Acute optic neuritis: retinal ganglion cell loss precedes retinal nerve fiber thinning

Abstract

Optic neuritis (ON) causes axonal loss as reflected by thinning of retinal nerve fiber layer (RNFL) and can be tracked by optical coherence tomography (OCT) about 6 months after ON onset, when swelling of optic nerve head (ONH) has vanished. Changes of macular ganglion cell layer (GCL) thickness provide another window to track the disease process in ON. GCL thinning over time in relation to RNFL change after ON remains elusive. Using OCT, we followed 4 patients with acute unilateral isolated ON for more than 9 months. A diagnosis of multiple sclerosis (MS) was established in all 4 patients. First follow-up was 2-3 weeks after ON onset, and thereafter every 2-3 months. RNFL swelling peaked during first month after acute ON, followed by rapidly reduced swelling (pseudoatrophy) during following 2 months, and thereafter successively vanished 6 months after ON onset. GCL thinning was observed 1-3 months after ON onset, i.e. already during optic disk swelling and before real RNFL thinning. The results imply that quantifying GCL thickness provides opportunities to monitor early axonal loss and ON-to-MS progression, and facilitates distinguishing real atrophy from pseudoatrophy of RNFL after acute ON.

Retinal ganglion cell and axonal loss in optic neuritis: risk factors and visual functions

“…These results show that the GCIPL thickness is less affected by optic disc edema, thereby supporting the results of a previous study regarding GCL thickness as a factor for monitoring the retinal ganglion cell status after acute ON. 14 Previous studies have reported a significant correlation among RNFL thickness, VA, and VF. 10,14 Trip et al 10 reported that there were significant relationships among RNFL thickness and VA, VF, color vision, and the visualevoked potential (VEP) amplitude.…”

“…14 Previous studies have reported a significant correlation among RNFL thickness, VA, and VF. 10,14 Trip et al 10 reported that there were significant relationships among RNFL thickness and VA, VF, color vision, and the visualevoked potential (VEP) amplitude. Walter et al 4 demonstrated that GCIPL thinning is most significantly correlated with visual function in MS patients with and without a history of acute ON and may serve as a useful structural marker of the disease.…”

“…14 Previous studies have reported the timing of pRNFL and GCIPL thinning after the onset of ON. 14,19 Henderson et al 19 showed that RNFL thinning can be observed during the first 6 months following ON and that 490% of this fiber loss occurred by the end of the third month. Another study reported that RNFL thinning occurred gradually, up to 6-9 months after ON, and that GCL thinning occurred earlier than RNFL thinning, within a few weeks after acute ON.…”

“…4 A recent study reported that quantifying GCL thickness after acute ON provides opportunities for monitoring early axonal loss and ONto-MS progression in early ON. 14 GCIPL and pRNFL thinning are important predictive factors for the prognosis of ON. An analysis of associated risk factors would be a very meaningful investigation.…”

Acute optic neuritis: retinal ganglion cell loss precedes retinal nerve fiber thinning

“…We congratulate Huang-Link et al [1] for their report entitled 'Acute optic neuritis: retinal ganglion cell loss precedes retinal nerve fiber thinning'. The authors reported the longitudinal OCT results of four patients with optic neuritis and showed that ganglion cell layer (GCL) thickness decreased before the thinning in retinal nerve fiber layer (RNFL).…”