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From the Departments of Neurology (R.T.N., N.T.T., J.X., E.C.K., A.H.C.), Ophthalmology (J.B.S.), and Radiology (S.-K.S.), Washington University, Saint 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
Objectives: Determine the utility of optical coherence tomography (OCT) to detect clinical and subclinical remote optic neuritis (ON), its relationship to clinical characteristics of ON and visual function, and whether the retinal nerve fiber layer (RNFL) thickness functions as a surrogate marker of global disease severity.
Methods: Cross-sectional study of 65 subjects with at least 1 clinical ON episode at least 6 months prior. Measures included clinical characteristics, visual acuity (VA), contrast sensitivity (CS), OCT, and visual evoked potentials (VEP).
Results: Ninety-six clinically affected optic nerves were studied. The sensitivity of OCT RNFL after ON was 60%, decreasing further with mild onset and good recovery. VEP sensitivity was superior at 81% (p = 0.002). Subclinical ON in the unaffected eye was present in 32%. VEP identified 75% of all subclinically affected eyes, and OCT identified <20%. RNFL thickness demonstrated linear correlations with VA (r = 0.65) and CS (r = 0.72) but was unable to distinguish visual categories <20/50. RNFL was thinner with severe onset and disease recurrence but was unaffected by IV glucocorticoids. OCT measurements were not related to overall disability, ethnicity, sex, or age at onset. The greatest predictor for RNFL in the unaffected eye was the RNFL in the fellow affected eye.
Conclusions: Visual evoked potentials (VEP) remains the preferred test for detecting clinical and subclinical optic neuritis. Optical coherence tomography (OCT) measures were unrelated to disability and demographic features predicting a worse prognosis in multiple sclerosis. OCT may provide complementary information to VEP in select cases, and remains a valuable research tool for studying optic nerve disease in populations.
Abbreviations: ANOVA = analysis of variance; CIS = clinically isolated syndrome; CS = contrast sensitivity; EDSS = Expanded Disability Status Score; logMAR = logarithm of the minimum angle of resolution; MS = multiple sclerosis; MSSS = Multiple Sclerosis Severity Score; NCRR = National Center for Research Resources; NMO = neuromyelitis optica; NS = not significant; OCT = optical coherence tomography; ON = optic neuritis; RNFL = retinal nerve fiber layer; VA = visual acuity; VEP = visual evoked potentials.
NIH funding included K23NS052430-01A1 (R.T.N.), K12RR02324902 (R.T.N.), UL1RR024992 (E.C.K.), K24 RR017100 (A.H.C.), and CA1012 (A.H.C.). National Multiple Sclerosis Society funding included FG1782A1 (J.X.), CA1012 (A.H.C., S.-K.S.), and RG 3670 (S.-K.S.). A.H.C. was supported in part by the Manny and Rosalyn Rosenthal–Dr. John L. Trotter Chair in Neuroimmunology. American Academy of Neurology Foundation Clinical Research Training Fellowship (E.C.K.).
This publication was made possible by grant UL1 RR024992 from the National Center for Research Resources (NCRR), a component of the NIH and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
Disclosure: Author disclosures are provided at the end of the article.
Received December 18, 2008. Accepted in final form April 1, 2009.
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