Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis

Naismith, Robert T.; Tutlam, Nhial T.; Xu, Junqian; Shepherd, James; Klawiter, Eric C.; Song, Shuang; Cross, Anne H.

doi:10.1212/wnl.0b013e3181aaea32

Cited by 138 publications

(107 citation statements)

References 41 publications

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“…However, because demyelination alone does not cause optic atrophy, we believe OCT was the best method with which to associate atrophy as they represent axonal loss. 28 Despite these limitations, our results add to the growing literature suggesting that OCT may allow for earlier detection of MS axonal loss in the visual pathway as measured by RNFL defects. Our study also supports the utility of OCT as a structural marker of axonal loss in clinical trials of neuroprotective drugs, and suggests a future clinical role.…”

Section: Resultsmentioning

confidence: 71%

Associations between retinal nerve fiber layer abnormalities and optic nerve examination

et al. 2010

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Objective: Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied. Methods:Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs.Results: Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 Ϯ 21 m; n ϭ 63) vs those without (97.0 Ϯ 15 m; n ϭ 417; p Ͻ 0.001, t test) and in eyes with an APD (84.1 Ϯ 16 m; n ϭ 44) than without an APD (95.8 Ϯ 17 m; n ϭ 436; p Ͻ 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity ϭ 0.56; specificity ϭ 0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) Ͻ0.90 was 73% (sensitivity ϭ 0.30; specificity ϭ 0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists. Conclusions:OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting. Multiple sclerosis (MS) is the primary cause of nontraumatic disability among young adults, and visual dysfunction is a major cause of disability in MS. 1-3 Examination of the peripapillary retinal nerve fiber layer (RNFL) provides a unique opportunity to directly visualize unmyelinated CNS axons and detect evidence of CNS pathology. [4][5][6] Traditionally, physicians have used the detection of optic disc pallor and afferent pupillary defects (APD) during clinical examination as signs of optic neuropathy. 7,8 Optical coherence tomography (OCT) is a high-resolution, noninvasive imaging technique that uses near infrared light to produce images used to generate quantitative measurements of the RNFL.9-11 Studies have demonstrated that RNFL thickness correlates with disease subtype, visual acuity, disability status, disease activity, and MRI measures of optic nerve atrophy in

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Section: Resultsmentioning

confidence: 71%

Associations between retinal nerve fiber layer abnormalities and optic nerve examination

et al. 2010

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“…Naismith et al [66] systematically evaluated the utility of OCT and VEPs to detect the presence of clinical and subclinical ON and examined the relation of these measures to visual function. This retrospective, crosssectional study evaluated 65 subjects (n=96 eyes) with MS (n=40), clinically isolated syndrome (n =1), neuromyelitis optica (NMO, n=20), and idiopathic demyelination (n=4).…”

Section: Role For Oct In Modeling Axonal and Neuronal Loss In Msmentioning

confidence: 99%

Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

et al. 2011

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Summary: Axonal and neuronal degeneration are important features of multiple sclerosis (MS) and other neurologic disorders that affect the anterior visual pathway. Optical coherence tomography (OCT) is a non-invasive technique that allows imaging of the retinal nerve fiber layer (RNFL), a structure which is principally composed of ganglion cell axons that form the optic nerves, chiasm, and optic tracts. Since retinal axons are nonmyelinated until they penetrate the lamina cribrosa, the RNFL is an ideal structure (no other central nervous system tract has this unique arrangement) for visualizing the processes of neurodegeneration, neuroprotection and, potentially, even neuro-repair. OCT is capable of providing high-resolution reconstructions of retinal anatomy in a rapid and reproducible fashion and permits objective analysis of the RNFL (axons) as well as ganglion cells and other neurons in the macula. In a systematic OCT examination of multiple sclerosis (MS) patients, RNFL thickness and macular volumes are reduced when compared to disease-free controls.Conspicuously, these changes, which signify disorganization of retinal structural architecture, occur over time even in the absence of a history of acute demyelinating optic neuritis. RNFL axonal loss in MS is most severe in those eyes with a corresponding reduction in low-contrast letter acuity (a sensitive vision test involving the perception of gray letters on a white background) and in those patients who exhibit the greatest magnitude of brain atrophy, as measured by validated magnetic resonance imaging techniques. These unique structure-function correlations make the anterior visual pathway an ideal model for investigating the effects of standard and novel therapies that target axonal and neuronal degeneration. We provide an overview of the physics of OCT, its unique properties as a non-invasive imaging technique, and its potential applications toward understanding mechanisms of brain tissue injury in MS, other optic neuropathies, and neurologic disorders.

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“…10,11 In conclusion, ON might be present in subclinical (occult) form without typical symptoms or complains. 32,33 Our patients did not have any complaints, especially visual, during the follow-up period and had not been examined by OCT or another technique for early detection of subclinical optic neuritis in the inter-observational period. For these reasons, we think that RNFL in some of the patients might tend to thicken, which is related to possible subclinical optic neuritis, and thus did not significantly decrease in the follow-up period, whereas RNFL thickness in healthy subject gradually reduced.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography in Patients with Relapsing-Remitting Multiple Sclerosis without Optic Neuritis: A 20-Month Longitudinal Study

Huseyinoglu¹,

Özben²,

Ekinci

et al. 2013

Neuro-Ophthalmology

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Optical coherence tomography is supported and used as a technique for visualisation of neuro-axonal loss in multiple sclerosis, but there are also a few studies expressing the opposite view. The aim of our study was to investigate retinal nerve fibre layer and optic nerve head parameters in patients with multiple sclerosis without a history of prior optic neuritis and symptoms of a new clinical attack during the follow-up for a total of 20-month period. Full ophthalmic evaluation was performed for all of the participants. The baseline retinal nerve fibre layer and macular thicknesses and focal and global loss of macular volume values were significantly lower in the eyes of the patients with multiple sclerosis compared with the healthy controls. No significant change between baseline and follow-up scans were found in all optical coherence tomography parameters in the multiple sclerosis group. Statistical analyses revealed significant retinal nerve fibre layer and macular thickness differences between baseline and second measurements in the controls. No significant difference in percent change between baseline and second measurements was observed between the patient and control groups. We conclude that whereas healthy subjects have an age-related tendency toward a decrease in retinal nerve fibre layer thickness, patients with multiple sclerosis patients are likely to pass through different stages of retinal thinning and thickening due to subclinical optic neuritis and, as a result, we could not detect any statistically significant change between baseline and second measurements in our multiple sclerosis patients.

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Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis

Cited by 138 publications

References 41 publications

Associations between retinal nerve fiber layer abnormalities and optic nerve examination

Associations between retinal nerve fiber layer abnormalities and optic nerve examination

Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

Optical Coherence Tomography in Patients with Relapsing-Remitting Multiple Sclerosis without Optic Neuritis: A 20-Month Longitudinal Study

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