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Bostan M, Li C, Sim YC, Bujor I, Wong D, Tan B, Ismail MB, Garhöfer G, Tiu C, Pirvulescu R, Schmetterer L, Popa-Cherecheanu A, Chua J. Combining retinal structural and vascular measurements improves discriminative power for multiple sclerosis patients. Ann N Y Acad Sci 2023; 1529:72-83. [PMID: 37656135 DOI: 10.1111/nyas.15060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Data on how retinal structural and vascular parameters jointly influence the diagnostic performance of detection of multiple sclerosis (MS) patients without optic neuritis (MSNON) are lacking. To investigate the diagnostic performance of structural and vascular changes to detect MSNON from controls, we performed a cross-sectional study of 76 eyes from 51 MS participants and 117 eyes from 71 healthy controls. Retinal macular ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thicknesses, and capillary densities from the superficial (SCP) and deep capillary plexuses (DCP) were obtained from the Cirrus AngioPlex. The best structural parameter for detecting MS was compensated RNFL from the optic nerve head (AUC = 0.85), followed by GCC from the macula (AUC = 0.79), while the best vascular parameter was the SCP (AUC = 0.66). Combining structural and vascular parameters improved the diagnostic performance for MS detection (AUC = 0.90; p<0.001). Including both structure and vasculature in the joint model considerably improved the discrimination between MSNON and normal controls compared to each parameter separately (p = 0.027). Combining optical coherence tomography (OCT)-derived structural metrics and vascular measurements from optical coherence tomography angiography (OCTA) improved the detection of MSNON. Further studies may be warranted to evaluate the clinical utility of OCT and OCTA parameters in the prediction of disease progression.
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Affiliation(s)
- Mihai Bostan
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Ophthalmology Emergency Hospital, Bucharest, Romania
| | - Chi Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Computer Science and Engineering, Nanyang Technological University, Singapore
| | - Yin Ci Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Inna Bujor
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
| | - Munirah Binte Ismail
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Cristina Tiu
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, Emergency University Hospital, Bucharest, Romania
| | - Ruxandra Pirvulescu
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Alina Popa-Cherecheanu
- Department of Ophthalmology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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Al-Nosairy KO, Duscha A, Buhr H, Lipp A, Desel C, Hegelmaier T, Thieme H, Haghikia A, Hoffmann MB. Functional and structural readouts for early detection of retinal involvement in multiple sclerosis. Front Integr Neurosci 2023; 17:1158148. [PMID: 37138797 PMCID: PMC10150010 DOI: 10.3389/fnint.2023.1158148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The retina, a window into the brain, allows for the investigation of many disease-associated inflammatory and neurodegenerative changes affecting the central nervous system (CNS). Multiple sclerosis (MS), an autoimmune disease targeting the CNS, typically impacts on the visual system including the retina. Hence, we aimed to establish innovative functional retinal measures of MS-related damage, e.g., spatially resolved non-invasive retinal electrophysiology, backed by established morphological retinal imaging markers, i.e., optical coherence tomography (OCT). Methods 20 healthy controls (HC) and 37 people with MS [17 without history of optic neuritis (NON) and 20 with (HON) history of optic neuritis] were included. In this work, we differentially assessed photoreceptor/bipolar cells (distal retina) and retinal ganglion cell (RGC, proximal retina) function besides structural assessment (OCT). We compared two multifocal electroretinography-based approaches, i.e., the multifocal pattern electroretinogram (mfPERG) and the multifocal electroretinogram to record photopic negative response (mfERG PhNR ). Structural assessment utilized peripapillary retinal nerve fiber layer thickness (pRNFL) and macular scans to calculate outer nuclear thickness (ONL) and macular ganglion cell inner plexiform layer thickness (GCIPL). One eye was randomly selected per subject. Results In NON, photoreceptor/bipolar cell layer had dysfunctional responses evidenced by reduced mfERG PhNR -N1 peak time of the summed response, but preserved structural integrity. Further, both NON and HON demonstrated abnormal RGC responses as evidenced by the photopic negative response of mfERG PhNR (mfPhNR) and mfPERG indices (P < 0.05). Structurally, only HON had thinned retina at the level of RGCs in the macula (GCIPL, P < 0.01) and the peripapillary area (pRNFL, P < 0.01). All three modalities showed good performance to differentiate MS-related damage from HC, 71-81% area under curve. Conclusion In conclusion, while structural damage was evident mainly for HON, functional measures were the only retinal read-outs of MS-related retinal damage that were independent of optic neuritis, observed for NON. These results indicate retinal MS-related inflammatory processes in the retina prior to optic neuritis. They highlight the importance of retinal electrophysiology in MS diagnostics and its potential as a sensitive biomarker for follow-up in innovative interventions.
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Affiliation(s)
- Khaldoon O. Al-Nosairy
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
- *Correspondence: Khaldoon O. Al-Nosairy,
| | - Alexander Duscha
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Henrike Buhr
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
| | - Antonia Lipp
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christiane Desel
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Tobias Hegelmaier
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Hagen Thieme
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Michael B. Hoffmann
- Department of Ophthalmology, University Hospital Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
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KILIÇPARLAR CENGİZ E, AKÇALI A, EKMEKYAPAR FIRAT Y, ÖZTÜRKMEN C, ÇOMRUK G. Is there a relationship between the ganglion cell complex thickness and macular thickness in patients with multiple sclerosis? MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1024136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Optic neuritis (ON) is the most common ocular finding of multiple sclerosis (MS). ON can cause axonal loss and abnormalities in both optical coherence tomography (OCT) parameters and visual evoked potentials (VEPs). In this study, the retinal fiber layer (RNFL), ganglion cell complex (GCC) and macular thicknesses were measured with OCT and compared between MS cases with and without a clinical history of ON and healthy individuals. In addition, it was examined whether these values were correlated with VEP and clinical findings and whether they could be used as a marker of axonal loss.
Method: The study included 49 patients with MS (98 eyes) and 30 healthy controls (60 eyes) aged 18-55 years. Visual acuity and color vision, VEP measurement, and OCT measurement were evaluated.
Results and Conclusion: The RNFL, foveal and macular thickness were found to be smaller among the patients with a history of ON than those without this history and the control group. The RNFL, GCC, foveal and macular thicknesses can be interchangeably used to show the relationship between axonal degeneration and optic nerve involvement in the course of MS.
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Ciftci Kavaklioglu B, Erdman L, Goldenberg A, Kavaklioglu C, Alexander C, Oppermann HM, Patel A, Hossain S, Berenbaum T, Yau O, Yea C, Ly M, Costello F, Mah JK, Reginald A, Banwell B, Longoni G, Ann Yeh E. Machine learning classification of multiple sclerosis in children using optical coherence tomography. Mult Scler 2022; 28:2253-2262. [PMID: 35946086 DOI: 10.1177/13524585221112605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In children, multiple sclerosis (MS) is the ultimate diagnosis in only 1/5 to 1/3 of cases after a first episode of central nervous system (CNS) demyelination. As the visual pathway is frequently affected in MS and other CNS demyelinating disorders (DDs), structural retinal imaging such as optical coherence tomography (OCT) can be used to differentiate MS. OBJECTIVE This study aimed to investigate the utility of machine learning (ML) based on OCT features to identify distinct structural retinal features in children with DDs. METHODS This study included 512 eyes from 187 (neyes = 374) children with demyelinating diseases and 69 (neyes = 138) controls. Input features of the analysis comprised of 24 auto-segmented OCT features. RESULTS Random Forest classifier with recursive feature elimination yielded the highest predictive values and identified DDs with 75% and MS with 80% accuracy, while multiclass distinction between MS and monophasic DD was performed with 64% accuracy. A set of eight retinal features were identified as the most important features in this classification. CONCLUSION This study demonstrates that ML based on OCT features can be used to support a diagnosis of MS in children.
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Affiliation(s)
- Beyza Ciftci Kavaklioglu
- Neuroscience and Mental Health Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada/Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lauren Erdman
- Department of Computer Science, University of Toronto, Toronto, ON, Canada; Vector Institute, Toronto, ON, Canada
| | - Anna Goldenberg
- Department of Computer Science, University of Toronto, Toronto, ON, Canada; Vector Institute, Toronto, ON, Canada/Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Can Kavaklioglu
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada
| | - Cara Alexander
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Hannah M Oppermann
- Department of Computer Science, University of Toronto, Toronto, ON, Canada/Department of Information and Computing Sciences, Utrecht University, Utrecht, the Netherlands
| | - Amish Patel
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Soaad Hossain
- Department of Computer Science, University of Toronto, Toronto, ON, Canada/Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada/Environics Analytics, Toronto, ON, Canada
| | - Tara Berenbaum
- Division of Neurology, Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Olivia Yau
- Division of Neurology, Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carmen Yea
- Division of Neurology, Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mina Ly
- Division of Neurology, Department of Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fiona Costello
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada/Department of Surgery (Ophthalmology), University of Calgary, Calgary, AB, Canada
| | - Jean K Mah
- Department Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Arun Reginald
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada/Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Brenda Banwell
- Division of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giulia Longoni
- SickKids Research Institute, Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada/Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada/Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- SickKids Research Institute, Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada/Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada/Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Neuroscience and Mental Health Program, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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Microvascular changes in the macular and parafoveal areas of multiple sclerosis patients without optic neuritis. Sci Rep 2022; 12:13366. [PMID: 35922463 PMCID: PMC9349324 DOI: 10.1038/s41598-022-17344-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023] Open
Abstract
Retinal imaging has been proposed as a biomarker for neurological diseases such as multiple sclerosis (MS). Recently, a technique for non-invasive assessment of the retinal microvasculature called optical coherence tomography angiography (OCTA) was introduced. We investigated retinal microvasculature alterations in participants with relapsing–remitting MS (RRMS) without history of optic neuritis (ON) and compared them to a healthy control group. The study was performed in a prospective, case–control design, including 58 participants (n = 100 eyes) with RRMS without ON and 78 age- and sex-matched control participants (n = 136 eyes). OCTA images of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) were obtained using a commercial OCTA system (Zeiss Cirrus HD-5000 Spectral-Domain OCT with AngioPlex OCTA, Carl Zeiss Meditec, Dublin, CA). The outcome variables were perfusion density (PD) and foveal avascular zone (FAZ) features (area and circularity) in both the SCP and DCP, and flow deficit in the CC. MS group had on average higher intraocular pressure (IOP) than controls (P < 0.001). After adjusting for confounders, MS participants showed significantly increased PD in SCP (P = 0.003) and decreased PD in DCP (P < 0.001) as compared to controls. A significant difference was still noted when large vessels (LV) in the SCP were removed from the PD calculation (P = 0.004). Deep FAZ was significantly larger (P = 0.005) and less circular (P < 0.001) in the eyes of MS participants compared to the control ones. Neither LV, PD or FAZ features in the SCP, nor flow deficits in the CC showed any statistically significant differences between the MS group and control group (P > 0.186). Our study indicates that there are microvascular changes in the macular parafoveal retina of RRMS patients without ON, showing increased PD in SCP and decreased PD in DCP. Further studies with a larger cohort of MS patients and MRI correlations are necessary to validate retinal microvascular changes as imaging biomarkers for diagnosis and screening of MS.
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