Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness

Shiv Saidha, Stephanie B. Syc, Mary K. Durbin, Christopher Eckstein, Jonathan D. Oakley, Scott A. Meyer, Amy Conger, Teresa C. Frohman, Scott Newsome, John N. Ratchford, Elliot M. Frohman, Peter Calabresi

Research output: Contribution to journalArticle

Abstract

Background: Post-mortem analyses of multiple sclerosis (MS) eyes demonstrate prominent retinal neuronal ganglion cell layer (GCL) loss, in addition to related axonal retinal nerve fiber layer (RNFL) loss. Despite this, clinical correlations of retinal neuronal layers remain largely unexplored in MS.Objectives: To determine if MS patients exhibit in vivo retinal neuronal GCL loss, deeper retinal neuronal loss, and investigate correlations between retinal layer thicknesses, MS clinical subtype and validated clinical measures.Methods: Cirrus HD-optical coherence tomography (OCT), utilizing automated intra-retinal layer segmentation, was performed in 132 MS patients and 78 healthy controls. MS classification, Expanded Disability Status Scale (EDSS) and visual function were recorded in study subjects.Results: GCL+inner plexiform layer (GCIP) was thinner in relapsing-remitting MS (RRMS; n = 96, 71.6 μm), secondary progressive MS (SPMS; n = 20, 66.4 μm) and primary progressive MS (PPMS; n = 16, 74.1 μm) than in healthy controls (81.8 μm; p <0.001 for all). GCIP thickness was most decreased in SPMS, and although GCIP thickness correlated significantly with disease duration, after adjusting for this, GCIP thickness remained significantly lower in SPMS than RRMS. GCIP thickness correlated significantly, and better than RNFL thickness, with EDSS, high-contrast, 2.5% low-contrast and 1.25% low-contrast letter acuity in MS. 13.6% of patients also demonstrated inner or outer nuclear layer thinning.Conclusions: OCT segmentation demonstrates in vivo GCIP thinning in all MS subtypes. GCIP thickness demonstrates better structure-function correlations (with vision and disability) in MS than RNFL thickness. In addition to commonly observed RNFL/GCIP thinning, retinal inner and outer nuclear layer thinning occur in MS.

Original languageEnglish (US)
Pages (from-to)1449-1463
Number of pages15
JournalMultiple Sclerosis
Volume17
Issue number12
DOIs
StatePublished - 2011

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Optical Coherence Tomography
Nerve Fibers
Ganglia
Multiple Sclerosis
Chronic Progressive Multiple Sclerosis
Retinal Ganglion Cells
Relapsing-Remitting Multiple Sclerosis
Vision Disorders

Keywords

  • EDSS
  • ganglion cell layer
  • multiple sclerosis
  • optical coherence tomography
  • retinal pathology
  • retinal segmentation
  • visual function

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness. / Saidha, Shiv; Syc, Stephanie B.; Durbin, Mary K.; Eckstein, Christopher; Oakley, Jonathan D.; Meyer, Scott A.; Conger, Amy; Frohman, Teresa C.; Newsome, Scott; Ratchford, John N.; Frohman, Elliot M.; Calabresi, Peter.

In: Multiple Sclerosis, Vol. 17, No. 12, 2011, p. 1449-1463.

Research output: Contribution to journalArticle

Saidha, Shiv ; Syc, Stephanie B. ; Durbin, Mary K. ; Eckstein, Christopher ; Oakley, Jonathan D. ; Meyer, Scott A. ; Conger, Amy ; Frohman, Teresa C. ; Newsome, Scott ; Ratchford, John N. ; Frohman, Elliot M. ; Calabresi, Peter. / Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness. In: Multiple Sclerosis. 2011 ; Vol. 17, No. 12. pp. 1449-1463.
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abstract = "Background: Post-mortem analyses of multiple sclerosis (MS) eyes demonstrate prominent retinal neuronal ganglion cell layer (GCL) loss, in addition to related axonal retinal nerve fiber layer (RNFL) loss. Despite this, clinical correlations of retinal neuronal layers remain largely unexplored in MS.Objectives: To determine if MS patients exhibit in vivo retinal neuronal GCL loss, deeper retinal neuronal loss, and investigate correlations between retinal layer thicknesses, MS clinical subtype and validated clinical measures.Methods: Cirrus HD-optical coherence tomography (OCT), utilizing automated intra-retinal layer segmentation, was performed in 132 MS patients and 78 healthy controls. MS classification, Expanded Disability Status Scale (EDSS) and visual function were recorded in study subjects.Results: GCL+inner plexiform layer (GCIP) was thinner in relapsing-remitting MS (RRMS; n = 96, 71.6 μm), secondary progressive MS (SPMS; n = 20, 66.4 μm) and primary progressive MS (PPMS; n = 16, 74.1 μm) than in healthy controls (81.8 μm; p <0.001 for all). GCIP thickness was most decreased in SPMS, and although GCIP thickness correlated significantly with disease duration, after adjusting for this, GCIP thickness remained significantly lower in SPMS than RRMS. GCIP thickness correlated significantly, and better than RNFL thickness, with EDSS, high-contrast, 2.5{\%} low-contrast and 1.25{\%} low-contrast letter acuity in MS. 13.6{\%} of patients also demonstrated inner or outer nuclear layer thinning.Conclusions: OCT segmentation demonstrates in vivo GCIP thinning in all MS subtypes. GCIP thickness demonstrates better structure-function correlations (with vision and disability) in MS than RNFL thickness. In addition to commonly observed RNFL/GCIP thinning, retinal inner and outer nuclear layer thinning occur in MS.",
keywords = "EDSS, ganglion cell layer, multiple sclerosis, optical coherence tomography, retinal pathology, retinal segmentation, visual function",
author = "Shiv Saidha and Syc, {Stephanie B.} and Durbin, {Mary K.} and Christopher Eckstein and Oakley, {Jonathan D.} and Meyer, {Scott A.} and Amy Conger and Frohman, {Teresa C.} and Scott Newsome and Ratchford, {John N.} and Frohman, {Elliot M.} and Peter Calabresi",
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T1 - Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness

AU - Saidha, Shiv

AU - Syc, Stephanie B.

AU - Durbin, Mary K.

AU - Eckstein, Christopher

AU - Oakley, Jonathan D.

AU - Meyer, Scott A.

AU - Conger, Amy

AU - Frohman, Teresa C.

AU - Newsome, Scott

AU - Ratchford, John N.

AU - Frohman, Elliot M.

AU - Calabresi, Peter

PY - 2011

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N2 - Background: Post-mortem analyses of multiple sclerosis (MS) eyes demonstrate prominent retinal neuronal ganglion cell layer (GCL) loss, in addition to related axonal retinal nerve fiber layer (RNFL) loss. Despite this, clinical correlations of retinal neuronal layers remain largely unexplored in MS.Objectives: To determine if MS patients exhibit in vivo retinal neuronal GCL loss, deeper retinal neuronal loss, and investigate correlations between retinal layer thicknesses, MS clinical subtype and validated clinical measures.Methods: Cirrus HD-optical coherence tomography (OCT), utilizing automated intra-retinal layer segmentation, was performed in 132 MS patients and 78 healthy controls. MS classification, Expanded Disability Status Scale (EDSS) and visual function were recorded in study subjects.Results: GCL+inner plexiform layer (GCIP) was thinner in relapsing-remitting MS (RRMS; n = 96, 71.6 μm), secondary progressive MS (SPMS; n = 20, 66.4 μm) and primary progressive MS (PPMS; n = 16, 74.1 μm) than in healthy controls (81.8 μm; p <0.001 for all). GCIP thickness was most decreased in SPMS, and although GCIP thickness correlated significantly with disease duration, after adjusting for this, GCIP thickness remained significantly lower in SPMS than RRMS. GCIP thickness correlated significantly, and better than RNFL thickness, with EDSS, high-contrast, 2.5% low-contrast and 1.25% low-contrast letter acuity in MS. 13.6% of patients also demonstrated inner or outer nuclear layer thinning.Conclusions: OCT segmentation demonstrates in vivo GCIP thinning in all MS subtypes. GCIP thickness demonstrates better structure-function correlations (with vision and disability) in MS than RNFL thickness. In addition to commonly observed RNFL/GCIP thinning, retinal inner and outer nuclear layer thinning occur in MS.

AB - Background: Post-mortem analyses of multiple sclerosis (MS) eyes demonstrate prominent retinal neuronal ganglion cell layer (GCL) loss, in addition to related axonal retinal nerve fiber layer (RNFL) loss. Despite this, clinical correlations of retinal neuronal layers remain largely unexplored in MS.Objectives: To determine if MS patients exhibit in vivo retinal neuronal GCL loss, deeper retinal neuronal loss, and investigate correlations between retinal layer thicknesses, MS clinical subtype and validated clinical measures.Methods: Cirrus HD-optical coherence tomography (OCT), utilizing automated intra-retinal layer segmentation, was performed in 132 MS patients and 78 healthy controls. MS classification, Expanded Disability Status Scale (EDSS) and visual function were recorded in study subjects.Results: GCL+inner plexiform layer (GCIP) was thinner in relapsing-remitting MS (RRMS; n = 96, 71.6 μm), secondary progressive MS (SPMS; n = 20, 66.4 μm) and primary progressive MS (PPMS; n = 16, 74.1 μm) than in healthy controls (81.8 μm; p <0.001 for all). GCIP thickness was most decreased in SPMS, and although GCIP thickness correlated significantly with disease duration, after adjusting for this, GCIP thickness remained significantly lower in SPMS than RRMS. GCIP thickness correlated significantly, and better than RNFL thickness, with EDSS, high-contrast, 2.5% low-contrast and 1.25% low-contrast letter acuity in MS. 13.6% of patients also demonstrated inner or outer nuclear layer thinning.Conclusions: OCT segmentation demonstrates in vivo GCIP thinning in all MS subtypes. GCIP thickness demonstrates better structure-function correlations (with vision and disability) in MS than RNFL thickness. In addition to commonly observed RNFL/GCIP thinning, retinal inner and outer nuclear layer thinning occur in MS.

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KW - retinal pathology

KW - retinal segmentation

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