Retinal nerve fiber layer atrophy is associated with physical and cognitive disability in multiple sclerosis

Abstract

Background Studying axonal loss in the retina is a promising biomarker for multiple sclerosis (MS). Our aim was to compare optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT) techniques to measure the thickness of the retinal nerve fiber layer (RNFL) in patients with MS, and to explore the relationship between changes in the RNFL thickness with physical and cognitive disability. We studied 52 patients with MS and 18 proportionally matched controls by performing neurological examination, neuropsychological evaluation using the Brief Repetitive Battery-Neuropsychology and RNFL thickness measurement using OCT and HRT. Results We found that both OCT and HRT could define a reduction in the thickness of the RNFL in patients with MS compared with controls, although both measurements were weakly correlated, suggesting that they might measure different aspects of the tissue changes in MS. The degree of RNFL atrophy was correlated with cognitive disability, mainly with the symbol digit modality test (r = 0.754, P < 0.001). Moreover, temporal quadrant RNFL atrophy measured with OCT was associated with physical disability. Conclusion In summary, both OCT and HRT are able to detect thinning of the RNFL, but OCT seems to be the most sensitive technique to identify changes associated with MS evolution. Multiple Sclerosis 2008; 14: 906-912.

Comparison of retinal nerve fiber layer measured by time domain and spectral domain optical coherence tomography in optic neuritis

“…Although the patterns of RNFL loss are different in ON compared with other diseases such as glaucoma, with the highest degree of RNFL loss in the temporal quadrant, 10,23 our findings are similar to that previously observed in glaucoma patients.…”

“…From a clinical point of view, patients who are part of clinical trials that require a high degree of consistency with RNFL thickness measurements may not be able to interchange between Stratus-and Cirrus-OCT. Perhaps, in the case of switching from Stratus-to Cirrus-OCT technology, the best strategy for switching from one to the other during the follow-up of a patient may be to perform a follow-up Stratus scan to determine whether there has been a change from prior Stratus scans and then perform a new baseline scan with Cirrus for future comparison. 10 In conclusion, our findings show that RNFL thickness measurements by Cirrus HD-OCT and Stratus-OCT were different in patients having ON, although the two measurements were well correlated. Stratus measurements are generally higher than Cirrus, except at thinner RNFL values.…”

“…These OCTs offer faster scan speed and higher image resolution for RNFL imaging than conventional time-domain OCT. 2 Several studies have focused on the measurements and reproducibility of RNFL thickness using Stratus-OCT after optic neuritis (ON) and multiple sclerosis (MS). [3][4][5][6][7][8][9][10][11][12][13] In fact, lower RNFL values correlate with impaired visual function. OCT is a promising tool for evaluating atrophy in patients with ON and MS, and it could evolve into an important primary or secondary outcome measure for MS clinical trials and patient care.…”

Pattern of gray matter volumes related to retinal thickness and its association with cognitive function in relapsing–remitting MS

“…Investigating focal cortical volume patterns might help to identify regions that are important hubs in functional or structural networks and might contribute to the disability of MS patients. Previous studies indicated, that impairment of visual function might be as well associated with cognitive function in MS (Toledo et al., 2008; Wieder et al., 2013). The purpose of this study was to investigate to what extent OCT measures correlate with cortical areas that are not part of the primary visual system, and to explore if there is a distinctive pattern of association with cortical regions and if these associations might be linked to neuropsychological performance.…”

How strong is the relationship between glaucoma, the retinal nerve fibre layer, and neurodegenerative diseases such as Alzheimer’s disease and multiple sclerosis?

“…119 Studies have shown significant correlations between RNFL atrophy and cognitive disability, in particular attention and executive deficits, assessed using the symbol digit modality test in patients with MS when compared with healthy controls. 121 These findings may be explained by the reported correlations between RNFL thickness and brain atrophy. 122,123 Not all studies have found the same, however, others have reported an association between cognitive impairment in MS patients and performance in visual function tests such as low contrast sensitivity testing.…”