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Shor N, Lamirel C, Rebbah S, Vignal C, Vasseur V, Savatovsky J, de la Motte MB, Gout O, Lecler A, Hage R, Deschamps R. High diagnostic accuracy of T2FLAIR at 3 T in the detection of optic nerve head edema in acute optic neuritis. Eur Radiol 2024; 34:1453-1460. [PMID: 37668695 DOI: 10.1007/s00330-023-10139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Optic nerve head edema (ONHE) detected by fundoscopy is observed in one-third of patients presenting optic neuritis (ON). While ONHE is an important semiological feature, the correlation between ONHE and optic nerve head MRI abnormalities (ONHMA), sometimes called "optic nerve head swelling," remains unknown. Our study aimed to assess the diagnostic accuracy of T2 fluid-attenuated inversion recovery (FLAIR) MRI sequence in detecting ONHE in patients with acute ON. METHODS In the present single-center study, data were extracted from two prospective cohort studies that consecutively included adults with a first episode of acute ON treated between 2015 and 2020. Two experienced readers blinded to study data independently analyzed imaging. A senior neuroradiologist resolved any discrepancies. The primary judgment criterion of ONHMA was assessed as optic nerve head high signal intensity on gadolinium-enhanced T2FLAIR MRI sequence. Its diagnostic accuracy was evaluated with both the gold standard of ONHE on fundus photography (FP) and peripapillary retinal nerve fiber layer thickening on optic coherence tomography (OCT). RESULTS A total of 102 patients were included, providing 110 affected and 94 unaffected optic nerves. Agreement was high between the different modalities: 92% between MRI and FP (k = 0.77, 95% CI: 0.67-0.88) and 93% between MRI and OCT (k = 0.77, 95% CI: 0.67-0.87). MRI sensitivity was 0.84 (95% CI: 0.70-0.93) and specificity was 0.94 (95% CI: 0.89-0.97) when compared with the FP. CONCLUSION Optic nerve head high T2FLAIR signal intensity corresponds indeed to the optic nerve head edema diagnosed by the ophthalmologists. MRI is a sensitive tool for detecting ONHE in patients presenting acute ON. CLINICAL RELEVANCE STATEMENT In patients with optic neuritis the high T2FLAIR (fluid-attenuated inversion recovery) signal intensity of the optic nerve head corresponds indeed to optic nerve head edema, which is a useful feature in optic neuritis etiological evaluation and treatment. KEY POINTS Optic nerve head edema is a prominent clinical feature of acute optic neuritis and is usually diagnosed during dilated or non-dilated eye fundus examination. Agreement was high between magnetic resonance imaging, fundus photography, and optical coherence tomography. Optic nerve head high T2 fluid attenuation inversion recovery signal intensity is a promising detection tool for optic nerve head edema in patients presenting acute optic neuritis.
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Affiliation(s)
- Natalia Shor
- Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France.
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- Department of Neuroradiology, C.H.N.O. des Quinze-Vingt, Paris, France.
| | - Cedric Lamirel
- Department of Neuro-ophthalmology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Sana Rebbah
- Data Analysis Core, Paris Brain Institute (ICM), Sorbonne University, Paris, France
| | - Catherine Vignal
- Department of Neuro-ophthalmology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Vivien Vasseur
- Clinical Research Department, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | | | - Olivier Gout
- Department of Neurology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Rabih Hage
- Department of Neuro-ophthalmology, Foundation Adolphe de Rothschild Hospital, Paris, France
| | - Romain Deschamps
- Department of Neurology, Foundation Adolphe de Rothschild Hospital, Paris, France
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Bennett JL, Grove NC, Johnson RK, Mizenko C, DuPont JC, Wagner BD, Lynch AM, Frohman TC, Shindler KS, Frohman EM. A Randomized Prospective Trial Comparing Repository Corticotropin Injection and Intravenous Methylprednisolone for Neuroprotection in Acute Optic Neuritis. J Neuroophthalmol 2023; 43:323-329. [PMID: 37261907 PMCID: PMC10414149 DOI: 10.1097/wno.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Repository corticotrophin injection (RCI, Acthar Gel) and intravenous methylprednisolone (IVMP) improve the rate but not the extent of visual recovery following acute optic neuritis. RCI has adrenal-stimulating and melanocortin receptor-stimulating properties that may endow it with unique anti-inflammatory properties relative to IVMP. METHODS Individuals with acute optic neuritis of less than 2 weeks duration were prospectively enrolled and randomized 1:1 to receive either RCI or IVMP. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell plus inner plexiform layer thickness (GC + IPL) were serially evaluated by OCT. In addition, patient-reported outcomes (PROs) for changes in fatigue, mood, visual function, depression, and quality of life (QOL) were measured, and high and low contrast visual acuity were recorded. RESULTS Thirty-seven subjects were enrolled (19 RCI; 18 IVMP); the average time from symptom to treatment was 8.8 days. At 6 months, there was no difference in the primary outcome: loss of average pRNFL thickness in the affected eye (RCI vs IVMP: -13.1 vs -11.7 µm, P = 0.88) 6 months after randomization. Additional outcomes also showed no difference between treatment groups: 6-month attenuation of GC + IPL thickness (RCI vs IVMP: -13.8 vs -12.0 µm, P = 0.58) and frequency of pRNFL swelling at 1 month (RCI vs IVMP: 63% vs 72%, P = 0.73) and 3 months (RCI vs IVMP: 26% vs 31%, P = 0.99). Both treatments resulted in improvement in visual function and PROs. CONCLUSIONS Treatment of acute optic neuritis with RCI or IVMP produced no clinically meaningful differences in optic nerve structure or visual function.
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Taşdelen R, Ayık B, Kaya H, Sevimli N. Investigation of the Relationship Between Cognitive Functions and Retinal Findings From Spectral Optical Coherence Tomography in Patients With Schizophrenia and Their Healthy Siblings. Psychiatry Investig 2023; 20:236-244. [PMID: 36990667 PMCID: PMC10064210 DOI: 10.30773/pi.2022.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/11/2022] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE Retinal structural changes which were investigated by optical coherence tomography (OCT) have been reported in schizophrenia. Since cognitive dysfunction is a core feature of schizophrenia, the correlations between retinal findings and cognitive functions of patients and their healthy siblings may provide insight into the pathophysiological processes of the disorder. We aimed to investigate the relationship between neuropsychiatric tests and retinal changes in schizophrenia patients and their healthy siblings. METHODS We measured OCT parameters and cognitive performance (via Trail Making Tests, verbal fluency tests, and The Digit Span Tests) of 72 participants (36 patients with schizophrenia and 36 healthy siblings) and disease severity (with Positive and Negative Syndrome Scale, Global Assessment of Functioning, and Clinical Global Impression scales) in patients with schizophrenia and evaluated the relationship between retinal findings and clinical parameters, especially neurocognitive tests. RESULTS We found decreased ganglion cell layer-inner plexiform layer thickness and macular volume in the patient group. There were strong correlations between neurocognitive tests and OCT findings in both groups. On the other hand, there was not any correlation between retinal findings and disease parameters. CONCLUSION The cognitive symptoms of schizophrenia may be more closely related to structural changes in the retina.
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Affiliation(s)
- Rümeysa Taşdelen
- Department of Psychiatry, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Türkiye
| | - Batuhan Ayık
- Department of Psychiatry, Sancaktepe Community Mental Health Center, Istanbul Erenkoy Education and Research Hospital, Istanbul, Türkiye
| | - Hatice Kaya
- Department of Psychiatry, Sultanbeyli Community Mental Health Center, Istanbul Sultanbeyli State Hospital, Istanbul, Türkiye
| | - Neslihan Sevimli
- Department of Ophthalmology, Istanbul Sultanbeyli State Hospital, Istanbul, Türkiye
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Torbus M, Niewiadomska E, Dobrakowski P, Papuć E, Rybus-Kalinowska B, Szlacheta P, Korzonek-Szlacheta I, Kubicka-Bączyk K, Łabuz-Roszak B. The Usefulness of Optical Coherence Tomography in Disease Progression Monitoring in Younger Patients with Relapsing-Remitting Multiple Sclerosis: A Single-Centre Study. J Clin Med 2022; 12:jcm12010093. [PMID: 36614893 PMCID: PMC9821099 DOI: 10.3390/jcm12010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of the study was to assess the usefulness of optical coherence tomography (OCT) in the detection of the neurodegenerative process in younger patients with multiple sclerosis (MS). The study group consisted of 61 patients with a relapsing remitting course of MS (mean age 36.4 ± 6.7 years) divided into two groups: short (≤5 years) and long (>10 years) disease duration. OCT, P300 evoked potential, Montreal Cognitive Assessment, and performance subtests (Picture Completion and Digit Symbol) of the Wechsler Adult Intelligence Scale were performed in all patients. Mean values of most parameters assessed in OCT (pRNFL Total, pRNFL Inferior, pRNFL Superior, pRNFL Temporalis, mRNFL, GCIPL, mRNFL+GCIPL) were significantly lower in MS patients in comparison to controls. And in patients with longer disease duration in comparison to those with shorter. Most OCT parameters negatively correlated with the EDSS score (p < 0.05). No significant correlation was found between OCT results and both P300 latency and the results of psychometric tests. OCT, as a simple, non-invasive, quick, and inexpensive method, could be useful for monitoring the progression of disease in MS patients.
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Affiliation(s)
- Magdalena Torbus
- Institute of Psychology, Humanitas University in Sosnowiec, 41-200 Sosnowiec, Poland
| | - Ewa Niewiadomska
- Department of Biostatistics, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Paweł Dobrakowski
- Institute of Psychology, Humanitas University in Sosnowiec, 41-200 Sosnowiec, Poland
| | - Ewa Papuć
- Department of Neurology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Barbara Rybus-Kalinowska
- Department of Basic Medical Sciences, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Patryk Szlacheta
- Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Ilona Korzonek-Szlacheta
- Department of Prevention of Metabolic Diseases, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Katarzyna Kubicka-Bączyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Beata Łabuz-Roszak
- Department of Neurology, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland
- Correspondence:
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Ciapă MA, Șalaru DL, Stătescu C, Sascău RA, Bogdănici CM. Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process. Curr Issues Mol Biol 2022; 44:3959-3979. [PMID: 36135184 PMCID: PMC9497878 DOI: 10.3390/cimb44090272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis is a central nervous system inflammatory demyelinating disease with a wide range of clinical symptoms, ocular involvement being frequently marked by the presence of optic neuritis (ON). The emergence and progression of ON in multiple sclerosis is based on various pathophysiological mechanisms, disease progression being secondary to inflammation, demyelination, or axonal degeneration. Early identification of changes associated with axonal degeneration or further investigation of the molecular processes underlying remyelination are current concerns of researchers in the field in view of the associated therapeutic potential. This article aims to review and summarize the scientific literature related to the main molecular mechanisms involved in defining ON as well as to analyze existing data in the literature on remyelination strategies in ON and their impact on long-term prognosis.
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Affiliation(s)
| | - Delia Lidia Șalaru
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Correspondence:
| | - Cristian Stătescu
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Radu Andy Sascău
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Camelia Margareta Bogdănici
- Department of Surgical Specialties (II), University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Ophthalmology Clinic, Saint Spiridon Hospital, Iași 700111, Romania
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Denis M, Woillez JP, Smirnov VM, Drumez E, Lannoy J, Boucher J, Zedet M, Pruvo JP, Labreuche J, Zephir H, Leclerc X, Outteryck O. Optic Nerve Lesion Length at the Acute Phase of Optic Neuritis Is Predictive of Retinal Neuronal Loss. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/2/e1135. [PMID: 35091465 PMCID: PMC8802684 DOI: 10.1212/nxi.0000000000001135] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives Acute optic neuritis (ON) is a classical presenting symptom of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and anti–MOG-associated disorders. The resulting visual impairment is variable and can be severe. Clinicians are in need of predictive biomarkers to optimize the management of acute ON. In this longitudinal study (IRMANO, NCT03651662), we evaluated the ability of optic nerve lesion length measured on MRI at the acute phase of ON to predict retinal neuro-axonal loss and visual impairment at a chronic stage. Methods We conducted a longitudinal study (IRMANO, NCT03651662) of patients who presented a clinical episode of ON (≤8 weeks). All patients underwent a retinal optical coherence tomography (OCT) and a brain/optic nerve MRI, including 3D double-inversion recovery (DIR) sequence at the acute phase of ON and 12 months later. Primary outcomes were optic nerve DIR hypersignal lesion length, macular ganglion cell–inner plexiform layer (GCIPL) volume measured on OCT, and low-contrast monocular visual acuity (LCMVA). Results The study group included 51 patients (33 women, mean age of 32.4 years ± 7.9). We recruited patients with a clinically isolated syndrome (n = 20), a relapsing-remitting MS (n = 23), an isolated ON (n = 6), and a first clinical episode of NMOSD (n = 2). Optic nerve DIR hypersignal was observed in all but 1 symptomatic optic nerves. At inclusion, the mean optic nerve lesion length (in mm) was 12.35 ± 5.98. The mean GCIPL volume (in mm3) significantly decreased between inclusion (1.90 ± 0.18) and M12 (1.67 ± 0.21; p < 0.0001). Optic nerve lesion length at inclusion was significantly associated with GCIPL thinning (estimate ± SD; −0.012 ± 0.004; p = 0.0016) and LCMVA at M12 (0.016 ± 0.003; p < 0.001). Optic nerve lesion length significantly increased at M12 (15.76 ± 8.70; p = 0.0007). The increase in optic nerve lesion length was significantly associated with the GCIPL thinning between inclusion and M12 (−0.012 ± 0.003; p = 0.0011). Discussion At the acute phase of ON, optic nerve lesion length is an imaging biomarker predictive of retinal neuro-axonal loss and chronic visual impairment, which can help to stratify future therapeutic strategies in acute ON. Classification of Evidence This study provides Class I evidence that optic nerve lesion length measured on MRI during the acute phase of a first episode of ON is associated with long-term retinal neuro-axonal loss and visual impairment.
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Aneesh A, Liu A, Moss HE, Feinstein D, Ravindran S, Mathew B, Roth S. Emerging concepts in the treatment of optic neuritis: mesenchymal stem cell-derived extracellular vesicles. Stem Cell Res Ther 2021; 12:594. [PMID: 34863294 PMCID: PMC8642862 DOI: 10.1186/s13287-021-02645-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/31/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Optic neuritis (ON) is frequently encountered in multiple sclerosis, neuromyelitis optica spectrum disorder, anti-myelin oligodendrocyte glycoprotein associated disease, and other systemic autoimmune disorders. The hallmarks are an abnormal optic nerve and inflammatory demyelination; episodes of optic neuritis tend to be recurrent, and particularly for neuromyelitis optica spectrum disorder, may result in permanent vision loss. MAIN BODY Mesenchymal stem cell (MSC) therapy is a promising approach that results in remyelination, neuroprotection of axons, and has demonstrated success in clinical studies in other neuro-degenerative diseases and in animal models of ON. However, cell transplantation has significant disadvantages and complications. Cell-free approaches utilizing extracellular vesicles (EVs) produced by MSCs exhibit anti-inflammatory and neuroprotective effects in multiple animal models of neuro-degenerative diseases and in rodent models of multiple sclerosis (MS). EVs have potential to be an effective cell-free therapy in optic neuritis because of their anti-inflammatory and remyelination stimulating properties, ability to cross the blood brain barrier, and ability to be safely administered without immunosuppression. CONCLUSION We review the potential application of MSC EVs as an emerging treatment strategy for optic neuritis by reviewing studies in multiple sclerosis and related disorders, and in neurodegeneration, and discuss the challenges and potential rewards of clinical translation of EVs including cell targeting, carrying of therapeutic microRNAs, and prolonging delivery for treatment of optic neuritis.
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Affiliation(s)
- Anagha Aneesh
- Department of Anesthesiology, College of Medicine, University of Illinois, 835 South Wolcott Avenue, Room E714, Chicago, IL, 60612, USA
| | - Alice Liu
- Department of Anesthesiology, College of Medicine, University of Illinois, 835 South Wolcott Avenue, Room E714, Chicago, IL, 60612, USA
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Douglas Feinstein
- Department of Anesthesiology, College of Medicine, University of Illinois, 835 South Wolcott Avenue, Room E714, Chicago, IL, 60612, USA
| | - Sriram Ravindran
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Biji Mathew
- Department of Anesthesiology, College of Medicine, University of Illinois, 835 South Wolcott Avenue, Room E714, Chicago, IL, 60612, USA.
| | - Steven Roth
- Department of Anesthesiology, College of Medicine, University of Illinois, 835 South Wolcott Avenue, Room E714, Chicago, IL, 60612, USA.
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Mehmood A, Ali W, Song S, Din ZU, Guo RY, Shah W, Ilahi I, Yin B, Yan H, Zhang L, Khan M, Ali W, Zeb L, Safari H, Li B. Optical coherence tomography monitoring and diagnosing retinal changes in multiple sclerosis. Brain Behav 2021; 11:e2302. [PMID: 34520634 PMCID: PMC8553325 DOI: 10.1002/brb3.2302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
This study explores the use of optical coherence tomography (OCT) to monitor and diagnose multiple sclerosis (MS). The analysis of reduced total macular volume and peripapillary retinal nerve fiber layer thinning are shown. The severity of these defects increases as MS progresses, reflecting the progressive degeneration of nerve fibers and retinal ganglion cells. The OCT parameters are noninvasive, sensitive indicators that can be used to assess the progression of neurodegeneration and inflammation in MS.
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Affiliation(s)
- Arshad Mehmood
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China
| | - Wajid Ali
- Key Laboratory of Functional Inorganic Materials Chemistry, School of Chemistry and Materials Science, Heilongjiang University, Harbin, P. R. China
| | - Shuang Song
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China
| | - Zaheer Ud Din
- Institute of Cancer Stem Cell, Dalian Medical University, Liaoning Province, P. R. China
| | - Ruo-Yi Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China
| | - Wahid Shah
- Department of Physiology, Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Ikram Ilahi
- Department of Zoology, University of Malakand, Chakdara, Khyber Pakhtunkhwa, Pakistan
| | - Bowen Yin
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China.,Department of Neurology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, P. R. China
| | - Hongjing Yan
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China
| | - Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China
| | - Murad Khan
- Department of Genetics, Hebei Key Lab of Laboratory Animal, Hebei Medical University, Shijiazhuang, Hebei Province, P. R. China
| | - Wajid Ali
- Green and Environmental Chemistry, Ecotoxicology and Ecology Laboratory, Department of Zoology, University of Malakand, Chakdara, Khyber Pakhtunkhwa, Pakistan
| | - Liaqat Zeb
- School of Bioengineering, Dalian University of Technology, Dalian, Liaoning, P.R. China
| | - Hamidreza Safari
- Department of Immunology, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, City Shijiazhuang, Hebei Province, P. R. China.,Key Laboratory of Neurology of Hebei Province, City Shijiazhuang, Hebei Province, P. R. China
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Abstract
Multiple sclerosis (MS) is a neurological inflammatory disorder known to attack the heavily myelinated regions of the nervous system including the optic nerves, cerebellum, brainstem and spinal cord. This review will discuss the clinical manifestations and investigations for MS and other similar neurological inflammatory disorders affecting vision, as well as the effects of MS treatments on vision. Assessment of visual pathways is critical, considering MS can involve multiple components of the visual pathway, including optic nerves, uvea, retina and occipital cortex. Optical coherence tomography is increasingly being recognised as a highly sensitive tool in detecting subclinical optic nerve changes. Magnetic resonance imaging (MRI) is critical in MS diagnosis and in predicting long-term disability. Optic neuritis in MS involves unilateral vision loss, with characteristic pain on eye movement. The visual loss in neuromyelitis optica spectrum disorder tends to be more severe with preferential altitudinal field loss, chiasmal and tract lesions are also more common. Other differential diagnoses include chronic relapsing inflammatory optic neuropathy and giant cell arteritis. Leber's hereditary optic neuropathy affects young males and visual loss tends to be painless and subacute, typically involving both optic nerves. MS lesions in the vestibulocerebellum, brainstem, thalamus and basal ganglia may lead to abnormalities of gaze, saccades, pursuit and nystagmus which can be identified on eye examination. Medial longitudinal fasciculus lesions can cause another frequent presentation of MS, internuclear ophthalmoplegia, with failure of ipsilateral eye adduction and contralateral eye abduction nystagmus. Treatments for MS include high-dose corticosteroids for acute relapses and disease-modifying medications for relapse prevention. These therapies may also have adverse effects on vision, including central serous retinopathy with corticosteroid therapy and macular oedema with fingolimod.
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Affiliation(s)
- Roshan Dhanapalaratnam
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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Cellina M, Pirovano M, Ciocca M, Gibelli D, Floridi C, Oliva G. Radiomic analysis of the optic nerve at the first episode of acute optic neuritis: an indicator of optic nerve pathology and a predictor of visual recovery? Radiol Med 2021; 126:698-706. [PMID: 33392980 DOI: 10.1007/s11547-020-01318-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/25/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Retinal nerve fiber layer thickness (RNFL) is a biomarker of neuroaxonal loss and index of visual function in multiple sclerosis (MS). We aimed to assess the correlation between radiomic features and RNFL, visual acuity (VA) at patients' presentation, visual outcome (VO), and clinical diagnosis. METHODS We reviewed imaging and clinical data of 25 patients with a first episode of optic neuritis (ON) (14 females, 11 males; 5 bilateral ON; 7 left ON; 13 right ON). All patients underwent a complete ophthalmological assessment, including visual acuity and RNFL, neurological evaluation, orbits MRI. Segmentation of the optic nerves was performed through 3D slicer open software to get radiomics analysis. All patients underwent a complete neuro-ophthalmological follow-up at 6 months to assess the VO, classified as: complete recovery, partial recovery, deficit persistence/relapse, or visual worsening and were diagnosed as MS or clinically isolated syndrome. RESULTS We observed significant correlations between radiomic features and RNFL and between radiomic features and VA. Regression model analysis identified 1 radiomic feature with significant association with VO (Gray Level non-uniformity Normalized, p = 0.004) and 6 radiomic features with significant correlation with diagnosis (High Gray Level Zone Emphasis, p < 0.001; Entropy, p < 0.001, for T1 segmentation; Mean Absolute Deviation, p < 0.001; Coarseness < 0.001; Small Area Low Gray Level Emphasis, p < 0.001; Contrast, p = 0.008, for STIR segmentation). CONCLUSION Orbits MRI analysis at the first episode of ON has the potential to assess the visual function and VO in ON patients, and predict MS development.
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Affiliation(s)
- Michaela Cellina
- Radiology Department, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20123, Milan, Italy.
| | - Marta Pirovano
- Neurology Department, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20123, Milan, Italy
| | - Matteo Ciocca
- Neurology Department, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20123, Milan, Italy
| | - Daniele Gibelli
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 31, 20121, Milan, Italy
| | - Chiara Floridi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Giancarlo Oliva
- Radiology Department, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20123, Milan, Italy
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Minakaran N, de Carvalho ER, Petzold A, Wong SH. Optical coherence tomography (OCT) in neuro-ophthalmology. Eye (Lond) 2021; 35:17-32. [PMID: 33239763 PMCID: PMC7852683 DOI: 10.1038/s41433-020-01288-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive medical imaging technology that is playing an increasing role in the routine assessment and management of patients with neuro-ophthalmic conditions. Its ability to characterise the optic nerve head, peripapillary retinal nerve fibre layer and cellular layers of the macula including the ganglion cell layer enables qualitative and quantitative assessment of optic nerve disease. In this review, we discuss technical features of OCT and OCT-based imaging techniques in the neuro-ophthalmic context, potential pitfalls to be aware of, and specific applications in more common neuro-ophthalmic conditions including demyelinating, inflammatory, ischaemic and compressive optic neuropathies, optic disc drusen and raised intracranial pressure. We also review emerging applications of OCT angiography within neuro-ophthalmology.
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Affiliation(s)
- Neda Minakaran
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Emanuel R de Carvalho
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Axel Petzold
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Neuro-ophthalmology Expertise Centre, University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- UCL Institute of Neurology, Queen Square, London, UK
| | - Sui H Wong
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Guys and St Thomas' NHS Foundation Trust, London, UK
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12
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Abstract
The current management of acute optic neuritis (ON) is focused on expediting visual recovery through the use of high-dose intravenous corticosteroids. The recent identification of specific autoantibodies associated with central nervous system inflammatory disorders has provided novel insights into immune targets and mechanisms that impact the prognosis, treatment, and recurrence of ON. Therefore, neurologists and ophthalmologists need to be aware of clinical, laboratory, and imaging findings that may provide important clues to the etiology of ON and the potential need for aggressive management. Moving forward, rapid and accurate diagnosis of inflammatory ON will likely be critical for implementing clinical care that optimizes short-term and long-term therapeutic outcomes.
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Celik M, Kalenderoglu A, Sevgi Karadag A, Bekir Egilmez O, Han-Almis B, Şimşek A. Decreases in ganglion cell layer and inner plexiform layer volumes correlate better with disease severity in schizophrenia patients than retinal nerve fiber layer thickness: Findings from spectral optic coherence tomography. Eur Psychiatry 2020; 32:9-15. [DOI: 10.1016/j.eurpsy.2015.10.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 01/30/2023] Open
Abstract
AbstractBackgroundOptic coherence tomography (OCT) is a new, contactless and fast neuroimaging method. Previous studies have observed thinning of the retinal nerve fibre layer (RNFL) in many neurodegenerative diseases, and researchers have suggested that correlations exist between the thinning of the RNFL and the neurodegeneration detected with other imaging methods or the severity of illness. More recently, OCT has been used in patients with schizophrenia. RNFL thinning has also been detected in these patients. With more sophisticated devices, segmentation of the retina and measurements of the ganglion cell layer (GCL) and internal plexiform layer (IPL) can be performed.MethodsWe measured the RNFL thickness and the GCL and IPL volumes in 40 treatment refractory patients with schizophrenia, 41 treatment responsive refractory patients and 41 controls using spectral-OCT, and we evaluated the correlations between the disease severity and OCT measurements.ResultsThe global RNFL thickness and GCL and IPL volumes were decreased in the patients with schizophrenia compared with the controls. In addition, the GCL and IPL volumes were lower in the treatment refractory patients with schizophrenia compared to the treatment responsive patients. Using parameters such as the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scores, the disease duration and number of hospitalizations, correlations between the GCL and IPL volumes and disease severity were stronger than the correlations between the RNFL and the disease parameters.ConclusionOur findings suggest that OCT can be used to detect neurodegeneration in schizophrenia and that the GCL and IPL volumes can also be used to monitor the progression of neurodegeneration.
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Wicki CA, Manogaran P, Simic T, Hanson JVM, Schippling S. Bilateral retinal pathology following a first-ever clinical episode of autoimmune optic neuritis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e671. [PMID: 31969471 PMCID: PMC7051214 DOI: 10.1212/nxi.0000000000000671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This longitudinal study aimed to assess changes in retinal structure and visual function following a first-ever episode of acute optic neuritis (ON). METHODS Clinical and optical coherence tomography (OCT) data obtained over a period of 12 months were retrospectively analyzed in 41 patients with a first-ever clinical episode of acute ON. OCT scans, high-contrast visual acuity (HCVA), and low-contrast visual acuity (LCVA) were acquired at baseline and at 1, 3, 6, and 12 months thereafter. Macular ganglion cell and inner plexiform layer (GCIP), peripapillary retinal nerve fiber layer (pRNFL), and macular inner nuclear layer (INL) thicknesses were assessed by OCT. Linear mixed-effects models were used to analyze OCT variables of ipsilateral ON and contralateral non-ON (NON) eyes over time. RESULTS The mean change of GCIP thickness in ON eyes was significant at all follow-up time points, with nearly 75% of the total reduction having occurred by month 1. In ON eyes, thinner GCIP thickness at month 1 correlated with lower LCVA at month 3. Mean pRNFL thickness in ON eyes differed significantly from NON eyes at all postbaseline time points. INL thickness was significantly increased in ON eyes (month 1) but also in contralateral NON eyes (month 12). CONCLUSIONS Retinal structural damage develops rapidly following acute ON and is associated with subsequent functional visual deficits. Our results also suggest bilateral retinal pathology following unilateral ON, possibly caused by subclinical involvement of the contralateral NON eyes. Moreover, our data may assist in clinical trial planning in studies targeting tissue damage in acute ON.
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Affiliation(s)
- Carla A Wicki
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich.
| | - Praveena Manogaran
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
| | - Tanja Simic
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
| | - James V M Hanson
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
| | - Sven Schippling
- From the Department of Health Sciences and Technology (C.A.W.), Swiss Federal Institute of Technology; Neuroimmunology and Multiple Sclerosis Research (C.A.W., P.M., T.S., J.V.M.H., S.S.), Department of Neurology, University Hospital Zurich and University of Zurich; Department of Information Technology and Electrical Engineering (P.M.), Swiss Federal Institute of Technology; and Department of Ophthalmology (J.V.M.H.), University Hospital Zurich and University of Zurich
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15
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Albert C, Mikolajczak J, Liekfeld A, Piper SK, Scheel M, Zimmermann HG, Nowak C, Dörr J, Bellmann-Strobl J, Chien C, Brandt AU, Paul F, Hoffmann O. Fingolimod after a first unilateral episode of acute optic neuritis (MOVING) - preliminary results from a randomized, rater-blind, active-controlled, phase 2 trial. BMC Neurol 2020; 20:75. [PMID: 32126977 PMCID: PMC7052969 DOI: 10.1186/s12883-020-01645-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background Neuroprotection and promotion of remyelination represent important therapeutic gaps in multiple sclerosis (MS). Acute optic neuritis (ON) is a frequent MS manifestation. Based on the presence and properties of sphingosine-1-phosphate receptors (S1PR) on astrocytes and oligodendrocytes, we hypothesized that remyelination can be enhanced by treatment with fingolimod, a S1PR modulator currently licensed for relapsing-remitting MS. Methods MOVING was an investigator-driven, rater-blind, randomized clinical trial. Patients with acute unilateral ON, occurring as a clinically isolated syndrome or MS relapse, were randomized to 6 months of treatment with 0.5 mg oral fingolimod or subcutaneous IFN-β 1b 250 μg every other day. The change in multifocal visual evoked potential (mfVEP) latency of the qualifying eye was examined as the primary (month 6 vs. baseline) and secondary (months 3, 6 and 12 vs. baseline) outcome. In addition, full field visual evoked potentials, visual acuity, optical coherence tomography as well as clinical relapses and measures of disability, cerebral MRI, and self-reported visual quality of life were obtained for follow-up. The study was halted due to insufficient recruitment (n = 15), and available results are reported. Results Per protocol analysis of the primary endpoint revealed a significantly larger reduction of mfVEP latency at 6 months compared to baseline with fingolimod treatment (n = 5; median decrease, 15.7 ms) than with IFN-β 1b treatment (n = 4; median increase, 8.15 ms) (p < 0.001 for interaction). Statistical significance was maintained in the secondary endpoint analysis. Descriptive results are reported for other endpoints. Conclusion Preliminary results of the MOVING trial argue in support of a beneficial effect of fingolimod on optic nerve remyelination when compared to IFN-β treatment. Interpretation is limited by the small number of complete observations, an unexpected deterioration of the control group and a difference in baseline mfVEP latencies. The findings need to be confirmed in larger studies. Trial registration The trial was registered as EUDRA-CT 2011–004787-30 on October 26, 2012 and as NCT01647880 on July 24, 2012.
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Affiliation(s)
- Christian Albert
- Department of Neurology, Alexianer St. Josefs-Krankenhaus Potsdam, Allee nach Sanssouci 7, 14471, Potsdam, Germany
| | - Janine Mikolajczak
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Liekfeld
- Department of Ophthalmology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Michael Scheel
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Hanna G Zimmermann
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jan Dörr
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Oberhavel-Kliniken Hennigsdorf, Hennigsdorf, Germany
| | | | - Claudia Chien
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U Brandt
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, University of California, Irvine, CA, USA
| | - Friedemann Paul
- Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité-Universitätmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Olaf Hoffmann
- Department of Neurology, Alexianer St. Josefs-Krankenhaus Potsdam, Allee nach Sanssouci 7, 14471, Potsdam, Germany. .,Neurocure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany.
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Abstract
PURPOSE OF REVIEW This article discusses the clinical presentation, evaluation, and management of the patient with optic neuritis. Initial emphasis is placed on clinical history, examination, diagnostic testing, and medical decision making, while subsequent focus is placed on examining specific inflammatory optic neuropathies. Clinical clues, examination findings, neuroimaging, and laboratory testing that differentiate autoimmune, granulomatous, demyelinating, infectious, and paraneoplastic causes of optic neuritis are assessed, and current treatments are evaluated. RECENT FINDINGS Advances in technology and immunology have enhanced our understanding of the pathologies driving inflammatory optic nerve injury. Clinicians are now able to interrogate optic nerve structure and function during inflammatory injury, rapidly identify disease-relevant autoimmune targets, and deliver timely therapeutics to improve visual outcomes. SUMMARY Optic neuritis is a common clinical manifestation of central nervous system inflammation. Depending on the etiology, visual prognosis and the risk for recurrent injury may vary. Rapid and accurate diagnosis of optic neuritis may be critical for limiting vision loss, future neurologic disability, and organ damage. This article will aid neurologists in formulating a systematic approach to patients with optic neuritis.
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Wilbur C, Reginald YA, Longoni G, Grover SA, Wong AM, Mabbott DJ, Arnold DL, Marrie RA, Bar-Or A, Banwell B, Costello F, Yeh EA. Early neuroaxonal injury is seen in the acute phase of pediatric optic neuritis. Mult Scler Relat Disord 2019; 36:101387. [DOI: 10.1016/j.msard.2019.101387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 01/18/2023]
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MRI of acute optic neuritis (ON) at the first episode: Can we predict the visual outcome and the development of multiple sclerosis (MS)? Radiol Med 2019; 124:1296-1303. [DOI: 10.1007/s11547-019-01073-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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19
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Optical coherence tomography as a means to characterize visual pathway involvement in multiple sclerosis. Curr Opin Neurol 2019; 31:662-668. [PMID: 30074495 DOI: 10.1097/wco.0000000000000604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Optical coherence tomography (OCT) is a noninvasive in-vivo imaging tool that enables the quantification of the various retinal layer thicknesses. Given the frequent involvement of the visual pathway in multiple sclerosis, OCT has become an important tool in clinical practice, research and clinical trials. In this review, the role of OCT as a means to investigate visual pathway damage in multiple sclerosis is discussed. RECENT FINDINGS Evidence from recent OCT studies suggests that the peripapillary retinal nerve fibre layer (pRNFL) appears to be an ideal marker of axonal integrity, whereas the macular ganglion cell and inner plexiform layer (GCIP) thickness enables early detection of neuronal degeneration in multiple sclerosis. The thickness of the macular inner nuclear layer (INL) has been suggested as a biomarker for inflammatory disease activity and treatment response in multiple sclerosis. OCT parameters may also be used as an outcome measure in clinical trials evaluating the neuroprotective or regenerative potential of new treatments. SUMMARY OCT provides insights into multiple sclerosis beyond the visual pathway. It is capable of quantifying the major pathological hallmarks of the disease, specifically inflammation and neuroaxonal degeneration. OCT, therefore, has the potential to become another mainstay in the monitoring of multiple sclerosis patients.
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Nishioka C, Liang HF, Barsamian B, Sun SW. Sequential phases of RGC axonal and somatic injury in EAE mice examined using DTI and OCT. Mult Scler Relat Disord 2018; 27:315-323. [PMID: 30469023 DOI: 10.1016/j.msard.2018.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Clinical imaging modalities including optical coherence tomography (OCT) and diffusion tensor imaging (DTI) are vital in Multiple Sclerosis (MS), but their relationships during the different phases of Retinal ganglion cell (RGC) degeneration are not clear. We hypothesize that initial injury in optic nerve causes axonal degeneration leading to RGC loss in retina, which can be characterized by a combination of DTI and OCT. Our objective was to examine the correlation between noninvasive and histological data to chronicle the degeneration profile of RGCs in the retina and optic nerve in a mouse model of MS. MATERIALS AND METHODS Experimental Autoimmune Encephalomyelitis (EAE) was induced in 11 C57Bl/6 mice, with 8 mice reserved as controls. OCT and DTI was conducted 2-8 weeks after induction of EAE. The thickness of the retinal ganglion cell complex (GCC) was measured using OCT and compared to DTI indices measured in optic nerves. End-stage histology was used to quantify axon/myelin loss in the optic nerve and retinal thinning/RGC loss in the retina. RESULTS Significant changes in DTI-derived Axial Diffusivity (AD, -17.2%) and Trace Diffusivity (TR, -18.3%) began after 2 weeks of EAE. Later significant reductions in Fractional Anisotropy (FA) and AD, with increases in Radial Diffusion (RD) were apparent after 4 and 8 weeks. OCT-derived measures of GCC thickness were reduced after 4 weeks, and reached significant reduction after 8 weeks. Among EAE mice, DTI (FA, AD and RD measures) and OCT measures were all significantly correlated after 4 and 8 weeks. Among histology measures, RGC density (-23%), RGC size (-27%), and the number of SMI31+ axons (-54%) were reduced significantly. DTI measures of FA and AD along with GCC thinning were the best independent predictors of axon loss. CONCLUSIONS DTI and OCT measures are tightly correlated during the chronic phase of axonal degeneration (4-8 weeks) in EAE mice. After 8 weeks of EAE, both OCT and DTI measures are strong predictors of axon loss in the Optic Nerve.
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Affiliation(s)
- Christopher Nishioka
- Basic Sciences, School of Medicine, Loma Linda University, CA, United States; Neuroscience Graduate Program, University of California, Riverside, United States
| | - Hsiao-Fang Liang
- Basic Sciences, School of Medicine, Loma Linda University, CA, United States; Pharmaceutical Science, School of Pharmacy, Loma Linda University, CA, United States
| | - Barsam Barsamian
- Basic Sciences, School of Medicine, Loma Linda University, CA, United States; Neuroscience Graduate Program, University of California, Riverside, United States
| | - Shu-Wei Sun
- Basic Sciences, School of Medicine, Loma Linda University, CA, United States; Neuroscience Graduate Program, University of California, Riverside, United States; Pharmaceutical Science, School of Pharmacy, Loma Linda University, CA, United States.
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Yoo YJ, Hwang JM, Yang HK. Differences in pupillary light reflex between optic neuritis and ischemic optic neuropathy. PLoS One 2017; 12:e0186741. [PMID: 29049405 PMCID: PMC5648212 DOI: 10.1371/journal.pone.0186741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 10/08/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives To determine the differences in pupillary light reflex (PLR) between the acute and chronic phases of optic neuritis (ON) and nonarteritic anterior ischemic optic neuropathy (NAION). Methods The study included 30 patients with ON and 22 patients with NAION whose PLR were measured by a dynamic pupillometer (PLR-200; NeurOptics Inc., Irvine, USA). Age-matched controls included 58 healthy individuals with normal vision and optic nerve function. Pupil diameters, latency, constriction ratio, constriction velocity and dilation velocity were noted. The differences in PLR measurements were compared among the acute and chronic phases of ON and NAION, and in age-matched controls. Regression analysis determined factors associated with PLR measurements, including visual acuity, color vision defect, visual field defects and retinal nerve fiber layer thickness measurements on optical coherence tomography. Results Pupillary constriction velocity, constriction ratio and latency were all significantly decreased in the acute phase of ON and NAION. ON showed significantly delayed constriction latency compared to NAION (P = 0.047). Pupillary constriction velocity, constriction ratio and latency were recovered in the chronic phase of ON (P = 0.038, 0.018, and 0.045), however, these parameters were not recovered in NAION (P = 0.693, 0.173 and 0.994). Conclusions Pupillary constriction velocity, constriction ratio, and latency were significantly decreased in the acute phase of ON and NAION compared to normal controls. ON showed delayed constriction latency compared to NAION. Decreased PLR were recovered in the chronic phase of ON, but not in NAION.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Britze J, Pihl-Jensen G, Frederiksen JL. Retinal ganglion cell analysis in multiple sclerosis and optic neuritis: a systematic review and meta-analysis. J Neurol 2017; 264:1837-1853. [PMID: 28567539 DOI: 10.1007/s00415-017-8531-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to summarise existing findings regarding optical coherence tomography (OCT) measurements of ganglion cell layer (GCL) alterations in optic neuritis (ON) and multiple sclerosis (MS). Peer-reviewed studies published prior to April 2016 were searched using PubMed, EMBASE, Web of Science and Scopus. Studies were included if they measured GCL thickness using OCT in patients with either ON, MS or clinically isolated syndrome. For the meta-analysis, we compared GCL thickness in MS patients with and without prior ON, to healthy controls. 42/252 studies were reviewed. In acute ON, studies showed significant thinning of the GCL within the first 5 weeks (n = 5), earlier than retinal nerve fibre layer (RNFL) thinning. GCL thinning at 1-2 months after acute ON predicted visual function at 6 months (n = 3). The meta-analysis showed that the thickness of the GCL was significantly reduced in MS patients both with and without previous ON compared to healthy controls. GCL thinning was associated with visual function in most studies (n = 10) and expanded disability status scale (EDSS) scores (n = 6). In acute ON, thinning of the GCL is measurable prior to RNFL thinning, and GCL thickness after 1-2 months may predict visual function after 6 months. Furthermore, GCL thinning occurs in MS both with and without prior ON, and may be associated with visual function and EDSS score. This suggests that the GCL is a promising biomarker, which may be used to examine in vivo neurodegeneration in ON and MS.
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Affiliation(s)
- Josefine Britze
- Department of Neurology, Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark
| | - Gorm Pihl-Jensen
- Department of Neurology, Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark
| | - Jette Lautrup Frederiksen
- Department of Neurology, Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
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Gospe SM, Bhatti MT, El-Dairi MA. Emerging Applications of Optical Coherence Tomography in Pediatric Optic Neuropathies. Semin Pediatr Neurol 2017; 24:135-142. [PMID: 28941529 DOI: 10.1016/j.spen.2017.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Limited cooperation and attention span often lead to poorly reliable assessments of visual acuity and visual fields in children, making diagnosis and monitoring of pediatric optic neuropathies challenging. As a noninvasive imaging modality, optical coherence tomography (OCT) could offer particular utility in this patient population. OCT provides high-resolution characterization of the optic nerve head, peripapillary retinal nerve fiber layer, and cellular layers of the macula, all of which can be used to assess the severity of optic nerve disease qualitatively and quantitatively. Application of OCT to pediatric patients has been limited by technical factors and lack of pediatric normative databases, but with recent technological improvements and rapidly expanding research efforts OCT is poised to revolutionize the management of optic neuropathies in children. We review current and emerging applications of OCT to important pediatric optic neuropathies such as glaucoma, papilledema, optic neuritis, optic pathway gliomas, and congenital optic disc anomalies.
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Affiliation(s)
- Sidney M Gospe
- From the (*)Department of Ophthalmology, Duke University Medical Center, Durham, NC
| | - M Tariq Bhatti
- From the (*)Department of Ophthalmology, Duke University Medical Center, Durham, NC; (†)Department of Neurology, Duke University Medical Center, Durham, NC; (‡)Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - Mays A El-Dairi
- (‡)Department of Neurosurgery, Duke University Medical Center, Durham, NC.
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Nonglaucomatous Cupping: Fundus Photography and Spectral Domain Optical Coherence Tomography Imaging Features. J Neuroophthalmol 2016; 36:402-403. [DOI: 10.1097/wno.0000000000000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kupersmith MJ, Garvin MK, Wang JK, Durbin M, Kardon R. Retinal ganglion cell layer thinning within one month of presentation for optic neuritis. Mult Scler 2016; 22:641-8. [PMID: 26362894 PMCID: PMC5300035 DOI: 10.1177/1352458515598020] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spectral domain optical coherence tomography (SD-OCT) reveals retinal ganglion cell layer plus inner plexiform layer (GCL+IPL) and peripapillary retinal nerve fiber layer (pRNFL) thinning in chronic optic nerve injury. At presentation, swelling of the pRNFL confounds evaluation of early axon loss. OBJECTIVE We studied whether the GCL+IPL thins before the pRNFL, the trajectory of GCL+IPL loss and relationship to vision. METHODS We prospectively evaluated 33 eyes (study) with new optic neuritis, using perimetry and SD-OCT with investigative three-dimensional layer segmentation and commercial two-dimensional segmentation to compute the GCL+IPL and pRNFL thickness. RESULTS At presentation, GCL+IPL thickness (82.4±8.8 µm) did not differ from unaffected fellow eyes (81.2±6.7 µm), via the three-dimensional method, while the two-dimensional method failed in 9% of study eyes. At 1-2 months, there was thinning of the pRNFL in 10% and of the GCL+IPL in 93% of study eyes. GCL+IPL reduction was greatest during the first 2 months. GCL+IPL thinning at 1-2 months correlated with GCL+IPL thinning at 6 months (r=0.84, P=0.01) and presentation visual acuity (r=0.48, P=0.006) and perimetric mean deviation (r=0.52, P=0.003). CONCLUSION GGL+IPL is an early biomarker of structural injury in optic neuritis as thinning develops within 1-2 months of onset, prior to pRNFL thinning.
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Affiliation(s)
- Mark J Kupersmith
- New York Eye and Ear Infirmary, Mount Sinai Roosevelt Hospital, New York, USA
| | - Mona K Garvin
- Department of Electrical and Computer Engineering, University of Iowa, Iowa, USA/Department of Ophthalmology, Iowa University School of Medicine and Center for Prevention and Treatment of Visual Loss, Iowa, USA
| | - Jui-Kai Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa, USA
| | | | - Randy Kardon
- Department of Ophthalmology, Iowa University School of Medicine and Center for Prevention and Treatment of Visual Loss, Iowa, USA
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Jiramongkolchai K, Freedman SF, El-Dairi MA. Retinal Changes in Pediatric Glaucoma and Nonglaucomatous Optic Atrophy. Am J Ophthalmol 2016; 161:188-95.e1. [PMID: 26498891 DOI: 10.1016/j.ajo.2015.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the incidence and significance of retinal changes in pediatric eyes with glaucoma and nonglaucomatous optic atrophy by optical coherence tomography (OCT). DESIGN Retrospective observational case series. METHODS OCT scans performed on children with either glaucoma or nonglaucomatous optic atrophy were retrospectively reviewed. Excluded were poor-quality scans and diagnoses of ocular hypertension or glaucoma suspects. RESULTS Included were 227 eyes (227 children), 151 with glaucoma and 76 with nonglaucomatous optic atrophy. Outer retinal changes were present in 20 of 151 glaucoma eyes (13.2%) (12 prior intraocular surgery, 5 uveitis, 3 primary retinopathy) and 6 of 76 nonglaucomatous optic atrophy eyes (7.9%) (1 retinal vasculitis, 3 papilledema, 2 infiltrative optic neuropathy). Excluding eyes with outer retinal changes, isolated inner nuclear layer (INL) cysts were found in 6 of 131 eyes with glaucoma (4.6%) (3 uveitis, 1 prior hydrocephalus, 1 uveitis and pars plana vitrectomy, and 1 juvenile open-angle glaucoma) and 21 of 70 eyes with nonglaucomatous optic atrophy (30%) (5 optic neuritis, 11 anterior visual pathway tumors, 2 papilledema, 3 other) (P < .0001). Compared to eyes without INL cysts, those with INL cysts had thinner average retinal nerve fiber layer (RNFL) (78.2 ± 1.8 μm vs 52.0 ± 4.8 μm, P < .0001) and worse vision (logMAR = 0.33 ± 0.04 vs 0.65 ± 0.09, P < .002). CONCLUSIONS INL cysts are more frequent in pediatric nonglaucomatous optic atrophy than glaucoma; they are associated with worse vision and thinner RNFL. Outer retinal changes were exclusively seen in pathology that directly affected the retina. In children, INL cysts and/or outer retinal changes without prior history of intraocular surgery or uveitis should prompt further evaluation.
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McKee JB, Elston J, Evangelou N, Gerry S, Fugger L, Kennard C, Kong Y, Palace J, Craner M. Amiloride Clinical Trial In Optic Neuritis (ACTION) protocol: a randomised, double blind, placebo controlled trial. BMJ Open 2015; 5:e009200. [PMID: 26553836 PMCID: PMC4654308 DOI: 10.1136/bmjopen-2015-009200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Neurodegeneration is a widely accepted contributor to the development of long-term disability in multiple sclerosis (MS). While current therapies in MS predominantly target inflammation and reduce relapse rate they have been less effective at preventing long-term disability. The identification and evaluation of effective neuroprotective therapies within a trial paradigm are key unmet needs. Emerging evidence supports amiloride, a licenced diuretic, as a neuroprotective agent in MS through acid sensing ion channel blockade. Optic neuritis (ON) is a common manifestation of MS with correlates of inflammation and neurodegeneration measurable within the visual pathways. Amiloride Clinical Trial In Optic Neuritis (ACTION) will utilise a multimodal approach to assess the neuroprotective efficacy of amiloride in acute ON. METHODS AND ANALYSIS 46 patients will be recruited within 28 days from onset of ON visual symptoms and randomised on a 1:1 basis to placebo or amiloride 10 mg daily. Double-blinded treatment groups will be balanced for age, sex and visual loss severity by a random-deterministic minimisation algorithm. The primary objective is to demonstrate that amiloride is neuroprotective in ON as assessed by scanning laser polarimetry of the peripapillary retinal nerve fibre layer (RNFL) thickness at 6 months in the affected eye compared to the unaffected eye at baseline. RNFL in combination with further retinal measures will also be assessed by optical coherence tomography. Secondary outcome measures on brain MRI will include cortical volume, diffusion-weighted imaging, resting state functional MRI, MR spectroscopy and magnetisation transfer ratio. In addition, high and low contrast visual acuity, visual fields, colour vision and electrophysiology will be assessed alongside quality of life measures. ETHICS AND DISSEMINATION Ethical approval was given by the south central Oxford B research ethics committee (REC reference: 13/SC/0022). The findings from ACTION will be disseminated through peer-reviewed publications and at scientific conferences. TRIAL REGISTRATION NUMBER EudraCT2012-004980-39, ClinicalTrials.gov Identifier: NCT01802489.
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Affiliation(s)
- Justin B McKee
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - John Elston
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Nikos Evangelou
- Department of Clinical Neuroscience, University of Nottingham Medical School, Queens Medical Centre, Nottingham, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Lars Fugger
- Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Christopher Kennard
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Yazhuo Kong
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jacqueline Palace
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Matthew Craner
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Hadhoum N, Hodel J, Defoort-Dhellemmes S, Duhamel A, Drumez E, Zéphir H, Pruvo JP, Leclerc X, Vermersch P, Outteryck O. Length of optic nerve double inversion recovery hypersignal is associated with retinal axonal loss. Mult Scler 2015; 22:649-58. [PMID: 26227005 DOI: 10.1177/1352458515598021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/07/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the association between optic nerve double inversion recovery (DIR) hypersignal length and retinal axonal loss in neuroinflammatory diseases affecting optic nerves. METHODS We recruited patients previously affected (> 6 months) by a clinical episode of optic neuritis (ON). We had 25 multiple sclerosis (MS) patients, eight neuromyelitis optica spectrum disorder (NMOSD) patients and two patients suffering from idiopathic caused ON undergo brain magnetic resonance imaging (MRI); including a 3-dimensional (3D) DIR sequence, optical coherence tomography (OCT) examination and visual disability evaluation. Evaluation criteria were retinal thickness/volume, optic nerve DIR hypersignal length and high/low contrast vision acuity. RESULTS In the whole cohort, we found good associations (< 0.0001) between optic nerve DIR hypersignal length, peripapillary retinal nerve fiber layer thickness, inner macular layers volumes, and visual disability. We found subclinical radiological optic nerve involvement in 38.5% of non-ON MS eyes. CONCLUSIONS Optic nerve DIR hypersignal length may be a biomarker for retinal axonal loss, easily applicable in routine and research on new anti-inflammatory or neuroprotective drug evaluation. Detection of subclinical ON with 3D-DIR in a non-negligible proportion of MS patients argues in favor of optic nerve imaging in future OCT MS studies, in order to achieve a better understanding of retinal axonal loss in non-ON eyes.
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Affiliation(s)
- N Hadhoum
- Roger Salengro Hospital, University of Lille, Lille, France
| | - J Hodel
- Roger Salengro Hospital, University of Lille, Lille, France
| | | | - A Duhamel
- Department of Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Lille, France
| | - E Drumez
- Department of Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Lille, France
| | - H Zéphir
- Roger Salengro Hospital, University of Lille, Lille, France
| | - J P Pruvo
- Roger Salengro Hospital, University of Lille, Lille, France
| | - X Leclerc
- Roger Salengro Hospital, University of Lille, Lille, France
| | - P Vermersch
- Roger Salengro Hospital, University of Lille, Lille, France
| | - O Outteryck
- Roger Salengro Hospital, University of Lille, Lille, France
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Bennett JL, Nickerson M, Costello F, Sergott RC, Calkwood JC, Galetta SL, Balcer LJ, Markowitz CE, Vartanian T, Morrow M, Moster ML, Taylor AW, Pace TWW, Frohman T, Frohman EM. Re-evaluating the treatment of acute optic neuritis. J Neurol Neurosurg Psychiatry 2015; 86:799-808. [PMID: 25355373 PMCID: PMC4414747 DOI: 10.1136/jnnp-2014-308185] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/28/2014] [Indexed: 12/28/2022]
Abstract
Clinical case reports and prospective trials have demonstrated a reproducible benefit of hypothalamic-pituitary-adrenal (HPA) axis modulation on the rate of recovery from acute inflammatory central nervous system (CNS) demyelination. As a result, corticosteroid preparations and adrenocorticotrophic hormones are the current mainstays of therapy for the treatment of acute optic neuritis (AON) and acute demyelination in multiple sclerosis.Despite facilitating the pace of recovery, HPA axis modulation and corticosteroids have failed to demonstrate long-term benefit on functional recovery. After AON, patients frequently report visual problems, motion perception difficulties and abnormal depth perception despite 'normal' (20/20) vision. In light of this disparity, the efficacy of these and other therapies for acute demyelination require re-evaluation using modern, high-precision paraclinical tools capable of monitoring tissue injury.In no arena is this more amenable than AON, where a new array of tools in retinal imaging and electrophysiology has advanced our ability to measure the anatomic and functional consequences of optic nerve injury. As a result, AON provides a unique clinical model for evaluating the treatment response of the derivative elements of acute inflammatory CNS injury: demyelination, axonal injury and neuronal degeneration.In this article, we examine current thinking on the mechanisms of immune injury in AON, discuss novel technologies for the assessment of optic nerve structure and function, and assess current and future treatment modalities. The primary aim is to develop a framework for rigorously evaluating interventions in AON and to assess their ability to preserve tissue architecture, re-establish normal physiology and restore optimal neurological function.
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Affiliation(s)
- Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - Molly Nickerson
- Department of Medical Affairs, Questcor Pharmaceuticals, Inc., Hayward, California, USA
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Hotchkiss Brain Institute, Alberta, Canada
| | - Robert C Sergott
- Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA
| | | | - Steven L Galetta
- Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA
| | - Laura J Balcer
- Department of Neurology, Division of Neuro-Ophthalmology, NYU Langone Medical Center, New York, USA
| | - Clyde E Markowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy Vartanian
- Rockefeller University and Memorial Sloan-Kettering Hospital, Weill Cornell Medical College, New York, USA
| | - Mark Morrow
- Department of Neurology, Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Mark L Moster
- Neuro-Ophthalmology Service, Wills Eye Institute, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA
| | - Andrew W Taylor
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thaddeus W W Pace
- College of Nursing at the University of Arizona, Tucson, Arizona, USA
| | - Teresa Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elliot M Frohman
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Hwang YH, Song M, Kim YY, Yeom DJ, Lee JH. Interocular symmetry of retinal nerve fibre layer thickness in healthy eyes: a spectral-domain optical coherence tomographic study. Clin Exp Optom 2015; 97:550-4. [PMID: 25331078 DOI: 10.1111/cxo.12218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/19/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study was performed to investigate the interocular symmetry of peripapillary retinal nerve fibre layer (RNFL) thickness, as measured by Cirrus high-definition spectral-domain optical coherence tomography (OCT), in healthy eyes. A wide range of subject ages and refractive errors was examined. METHODS The retinal nerve fibre layer thickness was measured in 1,234 healthy eyes from 617 subjects using OCT. Interocular differences (right eye minus left eye) in global area and quadrant nerve fibre layer thicknesses were measured. The effect of age and refractive error on interocular nerve fibre layer thickness difference was also examined. RESULTS Means (and standard deviations) of subjects' ages and average subject refractive errors were 36.4 ± 19.8 years (range: five to 80 years) and -2.67 ± 2.91 D (range: -14.13 to +5.75 D), respectively. Cutoff limits for normal interocular nerve fibre layer thickness differences (2.5th and 97.5th percentiles of normative data) in the global area and in the superior, nasal, inferior and temporal quadrants were 9.5, 23.0, 15.6, 20.0 and 22.6 μm, respectively. Mean interocular retinal nerve fibre layer thickness differences in global area and in superior, nasal, inferior and temporal quadrants were 0.7 (p < 0.001), -3.9 (p < 0.001), 2.6 (p < 0.001), 1.1 (p = 0.007) and 3.0 (p < 0.001) μm, respectively. Interocular nerve fibre layer thickness differences were not significantly correlated with age or refractive error (average of right and left eyes, both p > 0.05). CONCLUSIONS Significant interocular differences in peripapillary retinal nerve fibre layer thickness exist in healthy eyes, particularly in the superior quadrant. This finding should be considered when comparing retinal nerve fibre layer thickness between right and left eyes.
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Affiliation(s)
- Young Hoon Hwang
- Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea
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Kupersmith MJ. Optical imaging of the optic nerve: beyond demonstration of retinal nerve fiber layer loss. J Neuroophthalmol 2015; 35:210-9. [PMID: 25893873 DOI: 10.1097/wno.0000000000000248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although we are still early in the evolution of optical imaging of the optic nerve, the available techniques already play an important role in clinical decision making. I would summarize our findings to date as follows: For acute ON: Presentation: OCT shows RNFL swelling, normal GCL + IPL by OCT; 1 month: OCT and SLP show RNFL thinning and swelling, GCL + IPL thinning by OCT; 3 months or later: OCT and SLP show RNFL thinning, further mild GCL thinning by OCT; 6 months: RNFL and GCL + IPL thinning finished. For acute NAION: Presentation: OCT shows RNFL swelling and SLP shows loss of birefringence, normal GCL + IPL by OCT; 1 month: RNFL swelling and thinning by OCT and thinning by SLP, GCL + IPL thinning by OCT; 3 months or later: RNFL and further mild GCL + IPL thinning; 6 months: RNFL and GCL + IPL thinning finished. For IIH Papilledema with mild vision loss: Presentation: OCT shows swelling of RNFL, TRT, and ONH volume; Presentation: OCT shows normal GCL + IPL; Presentation: OCT shows neural canal border inward deflection; 6 months: OCT shows structural shape changes reflecting the effectiveness of treatment.
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Affiliation(s)
- Mark J Kupersmith
- New York Eye and Ear Infirmary, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
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Agarwal N, Hanumunthadu D, Afrasiabi M, Malaguarnera G, Cordeiro MF. Clinical update in optic nerve disorders. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1003544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ramanathan S, Reddel SW, Henderson A, Parratt JDE, Barnett M, Gatt PN, Merheb V, Kumaran RYA, Pathmanandavel K, Sinmaz N, Ghadiri M, Yiannikas C, Vucic S, Stewart G, Bleasel AF, Booth D, Fung VSC, Dale RC, Brilot F. Antibodies to myelin oligodendrocyte glycoprotein in bilateral and recurrent optic neuritis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2014; 1:e40. [PMID: 25364774 PMCID: PMC4215392 DOI: 10.1212/nxi.0000000000000040] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 09/11/2014] [Indexed: 12/23/2022]
Abstract
Objective: We examined a cohort of adults with aquaporin-4 (AQP4) antibody–negative neuromyelitis optica/neuromyelitis optica spectrum disorder (NMO/NMOSD) for antibodies to myelin oligodendrocyte glycoprotein (MOG). Methods: We performed a flow cytometry cell-based assay using live human lentivirus–transduced cells expressing full-length surface MOG. Serum was tested in 23 AQP4 antibody–negative NMO/NMOSD patients with bilateral and/or recurrent optic neuritis (BON, n = 11), longitudinally extensive transverse myelitis (LETM, n = 10), and sequential BON and LETM (n = 2), as well as in patients with multiple sclerosis (MS, n = 76) and controls (n = 52). Results: MOG antibodies were detected in 9/23 AQP4 antibody–negative patients with NMO/NMOSD, compared to 1/76 patients with MS and 0/52 controls (p < 0.001). MOG antibodies were detected in 8/11 patients with BON, 0/10 patients with LETM, and 1/2 patients with sequential BON and LETM. Six of 9 MOG antibody–positive patients had a relapsing course. MOG antibody–positive patients had prominent optic disc swelling and were more likely to have a rapid response to steroid therapy and relapse on steroid cessation than MOG antibody–negative patients (p = 0.034 and p = 0.029, respectively). While 8/9 MOG antibody–positive patients had good follow-up visual acuity, one experienced sustained visual impairment, 3 had retinal nerve fiber layer thinning, and one had residual spinal disability. Conclusions: MOG antibodies have a strong association with BON and may be a useful clinical biomarker. MOG antibody–associated BON is a relapsing disorder that is frequently steroid responsive and often steroid dependent. Failure to recognize the disorder early and institute immunotherapy promptly may be associated with sustained impairment. Classification of evidence: This study provides Class II evidence that MOG antibodies are associated with AQP4 antibody–negative BON (sensitivity 69%, 95% confidence interval [CI] 42%–87%; specificity 99%, 95% CI 93.7%–99.8%).
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Affiliation(s)
| | | | | | | | | | | | - Vera Merheb
- Authors' affiliations are listed at the end of the article
| | | | | | - Nese Sinmaz
- Authors' affiliations are listed at the end of the article
| | - Mahtab Ghadiri
- Authors' affiliations are listed at the end of the article
| | - Con Yiannikas
- Authors' affiliations are listed at the end of the article
| | - Steve Vucic
- Authors' affiliations are listed at the end of the article
| | - Graeme Stewart
- Authors' affiliations are listed at the end of the article
| | | | - David Booth
- Authors' affiliations are listed at the end of the article
| | | | - Russell C Dale
- Authors' affiliations are listed at the end of the article
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Waldman AT, Hiremath G, Avery RA, Conger A, Pineles SL, Loguidice MJ, Talman LS, Galetta KM, Shumski MJ, Wilson J, Ford E, Lavery AM, Conger D, Greenberg BM, Ellenberg JH, Frohman EM, Balcer LJ, Calabresi PA. Monocular and binocular low-contrast visual acuity and optical coherence tomography in pediatric multiple sclerosis. Mult Scler Relat Disord 2014; 3:326-334. [PMID: 24683535 DOI: 10.1016/j.msard.2013.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Low-contrast letter acuity and optical coherence tomography (OCT) capture visual dysfunction and axonal loss in adult-onset multiple sclerosis (MS), and have been proposed as secondary outcome metrics for therapeutic trials. Clinical trials will soon be launched in pediatric MS, but such outcome metrics have not been well-validated in this population. OBJECTIVES To determine whether MS onset during childhood and adolescence is associated with measurable loss of visual acuity and thinning of the retinal nerve fiber layer (RNFL), whether such features are noted only in the context of clinical optic nerve inflammation (optic neuritis, ON) or are a feature of MS even in the absence of optic nerve relapses, and to define the optimal methods for such detection. STUDY DESIGN Cross-sectional study. METHODS Monocular and binocular high- and low-contrast letter acuity and contrast sensitivity were assessed in a cross-sectional cohort of children (ages 5 to 17 years) with MS (N=22 patients, 44 eyes; 8 patients with a history of ON) and disease-free controls (N=29 patients; 58 eyes) from three academic centers. Binocular summation was determined by calculating the number of letters correctly identified using the binocular score minus the better eye score for each visual test. RNFL thickness was measured using OCT (Stratus OCT-3). Results were analyzed in terms of "eyes" as: MS ON+, MS ON-, and control eyes. Generalized estimating equation (GEE) regression models were used to compare patients to controls. RESULTS Traditional high-contrast visual acuity scores did not differ between MS ON+, MS ON-, and controls eyes. MS ON+ eyes had decreased monocular (p<0.001) and decreased binocular (p=0.007) low-contrast letter acuity (Sloan 1.25% contrast charts) scores. Monocular visual acuity did not differ when comparing MS ON- and control eyes. The magnitude of binocular summation using low-contrast charts was similar for pediatric MS participants and controls and was not diminished in children with a history of ON. While the mean RNFL thickness for all MS eyes (103±17 μm) trended lower when compared to corresponding measures in control eyes (109±9 μm, p=0.085), we confirmed a highly significant reduction in mean RNFL thickness in MS eyes with a history of ON (86±22 μm, p<0.001). RNFL thickness of MS ON- eyes in pediatric MS patients (109±11 μm) did not differ from controls (p=0.994). CONCLUSIONS Low-contrast letter acuity detects subtle visual loss in MS patients with prior ON, consistent with incomplete recovery, a finding further supported by RNFL loss in ON affected eyes. In MS patients with prior unilateral ON, binocular acuity is decreased; however, the magnitude of binocular summation is preserved, unlike adult-onset MS who exhibit a reduced capacity for visual compensation in the context of unilateral injury. Also unlike findings in adult-onset MS, we did not demonstrate RNFL thinning in ON- eyes of children and adolescents with MS. Further validation is required to confirm whether neurodegeneration of visual pathways occurs in the absence of relapse, and thus whether OCT will serve as a sensitive metric for such pathology in the pediatric and adolescent MS context.
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Affiliation(s)
- Amy T Waldman
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Girish Hiremath
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Avery
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy Conger
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stacy L Pineles
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Michael J Loguidice
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lauren S Talman
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Kristin M Galetta
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Michael J Shumski
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - James Wilson
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - E'tona Ford
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy M Lavery
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Darrel Conger
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin M Greenberg
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonas H Ellenberg
- Department of Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura J Balcer
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania ; Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Peter A Calabresi
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
Acute optic neuritis is the most common optic neuropathy affecting young adults. Exciting developments have occurred over the past decade in understanding of optic neuritis pathophysiology, and these developments have been translated into treatment trials. In its typical form, optic neuritis presents as an inflammatory demyelinating disorder of the optic nerve, which can be associated with multiple sclerosis. Atypical forms of optic neuritis can occur, either in association with other inflammatory disorders or in isolation. Differential diagnosis includes various optic nerve and retinal disorders. Diagnostic investigations include MRI, visual evoked potentials, and CSF examination. Optical coherence tomography can show retinal axonal loss, which correlates with measures of persistent visual dysfunction. Treatment of typical forms with high-dose corticosteroids shortens the period of acute visual dysfunction but does not affect the final visual outcome. Atypical forms can necessitate prolonged immunosuppressive regimens. Optical coherence tomography and visual evoked potential measures are suitable for detection of neuroaxonal loss and myelin repair after optic neuritis. Clinical trials are underway to identify potential neuroprotective or remyelinating treatments for acutely symptomatic inflammatory demyelinating CNS lesions.
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Affiliation(s)
- Ahmed T Toosy
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK.
| | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - David H Miller
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK; Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK; New Zealand Brain Research Institute, University of Otago, Christchurch, New Zealand
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Zhang Y, Metz LM, Scott JN, Trufyn J, Fick GH, Costello F. MRI texture heterogeneity in the optic nerve predicts visual recovery after acute optic neuritis. NEUROIMAGE-CLINICAL 2014; 4:302-7. [PMID: 25061567 PMCID: PMC4107369 DOI: 10.1016/j.nicl.2014.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/20/2013] [Accepted: 01/06/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To test the feasibility of using multi-scale MRI texture analysis to assess optic nerve pathology and to investigate how visual recovery relates to the severity of acute tissue damage in the optic nerve in patients after optic neuritis (ON). MATERIALS AND METHODS We recruited 25 patients with acute ON. Retinal nerve fiber layer (RNFL) thickness; MRI lesion length and enhancement; optic nerve area ratio; and multi-scale MRI texture analysis, a measure of structural integrity, were used to assess tissue damage at baseline, and at 6 and 12 months. The recovery in vision was defined as the functional outcome. Eight healthy subjects were imaged for control. RESULTS We identified 25 lesions in the affected eyes (9 enhanced) and 5 in the clinically non-affected eyes (none enhanced). At baseline, we found that RNFL values were 20% thicker and lesion texture 14% more heterogeneous in the affected eyes than in the non-affected eyes, and lesion texture ratio of affected to non-affected eyes was greater in patients than in controls. In the affected eyes, visual acuity recovered significantly over 6 (18/23 patients) and 12 months (18/21 patients) when RNFL thickness and optic nerve area ratio decreased over time. Texture heterogeneity in the standard MRI of acute optic nerve lesions was the only measure that predicted functional recovery after ON. CONCLUSIONS Tissue heterogeneity may be a potential measure of functional outcome in ON patients and advanced analysis of the texture in standard MRI could provide insights into mechanisms of injury and recovery in patients with similar disorders.
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Affiliation(s)
- Yunyan Zhang
- Department of Radiology, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada ; Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada ; Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Luanne M Metz
- Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada ; Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - James N Scott
- Department of Radiology, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada ; Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Jessie Trufyn
- Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada ; Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Gordon H Fick
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Fiona Costello
- Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada ; Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
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Hata M, Miyamoto K, Oishi A, Kimura Y, Nakagawa S, Horii T, Yoshimura N. Measurement of retinal nerve fiber layer thickness in eyes with optic disc swelling by using scanning laser polarimetry and optical coherence tomography. Clin Ophthalmol 2014; 8:105-11. [PMID: 24379653 PMCID: PMC3872170 DOI: 10.2147/opth.s46769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The retinal nerve fiber layer thickness (RNFLT) in patients with optic disc swelling of different etiologies was compared using scanning laser polarimetry (SLP) and spectral-domain optical coherence tomography (OCT). Methods Forty-seven patients with optic disc swelling participated in the cross-sectional study. Both GDx SLP (enhanced corneal compensation) and Spectralis spectral-domain OCT measurements of RNFLT were made in 19 eyes with papilledema (PE), ten eyes with optic neuritis (ON), and 18 eyes with nonarteritic anterior ischemic optic neuropathy (NAION) at the neuro-ophthalmology clinic at Kyoto University Hospital. Differences in SLP (SLP-RNFLT) and OCT (OCT-RNFLT) measurements among different etiologies were investigated. Results No statistical differences in average OCT-RNFLT among PE, ON, and NAION patients were noted. Average SLP-RNFLT in NAION patients was smaller than in PE (P<0.01) or ON (P=0.02) patients. When RNFLT in each retinal quadrant was compared, no difference among etiologies was noted on OCT, but on SLP, the superior quadrant was thinner in NAION than in PE (P<0.001) or ON (P=0.001) patients. Compared with age-adjusted normative data of SLP-RNFLT, average SLP-RNFLT in PE (P<0.01) and ON (P<0.01) patients was greater. Superior SLP-RNFLT in NAION patients was smaller (P=0.026). The ratio of average SLP-RNFLT to average OCT-RNFLT was smaller in NAION than in PE (P=0.001) patients. Conclusion In the setting of RNFL thickening, despite increased light retardance in PE and ON eyes, SLP revealed that NAION eyes have less retardance, possibly associated with ischemic axonal loss.
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Affiliation(s)
- Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Miyamoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yugo Kimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoko Nakagawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Horii
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kupersmith MJ, Anderson S, Durbin M, Kardon R. Scanning laser polarimetry, but not optical coherence tomography predicts permanent visual field loss in acute nonarteritic anterior ischemic optic neuropathy. Invest Ophthalmol Vis Sci 2013; 54:5514-9. [PMID: 23838768 DOI: 10.1167/iovs.13-12253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Scanning laser polarimetry (SLP) reveals abnormal retardance of birefringence in locations of the edematous peripapillary retinal nerve fiber layer (RNFL), which appear thickened by optical coherence tomography (OCT), in nonarteritic anterior ischemic optic neuropathy (NAION). We hypothesize initial sector SLP RNFL abnormalities will correlate with long-term regional visual field loss due to ischemic injury. METHODS We prospectively performed automated perimetry, SLP, and high definition OCT (HD-OCT) of the RNFL in 25 eyes with acute NAION. We grouped visual field threshold and RNFL values into Garway-Heath inferior/superior disc sectors and corresponding superior/inferior field regions. We compared sector SLP RNFL thickness with corresponding visual field values at presentation and at >3 months. RESULTS At presentation, 12 eyes had superior sector SLP reduction, 11 of which had inferior field loss. Six eyes, all with superior field loss, had inferior sector SLP reduction. No eyes had reduced OCT-derived RNFL acutely. Eyes with abnormal field regions had corresponding SLP sectors thinner (P = 0.003) than for sectors with normal field regions. During the acute phase, the SLP-derived sector correlated with presentation (r = 0.59, P = 0.02) and with >3-month after presentation (r = 0.44, P = 0.02) corresponding superior and inferior field thresholds. CONCLUSIONS Abnormal RNFL birefringence occurs in sectors corresponding to regional visual field loss during acute NAION when OCT-derived RNFL shows thickening. Since the visual field deficits show no significant recovery, SLP can be an early marker for axonal injury, which may be used to assess recovery potential at RNFL locations with respect to new treatments for acute NAION.
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Affiliation(s)
- Mark J Kupersmith
- New York Eye and Ear Infirmary and INN at Roosevelt Hospital, New York, New York, USA.
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Kupersmith MJ, Anderson S, Kardon R. Predictive value of 1 month retinal nerve fiber layer thinning for deficits at 6 months after acute optic neuritis. Mult Scler 2013; 19:1743-8. [PMID: 23698127 DOI: 10.1177/1352458513485149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Retinal nerve fiber layer (RNFL) loss occurs with multiple sclerosis and after optic neuritis. Vision or RNFL changes at presentation of optic neuritis are not predictive of outcome, but vision loss at 1 month correlates with vision deficits at 6 months. We hypothesized that RFNL thinning at 1 month would predict RNFL loss at 6 months. METHODS We prospectively studied the RNFL by optical coherence tomography (OCT) and scanning laser polarimetry (SLP), and determined the threshold field mean deviation, in 25 subjects with acute optic neuritis over a 6-month period. RNFL values, including the amount of thinning at 1-month, were correlated with 6-month outcome. RESULTS Baseline visual performance and RNFL values were similar for eyes grouped by 1 month RNFL thinning. Eyes with 1 month RNFL thinning had greater and significant RNFL thinning at 6 months, for all quadrants by OCT and for the nasal and inferior quadrants by SLP. RNFL thinning by OCT and SLP at 1 month correlated with 6-month OCT (r = 0.58; p = 0.006) and SLP (r = 0.59; p = 0.002) RNFL thinning, respectively. CONCLUSION Early RNFL loss at 1 month was predictive of the RNFL thinning at 6 months, which corroborated the importance of the 1-month time point for predicting the outcome of an optic neuritis attack.
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Affiliation(s)
- Mark J Kupersmith
- Institute of Neurology and Neurosurgery (INN), Roosevelt Hospital, New York, NY, USA
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Oliveira C, Cestari DM, Rizzo JF. The use of fourth-generation optical coherence tomography in multiple sclerosis: a review. Semin Ophthalmol 2013; 27:187-91. [PMID: 23163274 DOI: 10.3109/08820538.2012.708808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optical coherence tomography (OCT) has been routinely used to obtain high spatial resolution images of the retina and choroid non-invasively. Within the past decade, a fourth-generation OCT device using Fourier domain (FD) analysis has been developed that provides higher velocity and higher axial resolution images with better reproducibility than the previous generation time domain (TD) OCT technology. This review addresses the use of fourth-generation, FD ocular OCT in patients with multiple sclerosis.
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Affiliation(s)
- Cristiano Oliveira
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Kim JJ, Im JC, Shin JP, Kim IT, Park DH. Two Cases of Long-Term Changes in the Retinal Nerve Fiber Layer Thickness after Intravitreal Bevacizumab for Diabetic Papillopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.9.1445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Jin Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Chan Im
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - In Taek Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Ho Park
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Kupersmith MJ, Kardon R, Durbin M, Horne M, Shulman J. Scanning laser polarimetry reveals status of RNFL integrity in eyes with optic nerve head swelling by OCT. Invest Ophthalmol Vis Sci 2012; 53:1962-70. [PMID: 22410562 DOI: 10.1167/iovs.11-9339] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Optical coherence tomography (OCT) shows retinal nerve fiber layer (RNFL) thickening in optic nerve head (ONH) swelling, but does not provide information on acute axonal disruption. It was hypothesized that scanning laser polarimetry (SLP) compared with OCT might reveal the status of axon integrity and visual prognosis in acute RNFL swelling. METHODS Threshold perimetry, OCT, and SLP were used to prospectively study eyes with papilledema (24), optic neuritis (14), nonarteritic anterior ischemic optic neuropathy (NAION) (21), and ONH swelling (average RNFL value by OCT was above the 95th percentile of controls at presentation). Regional RNFL was judged reduced if the quadrant measurement was below the fifth percentile of controls. RESULTS At presentation, average RNFL by OCT was similar for eyes with papilledema and NAION (P = 0.97), and reduced for optic neuritis. Average RNFL by SLP was slightly increased for papilledema and optic neuritis, and reduced for NAION (P = 0.02) eyes. The RNFL by SLP was reduced in at least one quadrant in 1 eye with papilledema, 1 eye with optic neuritis, and in 13 eyes with NAION. In NAION eyes, quadrants with reduced SLP had corresponding visual field loss that did not recover. By one month, eyes with NAION showed RNFL thinning by OCT (7/17 eyes) and by SLP (14/16 eyes) in contrast to optic neuritis (by OCT, 0/12, P = 0.006; and by SLP, 1/12, P = 0.0004). CONCLUSIONS OCT and SLP revealed different aspects of RNFL changes associated with ONH swelling. OCT revealed thickening due to edema. SLP revealed a decrease in retardance in eyes with axonal injury associated with visual field loss, which is unlikely to recover.
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Affiliation(s)
- Mark J Kupersmith
- New York Eye and Ear Infirmary and INN at Roosevelt Hospital, New York, New York 10019, USA.
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Affiliation(s)
- Mays A El-Dairi
- Department of Ophthalmology, Duke University Eye Center, DUMC 3802, Durham, NC 27710, USA
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