Pattern of Macular Thickness Changes Measured by Ocular Coherence Tomography in Patients with Multiple Sclerosis

Gugleta, Konstantin; Mehling, Matthias; Kochkorov, Asan; Grieshaber, Matthias C.; Katamay, Robert; Flammer, Josef; Orgül, Selim; Kappos, L

doi:10.1055/s-2008-1027253

Cited by 21 publications

(22 citation statements)

References 23 publications

(28 reference statements)

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“…In some MS patients, ET-1 in the circulating blood [62] is increased, and therefore, ocular blood flow (OBF) decreased (Figure 5). This might contribute to the loss of retinal ganglion cells and their axons [63], to subclinical visual field defects [64], to narrower retinal arterioles and wider venules [65] and to increased rigidity of the retinal vessels [66]; furthermore, it may partially be the reason the ONH can turn slightly pale. Red wine can reduce ET-1 concentration which therefore explains why certain symptoms like visual disturbances in MS patients are reduced by red wine for a limited period of time [67].…”

Section: Vascular Dysregulationmentioning

confidence: 99%

The primary vascular dysregulation syndrome: implications for eye diseases

2013

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Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

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Section: Vascular Dysregulationmentioning

confidence: 99%

The primary vascular dysregulation syndrome: implications for eye diseases

2013

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“…31 Other investigators have demonstrated decreases in total macular volume in subjects with multiple sclerosis compared with controls, 6,13,32 while decreases in macular volume in optic neuritis-affected eyes compared with optic neuritis-unaffected eyes have been reported as well. 13,20,32,33 Although these earlier findings of macular volume abnormalities may be consistent with the concept of thinning secondary to axonal degeneration from multiple sclerosis and do not contradict our findings, the early reports, utilizing TDOCT exclusively, should be interpreted with caution.…”

mentioning

confidence: 92%

Retinal nerve fiber layer evaluation in multiple sclerosis with spectral domain optical coherence tomography

Khanifar

Parlitsis

Ehrlich

et al. 2010

OPTH

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Purpose: Histopathologic studies have reported retinal nerve fiber layer (RNFL) thinning in various neurodegenerative diseases. Attempts to quantify this loss in vivo have relied on time-domain optical coherence tomography (TDOCT), which has low resolution and requires substantial interpolation of data for volume measurements. We hypothesized that the significantly higher resolution of spectral-domain optical coherence tomography (SDOCT) would better detect RNFL changes in patients with multiple sclerosis, and that RNFL thickness differences between eyes with and without optic neuritis might be identified more accurately. Methods: In this retrospective case series, patients with multiple sclerosis were recruited from the Judith Jaffe Multiple Sclerosis Center at Weill Cornell Medical College in New York. Patients with a recent clinical diagnosis of optic neuritis (less than three months) were excluded. Eyes with a history of glaucoma, optic neuropathy (other than multiple sclerosis-related optic neuritis), age-related macular degeneration, or other relevant retinal and/or optic nerve disease were excluded. Both eyes of each patient were imaged with the Heidelberg Spectralis ® HRA + OCT. RNFL and macular thickness were measured for each eye using the Heidelberg OCT software. These measurements were compared with validated published normal values, and were modeled as linear functions of duration of disease. The odds of an optic neuritis diagnosis as a function of RNFL and macular thickness were calculated. Results: Ninety-four eyes were prospectively evaluated using OCT. Ages of patients ranged from 26 to 69 years, with an average age of 39 years. Peripapillary RNFL thinning was demonstrated in multiple sclerosis patients; mean RNFL thickness was 88.5 µm for individuals with multiple sclerosis compared with a reported normal value of 97 µm (P , 0.001). Eyes with a history of optic neuritis had more thinning compared with those without optic neuritis (83.0 µm versus 90.5 µm, respectively, P = 0.02). No significant differences were observed in macular thickness measurements between eyes with and without optic neuritis, nor were macular thickness measurements significantly different from normal values. As a function of multiple sclerosis duration and controlling for age, RNFL thickness was decreased in patients with a duration of multiple sclerosis greater than five years compared with those with a duration less than or equal to one year (P = 0.008). Conclusions:Patients with a history of multiple sclerosis had RNFL thinning that was detectable on SDOCT. Decreasing RNFL thickness in eyes with optic neuritis was found, and the odds of having optic neuritis were increased significantly with decreasing RNFL thickness. Average RNFL thinning with increasing duration of disease was an excellent predictor of a reported history of optic neuritis. SDOCT retinal imaging may represent a high-resolution, objective, noninvasive, and easily quantifiable in vivo biomarker of the presence of optic neuritis and severity of multiple s...

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“…A potential explanation of the negative relationship between BMI and fovea thickness is neurodegeneration, which is associated with obesity [36]. Fovea thickness is reduced in individuals with multiple sclerosis [37]. It is also negatively related to duration of diabetes in type 2 diabetic patients with no or mild retinopathy, a finding thought to reflect neurodegeneration in the diabetic retina [38].…”

Section: Discussionmentioning

confidence: 99%

Capillary pressure may predict preclinical changes in the eye

et al. 2010

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Aims/hypothesisMicrovascular dysfunction is associated with end-organ damage. Macular oedema is an important component of diabetic retinopathy. Macular thickness can be accurately quantified by optical coherence tomography (OCT), enabling accurate assessment of the macular prior to clinically apparent abnormalities. We investigated whether macular (fovea) thickness in non-diabetic individuals is related to the microvascular variables controlling fluid filtration across a blood vessel wall, in particular capillary pressure and the microvascular filtration capacity (Kf).MethodsWe recruited 50 non-diabetic individuals (25 men, 25 women; age range: 26–78 years; BMI range: 20–46 kg/m2). Fovea thickness was assessed by OCT. Microvascular assessments included: finger nailfold capillary pressure; Kf; microvascular structural assessments, i.e. skin vasodilatory capacity, minimum vascular resistance (MVR) and microvascular distensibility; and endothelial function.ResultsAt 214.6 (19.9) µm (mean [SD]), fovea thickness was within normal range. Capillary pressure, adjusted for BMI, was associated with fovea thickness (standardised beta 0.573, p = 0.006, linear regression). Fovea thickness was not associated with Kf, microvascular structural assessments or endothelial function. Capillary pressure was still associated with fovea thickness when adjusted for microvascular variables (Kf, vasodilatory capacity, MVR, microvascular distensibility or endothelial function), or for risk factors for diabetes (systemic blood pressure, insulin sensitivity, inflammation, glycaemic status and lipids) and age.Conclusions/interpretationCapillary pressure, a key determinant of movement of fluid across a blood vessel wall, is associated with fovea thickness in non-diabetic individuals. This suggests that with regard to potential preventative or therapeutic targets, attention should be directed at the mechanisms determining retinal microvascular pressure.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-010-1805-x) contains supplementary material, which is available to authorised users.

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Pattern of Macular Thickness Changes Measured by Ocular Coherence Tomography in Patients with Multiple Sclerosis

Cited by 21 publications

References 23 publications

The primary vascular dysregulation syndrome: implications for eye diseases

The primary vascular dysregulation syndrome: implications for eye diseases

Retinal nerve fiber layer evaluation in multiple sclerosis with spectral domain optical coherence tomography

Capillary pressure may predict preclinical changes in the eye

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