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Optical coherence tomography differs in neuromyelitis optica compared with multiple sclerosis

From the Departments of Neurology (R.T.N., N.T.T., J.X., E.C.K., A.H.C.), Ophthalmology (J.S.), Radiology (S.-K.S.), and Biostatistics (K.T.), and Hope Center for Neurological Disorders (S.-K.S., A.H.C.), Washington University, St. Louis, MO.

Address correspondence and reprint requests to Dr. Robert T. Naismith, Neurology, Box 8111, 660 S. Euclid Ave., St. Louis, MO 63110 naismithr{at}neuro.wustl.edu.

Background: Neuromyelitis optica (NMO) is associated with destructive inflammatory lesions, resulting in necrosis and axonal injury. Disability from multiple sclerosis (MS) is due to a combination of demyelination and varying axonal involvement. Optical coherence tomography (OCT), by measuring retinal nerve fiber layer (RNFL) as a surrogate of axonal injury, has potential to discriminate between these two conditions.

Methods: Included were 22 subjects with NMO or NMO spectrum disorders and 47 with MS. Seventeen subjects with NMO and all with MS had a remote history of optic neuritis (ON) in at least one eye, at least 6 months before OCT. Linear mixed modeling was used to compare the two diagnoses for a given level of vision loss, while controlling for age, disease duration, and number of episodes of ON.

Results: After ON, NMO was associated with a thinner mean RNFL compared to MS. This was found when controlling for visual acuity (56.7 vs 66.6 µm, p = 0.01) or for contrast sensitivity (61.2 vs 70.3 µm, p = 0.02). The superior and inferior quadrants were more severely affected in NMO than MS.

Conclusions: Optic neuritis (ON) within neuromyelitis optica (NMO) is associated with a thinner overall average retinal nerve fiber layer compared to multiple sclerosis, with particular involvement of the superior and inferior quadrants. This suggests that NMO is associated with more widespread axonal injury in the affected optic nerves. Optical coherence tomography can help distinguish the etiology of these two causes of ON, and may be useful as a surrogate marker of axonal involvement in demyelinating disease.

Abbreviations: CIS = clinically isolated syndrome; CS = contrast sensitivity; EDSS = Expanded Disability Status Scale; MS = multiple sclerosis; NMO = neuromyelitis optica; OCT = optical coherence tomography; ON = optic neuritis; RNFL = retinal nerve fiber layer; VA = visual acuity.

Supported by grant UL1 RR024992 from the National Center for Research Resources (NCRR), a component of the NIH and NIH Roadmap for Medical Research. NIH funding included K23NS052430-01A1 (R.T.N.), K12RR02324902 (R.T.N.), K24 RR017100 (A.H.C.), CA1012 (A.H.C., S.-K.S.), and RG 3670 (S.-K.S.); National MS Society FG1782A1 (J.X.); and American Academy of Neurology Foundation Clinical Research Training Fellowship (E.C.K.). Dr. Cross was supported in part by the Manny and Rosalyn Rosenthal–Dr. John L. Trotter Chair in Neuroimmunology.

Disclosure: Dr. Naismith is a participant in clinical trials for Fampridine SR by Acorda Therapeutics. He has received consulting fees and speaking honoraria from Bayer Healthcare, Biogen Idec, and Teva Neurosciences. Research funding is through the NIH and National MS Society. Dr. Cross has received research funding, clinical trial funding, honoraria, or consulting fees from the NIH, National MS Society USA, Consortium of Multiple Sclerosis Centers, Genentech, Inc., Bayer Healthcare, Biogen-Idec, Teva Neuroscience, Acorda Therapeutics, Serono, Pfizer, and BioMS. Dr. Shepherd has received speaking honoraria from Pfizer. Drs. Xu, Klawiter, Trinkaus, and Song and Mr. Tutlam have no disclosures.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Received September 22, 2008. Accepted in final form November 25, 2008.

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				R. T. Naismith, N. T. Tutlam, J. Xu, J. B. Shepherd, E. C. Klawiter, S. -K. Song, and A. H. Cross Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis Neurology, July 7, 2009; 73(1): 46 - 52. [Abstract] [Full Text] [PDF]