cheng H, Zhang B, Schiffman JS, Tang RA, Frishman LJ. Comparison of multifocal visual evoked potential, standard automated perimetry and optical coherence tomography in assessing visual pathway in multiple sclerosis patients. Mult Scler 2010; 16:412-26. [PMID: 20207786 DOI: 10.1177/1352458509359782] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multifocal visual evoked potentials (mfVEP) measure local response amplitude and latency in the field of vision. OBJECTIVE To compare the sensitivity of mfVEP, Humphrey visual field (HVF) and optical coherence tomography (OCT) in detecting visual abnormality in multiple sclerosis (MS) patients. METHODS mfVEP, HVF, and OCT (retinal nerve fiber layer [RNFL]) were performed in 47 MS-ON eyes (last optic neuritis [ON] attack >or=6 months prior) and 65 MS-no-ON eyes without ON history. Criteria to define an eye as abnormal were: (1) mfVEP amplitude/latency - either amplitude or latency probability plots meeting cluster criteria with 95% specificity; (2) mfVEP amplitude or latency alone (specificity: 97% and 98%, respectively); and (3) HVF and OCT, mean deviation and RNFL thickness meeting p < 0.05, respectively. RESULTS MfVEP (amplitude/latency) identified more abnormality in MS-ON eyes (89%) than HVF (72%), OCT (62%), mfVEP amplitude (66%) or latency (67%) alone. Eighteen percent of MS-no-ON eyes were abnormal for both mfVEP (amplitude/latency) and HVF compared with 8% with OCT. Agreement between tests ranged from 60% to 79%. mfVEP (amplitude/latency) categorized an additional 15% of MS-ON eyes as abnormal compared with HVF and OCT combined. CONCLUSIONS mfVEP, which detects both demyelination (increased latency) and neural degeneration (reduced amplitude), revealed more abnormality than HVF or OCT in MS patients.
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Affiliation(s)
- Michal Laron
- University of Houston, College of Optometry, Houston, Texas 77204-2020, USA
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Laron M, Cheng H, Zhang B, Schiffman JS, Tang RA, Frishman LJ. Assessing visual pathway function in multiple sclerosis patients with multifocal visual evoked potentials. Mult Scler 2009; 15:1431-41. [PMID: 19995841 DOI: 10.1177/1352458509350470] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multifocal visual evoked potentials provide a topographic measure of visual response amplitude and latency. The objective of this study was to evaluate the sensitivity and specificity of the multifocal visual evoked potential technique in detecting visual abnormalities in patients with multiple sclerosis. Multifocal visual evoked potentials were recorded from 74 patients with multiple sclerosis with history of optic neuritis (MS-ON, n = 74 eyes) or without (MS-no-ON, n = 71 eyes), and 50 normal subjects (controls, n = 100 eyes) using a 60-sector pattern reversal dartboard stimulus (VERIS). Amplitude and latency for each sector were compared with normative data and assigned probabilities. Size and location of clusters of adjacent abnormal sectors (p < 0.05) were examined. Mean response amplitudes were (+/- SE) 0.39 +/- 0.02, 0.53 +/- 0.02, and 0.60 +/- 0.01 for MS-ON, MS-no-ON, and control groups, respectively, with significant differences between all groups (p < 0.0001). Mean latencies (ms; +/-SE relative to normative data) were 12.7 +/- 1.3 (MS-ON), 4.3 +/- 1.1 (MS-no-ON), and 0.3 +/- 0.4 (controls); group differences again significant (p < 0.0001). Half the MS-ON eyes had clusters larger than five sectors compared with 13% in MS-no-ON and 2% in controls. Abnormal sectors were distributed diffusely, although the largest cluster was smaller than 15 sectors in two-thirds of MS-ON eyes. Cluster criteria combining amplitude and latency showed an area of 0.96 under the receiver operating characteristic curve, yielding a criterion with 91% sensitivity and 95% specificity. We conclude that the multifocal visual evoked potential provides high sensitivity and specificity in detecting abnormalities in visual function in multiple sclerosis patients.
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Affiliation(s)
- Michal Laron
- University of Houston, College of Optometry, Houston, TX, USA
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