Changes In Retinal Nerve Fiber Layer Research Articles

Cross-sectional study of smoking exposure: no differential effect on OCT metrics in a cohort of MS patients

BackgroundOptical coherence tomography (OCT) provides quantitative measures of retinal layer thickness. Cigarette smoking is a risk factor for multiple sclerosis (MS) onset and disease severity: its effects on OCT metrics have not been assessed.ObjectiveThe objective of this study was to assess the effect of smoking history on retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform (GCIP) of MS patients by OCT.Methods112 MS patients were recruited from the Brigham and Women’s Hospital. Spectralis OCT scans were acquired to measure GCIP, peripapillary RNFL, and total macular volume. Multivariable linear mixed effects regression model assessed RNFL and GCIP change with fixed effects for smoking history while adjusting for optic neuritis eye status, age, disease duration, sex, baseline EDSS, and disease modifying therapies (DMTs).ResultsSmoking histories were available for 102 patients: 46 (45.10%) had a history of smoking cigarettes and 56 (54.90%) never smoked. No statistically significant differences were found between ever-smokers and never-smokers with respect to GCIP, RNFL, and macular volume.ConclusionOur study shows no significant difference in retinal thickness between ever-smokers and never-smokers. If confirmed, this result suggests mechanistic differences between the retina and other central nervous system (CNS) compartments in response to smoking and should be noted when considering OCT as a surrogate measure of CNS activity.

Effect of panretinal photocoagulation on the peripapillary retinal nerve fiber layer in diabetic retinopathy patients

OBJECTIVES:To determine the effect of panretinal photocoagulation (PRP) on the peripapillary retinal nerve fiber layer (RNFL) in nonglaucomatous patients with proliferative diabetic retinopathy (PDR).METHODS:This is a prospective, single center, observational study. Thirty-eight eyes of 26 diabetic patients underwent PRP for proliferative diabetic retinopathy. Peripapillary RNFL thickness was measured using scanning laser polarimetry (SLP) with variable corneal compensation (GDx VCC; by Carl Zeiss Meditec, Dublin, CA) and spectral-domain optical coherence tomography (OCT) (Heidelberg Spectralis, Carlsbad, USA) at baseline and 12 months after PRP was performed.RESULTS:Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 years (range 26 to 74 years) were recruited. No significant difference was found among all RNFL thickness parameters tested by GDx VCC software (p=0.952, 0.464 and 0.541 for temporal-superior-nasal-inferior-temporal (TSNIT) average, superior average, inferior average, respectively). The nerve fiber indicator (NFI) had a nonsignificant increase (p=0.354). The OCT results showed that the average RNFL thickness (360° measurement) decreased nonsignificantly from 97.2 mm to 96.0 mm at 1 year post-PRP (p=0.469). There was no significant difference when separately analyzing all the peripapillary sectors (nasal superior, temporal superior, temporal, temporal inferior, nasal inferior and nasal thickness).CONCLUSION:Our results suggest that PRP, as performed in our study, does not cause significant changes in peripapillary RNFL in diabetic PDR patients after one year of follow-up.

Progressive Optic Disc Tilt in Young Myopic Glaucomatous Eyes.

PurposeTo explore the progressive change and associated factors of optic disc tilt in young myopic glaucomatous eyes by analyzing long-term follow-up data.MethodsOptic disc images were obtained from spectral-domain optical coherence tomography enhanced depth imaging from at least five different visits. At each visit, the disc tilt angle (DTA), defined as the angle between the Bruch's membrane opening plane and the optic canal plane, was estimated at the central frame that passes through the optic disc. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field (VF). A linear mixed effect model was used to assess the influence of parameters (age, sex, baseline and follow-up intraocular pressure, retinal nerve fiber layer thickness, VF mean deviation, axial length, central corneal thickness), and presence of glaucomatous progression upon DTA change.ResultsA total of 26 eyes of 26 young myopic primary open-angle glaucoma patients (axial length >24.0 mm; mean age, 25.1 ± 4.0 years; mean follow-up, 3.3 ± 0.9 years) were included. DTA was 7.0 ± 3.4 degrees at baseline and 8.3 ± 3.8 degrees at last visit, which represents a significant difference (p < 0.001). Worse VF mean deviation (p < 0.001) and longer axial length (p = 0.006) were significantly associated with DTA increase.ConclusionsYoung myopic glaucomatous eyes showed progressive optic disc tilting. Progressive optic disc tilting in young myopic glaucomatous eyes may be related to either continuous axial myopic shift or glaucomatous structural change.

Effect of Antiplatelet/Anticoagulant Use on Glaucoma Progression in Eyes With Optic Disc Hemorrhage.

To assess whether the use of antiplatelets (APs)/anticoagulants (ACs) affects glaucoma progression in eyes with optic disc hemorrhage (DH). One hundred and nineteen eyes from 119 patients with primary open-angle glaucoma in whom a DH was observed at least once during the follow-up period (mean follow-up duration: 6.2 y) were included in this retrospective observational study. Cox proportional hazard models were used to identify the association between putative factors, including AP/AC use, and glaucoma progression. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field. Nineteen of the 119 patients took AP/AC drugs daily [AP/AC use group (AG)], while the others did not [no use group (NG)]. The follow-up period to progression was significantly different between the 2 groups (61.2±23.5 mo for the AG and 47.6±22.0 mo for the NG; P=0.016). Kaplan-Meier analysis revealed a greater cumulative probability of glaucoma progression in the NG than in the AG, with borderline statistical significance (P=0.081). Higher mean intraocular pressure during the follow-up period was a risk factor for glaucoma progression (hazard ratio, 1.107; P=0.014), while AP/AC drug use protected against glaucoma progression (hazard ratio, 0.576; P=0.046). According to our result, use of AP/AC drugs was associated with lower risk of glaucoma progression in eyes with DH.

Steroids versus No Steroids in Nonarteritic Anterior Ischemic Optic Neuropathy: A Randomized Controlled Trial

To examine the role of oral steroid therapy in the treatment of nondiabetic cases of acute nonarteritic anterior ischemic optic neuropathy (NAAION). Randomized double-blind clinical trial. Thirty-eight patients with acute nondiabetic NAAION divided into 2 arms of 19 patients each. One arm constituted the cases and the other constituted the controls. Cases received oral steroid therapy and were designated the steroid group, whereas controls received placebo and were designated the nonsteroid group. Best-corrected visual acuity (BCVA), visual evoked response (VER), and OCT were performed at baseline, 1 month, 3 months, and 6 months after recruitment into thetrial. Best-corrected visual acuity, VER, and retinal nerve fiber layer changes on OCT. Both groups showed significant improvement in BCVA, VER latency, and resolution of disc edema on OCT parameters over 6 months. Final outcome showed no statistically significant difference with regard to visual acuity, although VER was better in the steroid group (P= 0.011). Best-corrected visual acuity, VER amplitude, and VER latency (P= 0.02, P= 0.02, and P= 0.04, respectively) showed a greater percentage improvement in the steroid group, which also saw a faster resolution of disc edema on OCT (1-month follow-up). Oral steroids in acute NAAION did not improve the visual acuity significantly at 6 months. However, they improved resolution of disc edema significantly and enabled a greater improvement in VER parameters. This subtle benefit of oral steroids in NAAION is clinically unimportant and does not provide support for its use.

The relationship between age, axial length and retinal nerve fiber layer thickness in the normal elderly population in Taiwan: The Chiayi eye study in Taiwan.

AimsTo interpret how the thickness of the peripapillary retinal nerve fiber layer (RNFL) changes with increasing age, axial length, or anterior chamber depth as measured by spectral domain optical coherence tomography (OCT) in the normal elderly population in Taiwan.MethodsA total of 82 volunteers (143 eyes) were enrolled. Generalized estimating equations were used to evaluate the correlation.ResultsThe RNFL was significantly thinner in the superonasal (p = 0.004), inferotemporal (p = 0.046), and temporolower (p = 0.009) segments with age. The same trend was also observed in the superotemporal (p = 0.330) segment, although it was not statistically significant. The global RNFL thickness decreased by 4.97 μm per decade (β = -0.497; p = 0.021), and thinning was significant in the superonasal (-9.90 μm per decade, p < 0.001) and temporolower (-6.78 μm per decade, p < 0.001) segments; the same trend showed borderline significance in the superotemporal (-6.96 μm per decade, p = 0.073) and inferotemporal (-7.23 μm per decade, p = 0.059) segments. In eyes with longer axial length, the RNFLs significantly decreased in the non-temporal segments. Global RNFL thickness decreased by 3.086 μm for each additional millimeter of axial length (β = -3.086; p < 0.001).ConclusionsChanges in RNFL thickness were correlated with age in the superonasal, superotemporal, inferotemporal, and temporolower segments, and were correlated with axial length in the non-temporal segments. Anterior chamber depth was not correlated with RNFL thickness.

Detecting Glaucomatous Progression With a Region-of-Interest Approach on Optical Coherence Tomography: A Signal-to-Noise Evaluation.

PurposeTo compare two region-of-interest (ROI) approaches and a global thickness approach for capturing progressive circumpapillary retinal nerve fiber layer (cpRNFL) changes on optical coherence tomography (OCT) imaging.MethodsProgressive cpRNFL thickness changes were evaluated in 164 eyes with a clinical diagnosis of glaucoma or suspected glaucoma; all eyes underwent optic disc OCT imaging on two visits at least 1 year apart. Such changes were evaluated with a manual ROI approach (ROIM), which involved manual identification of region(s) of observed or suspected glaucomatous damage. The ROIM was compared with an automatic ROI approach (ROIA), where regions were automatically identified if the cpRNFL thickness fell below the 1% lower normative limits, and to global cpRNFL thickness. These methods were compared using longitudinal signal-to-noise ratios (SNRs), calculated based upon individualized estimates of measurement variability and age-related changes for each ROI, obtained from 321 glaucoma eyes and 394 healthy eyes, respectively.ResultsThe average longitudinal SNR of the ROIM, ROIA and global thickness methods were −0.46, −0.39, and −0.30 y−1, respectively. The average longitudinal SNR for the ROIM was significantly more negative compared with both the ROIA and global thickness methods (P = 0.005 for both).ConclusionsA manual ROI approach was the optimal method for detecting progressive cpRNFL loss compared with an automatic ROI approach and the global cpRNFL thickness measure.Translational RelevanceThese findings highlight the potential advantages conferred by a careful qualitative evaluation of OCT imaging for detecting glaucoma progression.

Retinal nerve fiber layer and ganglion cell layer changes on optical coherence tomography in early multiple sclerosis and optic neuritis cases.

Purpose:To study the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) changes on optical coherence tomography in early multiple sclerosis (MS) patients.Methods:A prospective cohort study was conducted at a tertiary care center. Patients of early MS (expanded disability status scale <3) with or without optic neuritis (ON) and idiopathic ON were included. Twenty age-matched individuals were taken as controls. Changes in RNFL and GCL thickness were evaluated along with the correlation with visual function parameters such as visual acuity, contrast sensitivity, and visual evoked response at first visit and again at six months.Results:Forty-four patients of MS with or without ON (24 and 20 patients respectively), 29 patients with idiopathic ON, and 20 healthy controls constituted the cohorts. Mean LogMAR best-corrected visual acuity was found to be significantly reduced in all groups except fellow eyes (FE) of ON group. Mean values of average RNFL thickness and values in superior, temporal, and inferior quadrant were significantly reduced. Similarly, overall mean values of average GCL-inner plexiform layer (IPL) thickness and values in superior, superonasal, superotemporal, inferonasal, and inferotemporal quadrant were significantly reduced in all groups except FE of ON group (P < 0.05). All the visual parameters significantly correlated with GCL + IPL thickness.Conclusion:GCL + IPL thickness is a more sensitive clinical structural marker than RNFL in early MS with/without ON and ON patients and correlates with all the visual parameters better than RNFL thickness.

Retinal Nerve Fiber Layer Changes Following Primary Retinal Detachment Repair with Silicone Oil Tamponade and Subsequent Oil Removal.

Purpose:To evaluate the correlation between the retinal nerve fiber layer (RNFL), particularly the temporal RNFL (TRNFL), and visual outcomes following surgery for rhegmatogenous retinal detachment (RRD).Methods:This retrospective study was performed at a tertiary center; 32 patients underwent single and successful vitrectomy for total RRD using silicone oil as tamponade. Data were collected after oil removal. RNFL thickness and central foveal thickness (CFT) were measured using spectral domain optical coherence tomography. RNFL thickness and CFT of normal eyes were acquired as a control to calculate percentage changes in the affected eyes. The correlation between postoperative best-corrected visual acuity (BCVA) and TRNFL changes was the primary outcome measure.Results:Postoperative BCVA correlated negatively with retinal detachment (RD) duration (Pearson coefficient 0.56, P = 0.001) and percentage loss in TRNFL thickness (Pearson Coefficient 0.41, P = 0.02). The macula lost the maximum RNFL thickness (26%). The mean percentage loss of TRNFL was significantly higher in patients with postoperative BCVA <6/60 (42.63% vs. 24.06%, P = 0.009). Patients with postoperative BCVA <6/60 had a significantly longer mean RD duration (29 days) than those with postoperative BCVA >6/60 (17.5 days) (P = 0.026).Conclusion:When eyes with RRD are successfully repaired using silicone oil tamponade, the thickness of the RNFL decreases, particularly in the macula, and less macular neuronal loss is associated with better visual outcomes.

Analysis of Retinal Nerve Fibre Layer Changes in Cases of Phacomorphic Angle Closure Post Phacoemulsification

Introduction: To investigate the retinal nerve fibre layer (RNFL) changes after an acute attack of phacomorphic angle closure. Methods: This prospective study involved 25 cases of phacomorphic angle closure that underwent phacoemulsification and intraocular lens insertion after intraocular pressure lowering. Apart from visual acuity and intraocular pressure (IOP), RNFL thickness was measured by optical coherence tomography (OCT) at 3–6 months post attack. Result: All cases had mean phacomorphic duration of <10 days. Postoperatively, best correct Snellen visual acuity was 0.42±0.23 and IOP at 6 months was 13.92 ± 2.41 mmHg. There was no difference RNFL between the attack and contralateral eye at 3 months post attack (both p = 0.102). At 6 months post attack, there was significant thinning in the average (p <0.001), superior (p =<0.001), and inferior (p = 0.001) RNFL. Patients with <5 days duration of phacomorphic angle closure are likely to have reasonable postoperative vision. Conclusion: An acute episode of phacomorphic angle closure can trigger an accelerated RNFL thinning despite normal IOP and open angles, most noticeable in the superior and inferior quadrants, occurring between 3 and 6 months post attack. There is a need of long term follow up of such patients.

Detecting Structural Progression in Glaucoma with Optical Coherence Tomography

Optical coherence tomography (OCT) is increasingly used to obtain objective measurements of the retinal nerve fiber layer (RNFL), optic nerve head, and macula for assessing glaucoma progression. Although OCT has been adopted widely in clinical practice, uncertainty remains concerning its optimal role. Questions include: What is the best structure to measure? What quantity of change is significant? Are structural changes relevant to the patient? How are longitudinal measurements affected by aging? How can changes resulting from aging be differentiated from true progression? How best should OCT be used alongside visual fields, and how often should OCT be performed? Recent studies have addressed some of these questions. Important developments include appreciation of the need to use a consistent point of reference for structural measurements, leading to the introduction of Bruch's membrane opening (BMO)-based measurements, including BMO-minimum rim width and BMO-minimum rim area. Commercially available OCT devices also permit analysis of macular changes over time, for example, changes in the ganglion cell and inner plexiform layers, the sites of the retinal ganglion cell bodies and dendrites, respectively. Several longitudinal studies have compared rates of change in RNFL and macular measurements, with some suggesting that the relative value of each parameter may differ at different stages of disease. In early disease, looking for change over time also may be useful for glaucoma diagnosis, with advantages over classifying eyes using cross-sectional normative databases. Optimal glaucoma management requires information from imaging and visual fields, and efforts have been made to combine information, reducing the noise inherent in both tests to benefit from their different performances according to the stage of disease. Combining information from different structural measurements may also be useful. There is now substantial evidence that progressive structural changes are of direct clinical relevance, with progressive changes on OCT often preceding functional loss and patients with faster change on OCT at increased risk of worsening visual losses. Identification of such patients offers the possibility of commencing or escalating treatment at an earlier stage. This review appraises recent developments in the use of OCT for assessing glaucoma progression.

No evidence of disease activity is associated with reduced rate of axonal retinal atrophy in MS.

To explore, in a longitudinal study, the usefulness of optical coherence tomography (OCT) in monitoring people with multiple sclerosis (MS) by testing the association between retinal nerve fiber layer (RNFL) thinning and clinical and brain MRI criteria of no evidence of disease activity (NEDA). OCT, visual evoked potentials (VEPs), and disability, using the Expanded Disability Status Scale (EDSS), were tested at baseline and after 2 years in 72 patients, 63 with routine yearly brain MRI. Longitudinal mean binocular RNFL thinning, in absence of optic neuritis during follow-up, was correlated with EDSS worsening, also controlling for baseline EDSS, RNFL, disease duration, and MS subtype (Spearman ρ -0.462, p < 0.001; partial correlation coefficient -0.437, p < 0.001). At follow-up, patients classified as NEDA (20; 31.7%) had RNFL loss of -0.93 μm ± 1.35 SD, while patients with active disease had -2.83 μm ± 2 SD thinning (t test; p < 0.001). At logistic regression, mean RNFL reduction correctly classified 76.2% of patients as NEDA at 2 years (R2 0.355; p = 0.003). A cutoff of -1.25 μm RNFL loss classified NEDA status with specificity 81.4% and sensitivity 80% (receiver operating characteristic curve: area under the curve 0.8; p < 0.001). No significant longitudinal correlations were found between changes in RNFL and in VEP latencies or scores. NEDA is associated with a relatively preserved RNFL over 2 years. A greater neuroretinal loss was detected even in patients with clinical evidence of disease activity independently from changes in brain MRI lesions, prompting further validation of OCT as an additional tool in MS monitoring.

Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis - a pilot study.

Assessment of retinal oxygen saturation, thickness of a retinal nerve fibre layer (RNFL) and functional changes in the optic nerve during optic neuritis (ON) in patients with multiple sclerosis (MS). Thirty-two patients with ON due to MS within 3months of onset of symptoms were enrolled [22 females, 10 males, age 34±9years, median 32.5years, 22 patients with the clinically isolated syndrome (CIS), 10 patients with relapsing-remitting from of MS (RRMS)]. All patients were examined using optical coherence tomography (OCT model 4000, Carl Zeiss Meditec, Dublin, CA, USA), automatic optical oximetry (Oxymap ehf, Reykjavik, Iceland) and using visual evoked potentials (VEP) (Metronic Keypoint® , Minneapolis, MN, USA). Arterio-venous difference (AVD) was increased in patients ON affected eye compared to patients' unaffected eye (PUE) [34.2±4.7 versus 31.3±4.6, p=0.044 (mean±standard deviation)]. No statistically significant difference was found in vessel oxygen saturation as well as in RNFL thickness in ON affected eyes when compared to unaffected MS eyes and healthy individuals. Significantly lower optic nerve conduction velocity was found in the affected eye when compared to unaffected MS eye and healthy (p<0.0001 for both comparisons). No correlation between oxygen saturation values and VEP was observed in patients with MS. The AVD in oxygen saturation is altered in patients with acute ON. In the early stage of ON, AVD could reflect inflammatory and metabolic changes in the affected eye. Therefore, oximetry could be used as another diagnostic method in MS patients in suspicion of ON. This result would be promising for future investigation in this field.

The relationship between contrast sensitivity and retinal nerve fiber layer thickness in patients with glaucoma.

To evaluate the correlation between contrast sensitivity (CS) and retinal nerve fiber layer (RNFL) in different areas of vision. This report is a sub-analysis of a prospective, observational cohort study investigating changes in performance-based assessment, vision-related quality of life, and clinical measures in patients with moderate to advanced glaucoma. The study included 161 participants with at least a 2-year history of glaucoma who underwent annual testing for 4years. Contrast sensitivity was measured using the Spaeth/Richman contrast sensitivity (SPARCS) test, while RNFL thickness (RNFLT) was measured using Cirrus optical coherence tomography (OCT). Statistical analyses were performed to determine correlations between CS and RNFLT; the correlations were calculated for each annual visit, totaling four correlation coefficients for each patient over the course of 4years. The SPARCS score in the left upper area of vision correlated the most strongly with the RNFLT of the inferior quadrant for both eyes at each annual visit, specifically in the seven o'clock sector for the left eye and the six o'clock sector for the right eye (p<0.05). There were no discernible trends for the correlations between the other areas of CS and RNFL quadrants or clock hours over the 4years of the study. Linear regression between the SPARCS total score and average RNFLT showed a significant direct correlation at each visit (p<0.01). Contrast sensitivity in the left upper area of vision for both eyes correlated most strongly with the thickness of the inferior quadrant of the RNFL. These fibers project to the temporal portion of the right occipital lobe, implying a potential center for contrast perception in this area. The longitudinal nature of the study suggests that CS may be a predictive tool for changes in RNFL in patients with glaucoma. Despite this finding, retinal damage and its relationship to CS was diffuse. In addition, SPARCS was shown to predict RNFLT. Further research is warranted to understand how CS can be used as a tool in the clinical setting.

Intraocular Pressure and Retinal Nerve Fibre Layer Thickness Changes After Carotid Artery Stenting.

Objectives:The aim of this study was to evaluate intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) changes in patients with carotid artery stenosis (CAS) after carotid artery stenting.Materials and Methods:This study was conducted as a cross-sectional, non-randomised clinical case series. Fifteen male patients (mean age: 63.6±9.1) with CAS and more than 70% carotid artery narrowing were included. All of the patients were followed in the department of neurology and were operated in the interventional radiology division. Eighteen healthy male subjects (mean age: 63.7±5.3) were included in the control group. All of the healthy subjects had a detailed ophthalmological examination and subjects with any chronic eye disease were excluded from the study. All of the participants had a detailed ophthalmological examination including tonometry using Goldmann applanation tonometry and RNFL analysis using optical coherence tomography (RTVue-100 5.1).Results:There were no ocular ischemic symptoms in any of the participants. The mean IOP value was 15.1±2.1 mmHg in the control group and 16.6±2.4 mmHg before stent implantation, 16.4±2.2 mmHg at 1 week after implantation, 16.6±2.5 mmHg at 1 month after implantation, and 16.7±2.9 mmHg at 3 months after implantation in the CAS group. Mean RNFL thickness was 105±6 µm in the control group; in the CAS group, mean RNFL thickness values were 98±27 µm before stent implantation and 103±11 µm, 101±10 µm, and 101±11 µm at 1 week, 1 month, and 3 months after stenting. There were no significant differences between the CAS group and control group regarding IOP and RNFL thickness values (p>0.05). IOP and RNFL thickness also did not show any statistically significant changes from preoperative measurements in 3 months postoperative follow-up in the CAS group (p>0.05).Conclusion:IOP and RNFL thickness remained unchanged after carotid stent implantation in carotid artery stenosis patients with no signs of ocular ischemic syndrome.

Retinal Nerve Fiber Layer Thickness Measurement by Spectral-Domain Optical Coherence Tomography in Patients with Major Depressive Disorder.

In recent years, an increasing number of studies have researched retinal nerve fiber layer (RNFL) changes in neurodegenerative disorders. In this study, our aim was to determine structural RNFL changes in patients with major depressive disorder. A total of 30 patients with major depressive disorder and 30 age- and sex-matched controls were recruited. Using optical coherence tomography (OCT), the peripapillary RNFL thickness in major depressive disorder patients and control subjects was measured and compared at each location. Patients with major depressive disorder did not show a statistically significant reduction in overall peripapillary RNFL thickness. Our study showed that RNFL thickness is not reduced in major depressive disorder patients and that OCT is not a useful tool for diagnosing and monitoring the progression of major depressive disorder. This study suggests that the pathophysiology of unipolar depression is different than in neurodegenerative disorders, pervasive developmental disorders, schizophrenia, and bipolar disorder.

Comparing the Rates of Retinal Nerve Fiber Layer and Ganglion Cell–Inner Plexiform Layer Loss in Healthy Eyes and in Glaucoma Eyes

To compare the rates of circumpapillary retinal nerve fiber layer (RNFL) and macular retinal ganglion cell-inner plexiform layer (GCIPL) change over time in healthy and glaucoma eyes. Cohort study. The rates of circumpapillary RNFL and macular GCIPL loss in 28 healthy subjects and 97 glaucoma subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were compared using mixed-effects models. The median follow-up time and number of visits were 1.7 years and 6 visits and 3.2 years and 7 visits for healthy and glaucoma eyes, respectively. Significant rates of loss of both global circumpapillary RNFL and average macular GCIPL thickness were detectable in early and moderate glaucoma eyes; in severe glaucoma eyes, rates of average macular GCIPL loss were significant, but rates of global circumpapillary RNFL loss were not. In glaucoma eyes, mean rates of global circumpapillary RNFL thickness change (-0.98μm/year [95% confidence interval (CI),-1.20 to-0.76]) and normalized global circumpapillary RNFL change (-1.7%/year [95% CI,-2.1 to-1.3]) were significantly faster than average macular GCIPL change (-0.57μm/year [(95% CI,-0.73 to-0.41]) and normalized macular GCIPL change (-1.3%/year [95% CI,-1.7 to-0.9]). The rates of global and inferior RNFL change were weakly correlated with global and inferior macular GCIPL change (r ranges from 0.16 to 0.23, all P < .05). In this cohort, the rate of circumpapillary RNFL thickness change was faster than macular GCIPL change for glaucoma eyes. Global circumpapillary RNFL thickness loss was detectable in early and moderate glaucoma, and average macular GCIPL thickness loss was detectable in early, moderate, and severe glaucoma, suggesting that structural changes can be detected in severe glaucoma.

Retinal and Optic Nerve Degeneration in Patients with Multiple Sclerosis Followed up for 5 Years

To quantify retinal nerve fiber layer (RNFL) changes in patients with multiple sclerosis (MS) and healthy controls with a 5-year follow-up and to analyze correlations between disability progression and RNFL degeneration. Observational and longitudinal study. One hundred patients with relapsing-remitting MS and 50 healthy controls. All participants underwent a complete ophthalmic and electrophysiologic exploration and were re-evaluated annually for 5 years. Visual acuity (Snellen chart), color vision (Ishihara pseudoisochromatic plates), visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (SLP), and visual evoked potentials. Expanded Disability Status Scale (EDSS) scores, disease duration, treatments, prior optic neuritis episodes, and quality of life (QOL; based on the 54-item Multiple Sclerosis Quality of Life Scale score). Optical coherence tomography (OCT) revealed changes in all RNFL thicknesses in both groups. In the MS group, changes were detected in average thickness and in the mean deviation using the GDx-VCC nerve fiber analyzer (Laser Diagnostic Technologies, San Diego, CA) and in the P100 latency of visual evoked potentials; no changes were detected in visual acuity, color vision, or visual fields. Optical coherence tomography showed greater differences in the inferior and temporal RNFL thicknesses in both groups. In MS patients only, OCT revealed a moderate correlation between the increase in EDSS and temporal and superior RNFL thinning. Temporal RNFL thinning based on OCT results was correlated moderately with decreased QOL. Multiple sclerosis patients exhibit a progressive axonal loss in the optic nerve fiber layer. Retinal nerve fiber layer thinning based on OCT results is a useful marker for assessing MS progression and correlates with increased disability and reduced QOL.

Assessment of Retinal Nerve Fiber Layer Changes by Cirrus High-definition Optical Coherence Tomography in Myopia.

ABSTRACTIntroduction To evaluate the relationship between retinal nerve fiber layer (RNFL) thickness measured by Cirrus high-definition (HD) optical coherence tomography (OCT) and the axial length and refractive error of the eye.Materials and methods A total of 100 eyes of 100 healthy subjects (age 20-34 years with M/F ratio of 57/43), comprising 50 eyes with emmetropia [spherical equivalent (SE) 0 D], 25 eyes with moderate myopia (SE between -4 D and -8 D), and 25 eyes with high myopia (SE between -8 D and -12 D) were analyzed in this cross-sectional study. Average and mean clock hour RNFL thicknesses were measured by cirrus HD-OCT and compared between the three groups. Associations between RNFL measurements and axial length and SE were evaluated by linear regression analysis.Results The average RNFL measurements were significantly lower in high myopia (78.68 +/- 5.67) and moderate myopia (83.76 +/- 3.44) group compared with emmetropia group (91.26 +/- 2.99), also in the superior and inferior mean clock hours. Significant correlations were evident between RNFL measurements and the SE and axial length. The average RNFL thickness decreased with increasing axial length (r = -0.8115) and negative refractive power (r = 0.8397). Myopia also affected the RNFL thickness distribution. As the axial length increased and the SE decreased, the thickness of the superior, inferior, and nasal peripapillary RNFL decreased.Conclusion The axial length/refractive error of the eye affected the average RNFL thickness and the RNFL thickness distribution. Analysis of RNFL thickness in the evaluation of glaucoma should always be interpreted with reference to the refractive status. When interpreting the RNFL thickness of highly myopic patients by OCT, careful attention must be given to the inherently thinner RNFL to avoid a false diagnosis of glaucoma.How to cite this article Singh D, Mishra SK, Agarwal E, Sharma R, Bhartiya S, Dada T. Assessment of Retinal Nerve Fiber Layer Changes by Cirrus High-definition Optical Coherence Tomography in Myopia. J Curr Glaucoma Pract 2017;11(2):52-57.

Decreases in retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness in schizophrenia, relation to insight: a controlled study

Objective: The present study aimed to examine retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses in schizophrenia patients according to the control group and in schizophrenia patients with good and poor insight. Methods: Sixty-three patients with schizophrenia recruited from the outpatient clinic of psychiatry and 39 healthy controls were included in the study. Patients were separated to two groups: good insight (n=31) and poor insight (n=32) schizophrenia. Group with schizophrenia were evaluated by using Positive and Negative Symptoms Scale (PANSS), Scale to Assess Unawareness of Mental Disorder. Changes in RNFL and GCIPL of all participants were analyzed with spectral optical coherence tomography (OCT). Results: Schizophrenia patients with good and poor insight were similar according to mean age of onset for illness, mean duration of illness, mean number of hospitalizations and mean daily used antipsychotic doses equivalent to chlorpromazine. There was no difference between the schizophrenia patients and the control group in terms of age and gender. In patients with schizophrenia all quadrants of RNFL, superior temporal (ST), superior (S), and inferior (I) quadrants of GCIPL were thinner than the controls. Inferior, inferior nasal quadrants of GCIPL and all quadrants of RNFL except nasal quadrant in schizophrenia patients with poor insight was found to be thinner than the schizophrenia patients with good insight and controls. Discussion: OCT can be used to detect neurodegeneration in schizophrenic patients. It can be argued that the GCIP layer may be a more sensitive biomarker than other retinal layers, requiring further investigation in this area.