In vivo identification of morphologic retinal abnormalities in neuromyelitis optica

Elias S. Sotirchos, Shiv Saidha, Gita Byraiah, Maureen A. Mealy, Mohamed A. Ibrahim, Yasir Jamal Sepah, Scott Newsome, John N. Ratchford, Elliot M. Frohman, Laura J. Balcer, Ciprian M Crainiceanu, Quan Dong Nguyen, Michael Levy, Peter Calabresi

Research output: Contribution to journalArticle

Abstract

Objective: To assess eyes with neuromyelitis optica (NMO) for morphologic retinal abnormalities utilizing high-definition optical coherence tomography (OCT) imaging. Methods: In this cross-sectional study, 39 patients with NMO spectrum disorders and 39 age- and sex-matched healthy controls underwent spectral-domain OCT and visual function testing. Results: Microcystic macular edema (MME) of the inner nuclear layer (INL) was identified in 10 of 39 patients (26%) and was exclusively found in eyes with a history of optic neuritis (ON). MME eyes had lower high- and low-contrast letter-acuity scores (100%: p = 0.002; 2.5%: p = 0.002; 1.25%: p = 0.004), lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.04), lower macular RNFL thickness (p = 0.004), lower ganglion cell layer + inner plexiform layer (GCIP) thickness (p = 0.007), higher INL thickness (p <0.001), and a greater number of ON episodes (p = 0.008) relative to non-MME eyes with a history of ON. After adjusting for history of multiple ON episodes, these findings remained significant for macular-RNFL thickness (p = 0.03), INL thickness (p <0.001), and 100% and 2.5% contrast letter-acuity scores (p = 0.008 and p = 0.03, respectively). NMO spectrum eyes without ON history had lower macular RNFL thickness (p = 0.003), GCIP thickness (p = 0.002), outer nuclear layer thickness (p = 0.02), and low-contrast letter-acuity scores (2.5%: p = 0.03; 1.25%: p = 0.002) compared to healthy controls. Conclusions: We have identified a pattern of retinal morphologic abnormalities in NMO that is associated with severe retinal axonal and neuronal loss and corresponding visual disability. MME may contribute to poor visual outcomes following NMO-associated ON or alternatively represent a marker of ON severity. Additionally, our results support that subclinical involvement of the anterior visual pathway may occur in NMO spectrum disorders.

Original languageEnglish (US)
Pages (from-to)1406-1414
Number of pages9
JournalNeurology
Volume80
Issue number15
DOIs
StatePublished - Apr 9 2013

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Neuromyelitis Optica
Optic Neuritis
Macular Edema
Nerve Fibers
Optical Coherence Tomography
Ganglia
Neuritis
Visual Pathways
Layer
Cross-Sectional Studies
Thickness
Optics

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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In vivo identification of morphologic retinal abnormalities in neuromyelitis optica. / Sotirchos, Elias S.; Saidha, Shiv; Byraiah, Gita; Mealy, Maureen A.; Ibrahim, Mohamed A.; Sepah, Yasir Jamal; Newsome, Scott; Ratchford, John N.; Frohman, Elliot M.; Balcer, Laura J.; Crainiceanu, Ciprian M; Nguyen, Quan Dong; Levy, Michael; Calabresi, Peter.

In: Neurology, Vol. 80, No. 15, 09.04.2013, p. 1406-1414.

Research output: Contribution to journalArticle

Sotirchos, ES, Saidha, S, Byraiah, G, Mealy, MA, Ibrahim, MA, Sepah, YJ, Newsome, S, Ratchford, JN, Frohman, EM, Balcer, LJ, Crainiceanu, CM, Nguyen, QD, Levy, M & Calabresi, P 2013, 'In vivo identification of morphologic retinal abnormalities in neuromyelitis optica', Neurology, vol. 80, no. 15, pp. 1406-1414. https://doi.org/10.1212/WNL.0b013e31828c2f7a
Sotirchos, Elias S. ; Saidha, Shiv ; Byraiah, Gita ; Mealy, Maureen A. ; Ibrahim, Mohamed A. ; Sepah, Yasir Jamal ; Newsome, Scott ; Ratchford, John N. ; Frohman, Elliot M. ; Balcer, Laura J. ; Crainiceanu, Ciprian M ; Nguyen, Quan Dong ; Levy, Michael ; Calabresi, Peter. / In vivo identification of morphologic retinal abnormalities in neuromyelitis optica. In: Neurology. 2013 ; Vol. 80, No. 15. pp. 1406-1414.
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abstract = "Objective: To assess eyes with neuromyelitis optica (NMO) for morphologic retinal abnormalities utilizing high-definition optical coherence tomography (OCT) imaging. Methods: In this cross-sectional study, 39 patients with NMO spectrum disorders and 39 age- and sex-matched healthy controls underwent spectral-domain OCT and visual function testing. Results: Microcystic macular edema (MME) of the inner nuclear layer (INL) was identified in 10 of 39 patients (26{\%}) and was exclusively found in eyes with a history of optic neuritis (ON). MME eyes had lower high- and low-contrast letter-acuity scores (100{\%}: p = 0.002; 2.5{\%}: p = 0.002; 1.25{\%}: p = 0.004), lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.04), lower macular RNFL thickness (p = 0.004), lower ganglion cell layer + inner plexiform layer (GCIP) thickness (p = 0.007), higher INL thickness (p <0.001), and a greater number of ON episodes (p = 0.008) relative to non-MME eyes with a history of ON. After adjusting for history of multiple ON episodes, these findings remained significant for macular-RNFL thickness (p = 0.03), INL thickness (p <0.001), and 100{\%} and 2.5{\%} contrast letter-acuity scores (p = 0.008 and p = 0.03, respectively). NMO spectrum eyes without ON history had lower macular RNFL thickness (p = 0.003), GCIP thickness (p = 0.002), outer nuclear layer thickness (p = 0.02), and low-contrast letter-acuity scores (2.5{\%}: p = 0.03; 1.25{\%}: p = 0.002) compared to healthy controls. Conclusions: We have identified a pattern of retinal morphologic abnormalities in NMO that is associated with severe retinal axonal and neuronal loss and corresponding visual disability. MME may contribute to poor visual outcomes following NMO-associated ON or alternatively represent a marker of ON severity. Additionally, our results support that subclinical involvement of the anterior visual pathway may occur in NMO spectrum disorders.",
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T1 - In vivo identification of morphologic retinal abnormalities in neuromyelitis optica

AU - Sotirchos, Elias S.

AU - Saidha, Shiv

AU - Byraiah, Gita

AU - Mealy, Maureen A.

AU - Ibrahim, Mohamed A.

AU - Sepah, Yasir Jamal

AU - Newsome, Scott

AU - Ratchford, John N.

AU - Frohman, Elliot M.

AU - Balcer, Laura J.

AU - Crainiceanu, Ciprian M

AU - Nguyen, Quan Dong

AU - Levy, Michael

AU - Calabresi, Peter

PY - 2013/4/9

Y1 - 2013/4/9

N2 - Objective: To assess eyes with neuromyelitis optica (NMO) for morphologic retinal abnormalities utilizing high-definition optical coherence tomography (OCT) imaging. Methods: In this cross-sectional study, 39 patients with NMO spectrum disorders and 39 age- and sex-matched healthy controls underwent spectral-domain OCT and visual function testing. Results: Microcystic macular edema (MME) of the inner nuclear layer (INL) was identified in 10 of 39 patients (26%) and was exclusively found in eyes with a history of optic neuritis (ON). MME eyes had lower high- and low-contrast letter-acuity scores (100%: p = 0.002; 2.5%: p = 0.002; 1.25%: p = 0.004), lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.04), lower macular RNFL thickness (p = 0.004), lower ganglion cell layer + inner plexiform layer (GCIP) thickness (p = 0.007), higher INL thickness (p <0.001), and a greater number of ON episodes (p = 0.008) relative to non-MME eyes with a history of ON. After adjusting for history of multiple ON episodes, these findings remained significant for macular-RNFL thickness (p = 0.03), INL thickness (p <0.001), and 100% and 2.5% contrast letter-acuity scores (p = 0.008 and p = 0.03, respectively). NMO spectrum eyes without ON history had lower macular RNFL thickness (p = 0.003), GCIP thickness (p = 0.002), outer nuclear layer thickness (p = 0.02), and low-contrast letter-acuity scores (2.5%: p = 0.03; 1.25%: p = 0.002) compared to healthy controls. Conclusions: We have identified a pattern of retinal morphologic abnormalities in NMO that is associated with severe retinal axonal and neuronal loss and corresponding visual disability. MME may contribute to poor visual outcomes following NMO-associated ON or alternatively represent a marker of ON severity. Additionally, our results support that subclinical involvement of the anterior visual pathway may occur in NMO spectrum disorders.

AB - Objective: To assess eyes with neuromyelitis optica (NMO) for morphologic retinal abnormalities utilizing high-definition optical coherence tomography (OCT) imaging. Methods: In this cross-sectional study, 39 patients with NMO spectrum disorders and 39 age- and sex-matched healthy controls underwent spectral-domain OCT and visual function testing. Results: Microcystic macular edema (MME) of the inner nuclear layer (INL) was identified in 10 of 39 patients (26%) and was exclusively found in eyes with a history of optic neuritis (ON). MME eyes had lower high- and low-contrast letter-acuity scores (100%: p = 0.002; 2.5%: p = 0.002; 1.25%: p = 0.004), lower peripapillary retinal nerve fiber layer (RNFL) thickness (p = 0.04), lower macular RNFL thickness (p = 0.004), lower ganglion cell layer + inner plexiform layer (GCIP) thickness (p = 0.007), higher INL thickness (p <0.001), and a greater number of ON episodes (p = 0.008) relative to non-MME eyes with a history of ON. After adjusting for history of multiple ON episodes, these findings remained significant for macular-RNFL thickness (p = 0.03), INL thickness (p <0.001), and 100% and 2.5% contrast letter-acuity scores (p = 0.008 and p = 0.03, respectively). NMO spectrum eyes without ON history had lower macular RNFL thickness (p = 0.003), GCIP thickness (p = 0.002), outer nuclear layer thickness (p = 0.02), and low-contrast letter-acuity scores (2.5%: p = 0.03; 1.25%: p = 0.002) compared to healthy controls. Conclusions: We have identified a pattern of retinal morphologic abnormalities in NMO that is associated with severe retinal axonal and neuronal loss and corresponding visual disability. MME may contribute to poor visual outcomes following NMO-associated ON or alternatively represent a marker of ON severity. Additionally, our results support that subclinical involvement of the anterior visual pathway may occur in NMO spectrum disorders.

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