Ganglion Cell And Inner Plexiform Layer Thicknesses Research Articles

Temporal-to-Nasal Macular Ganglion Cell and Inner Plexiform Layer Ratios in a Large Adult Twin Cohort:Correlations With Age and Heritability.

Temporal-to-nasal macular ganglion cell layer thickness ratios are reduced in albinism. We explored similar ratios in a large twin cohort to investigate ranges in healthy adults, correlations with age, and heritability. More than 1000 twin pairs from TwinsUK underwent macular optical coherence tomography (OCT) scans. Automated segmentation yielded thicknesses for the combined ganglion cell and inner plexiform layer (GCIPL) in Early Treatment of Diabetic Retinopathy Study subfields. Participants with diseases likely to affect these layers or segmentation accuracy were excluded. Inner and outer ratios were defined as the ratio of temporal-to-nasal GCIPL thickness for inner and outer subfields respectively. Corresponding ratios were obtained from a smaller cohort undergoing OCTs with a different device (three-dimensional (3D)-OCT, Topcon, Japan). Scans from 2300 twins (1150 pairs) were included (mean [SD] age, 53.9 (16.5) years). Mean (SD) inner and outer ratios were 0.89 (0.09) and 0.84 (0.11), correlating negatively with age (coefficients, -0.17 and -0.21, respectively). In males (150 pairs) ratios were higher and did not correlate significantly with age. Intrapair correlation coefficients were higher in monozygotic than dizygotic pairs; age-adjusted heritability estimates were 0.20 and 0.23 for inner and outer ratios, respectively. For the second cohort (n = 166), mean (SD) ratios were 0.93 (0.08) and 0.91 (0.09), significantly greater than for the larger cohort. Our study gives reference values for temporal-to-nasal macular GCIPL subfield ratios. Weak negative correlations with age emerged. Genetic factors may contribute to ∼20% to 23% of the variance in healthy individuals. The ratios differ according to the OCT platform used.

Sectorial Ganglion Cell Complex Thickness as Biomarker of Vision Outcome in Patients With Dominant Optic Atrophy.

Dominant optic atrophy (DOA) is an inherited condition caused by autosomal dominant mutations involving the OPA-1 gene. The aim of this study was to assess the relationship between macular ganglion cell and inner plexiform layer (GC-IPL) thickness obtained from structural optical coherence tomography (OCT) and visual outcomes in DOA patients. The study recruited 33 patients with confirmed OPA-1 heterozygous mutation and DOA. OCT scans were conducted to measure the GC-IPL thickness. The average and sectorial Early Treatment Diabetic Retinopathy Study (ETDRS) charts (six-sector macular analysis to enhance the topographical analysis) centered on the fovea were considered. Several regression analyses were carried out to investigate the associations between OCT metrics and final best-corrected visual acuity (BCVA) as the dependent variable. The mean BCVA was 0.43 ± 0.37 logMAR, and the average macular GC-IPL thickness was 43.65 ± 12.56 µm. All of the GC-IPL sectors were significantly reduced and correlated with BCVA. The univariate linear regression and the multivariate stepwise regression modeling showed that the strongest association with final BCVA was observed with the internal superior GC-IPL thickness. Dividing patients based on BCVA, we found a specific pattern. Specifically, in patients with BCVA ≤ 0.3 logMAR, the external superior and inferior sectors together with the internal superior were more significant; whereas, for BCVA > 0.3 logMAR, the external superior sector and internal superior sector were more significant. The study identified OCT biomarkers associated with visual outcomes in DOA patients. Moreover, we assessed a specific OCT biomarker for DOA progression, ranging from patients in the early stages of disease with more preserved GC-IPL sectorial thickness to advanced stages with severe thinning.

Anatomical changes in idiopathic epiretinal membrane at 2-year follow-up assessed using spectral domain optical coherence tomography and optical coherence tomographic angiography.

To evaluate anatomical changes in the low-stage partial attachment-type idiopathic epiretinal membrane (iERM) over 2 years. Data from patients with low-stage partial attachment-type iERM (stage 2) were analyzed. The main outcome measures were anatomical changes, including changes in the foveal avascular zone (FAZ) area, vessel density (VD) in the vascular plexus, and thickness of retinal sublayers during the follow-up period. Thirty patients (mean age: 68±12 years) were included in the study. The FAZ area on the superficial vascular plexus (SVP) significantly decreased from baseline (0.12±0.08 mm2) to month 24 (0.10±0.08 mm2, p=0.024). However, the FAZ area on the deep vascular plexus (DVP) did not significantly decrease from baseline (0.15±0.13 mm2) to month 24 (0.14±0.14 mm2, p=0.099). VDs on both the SVP and DVP did not show significant change from baseline (29.51±8.14% vs. 28.35±5.63%) to month 24 (29.79±9.77%, p=0.564 vs. 28.17±5.75%, p=0.417). Parafoveal ganglion cell and inner plexiform layer (GCIPL) thickness decreased from baseline (108.77±13.61 μm) to month 24 (103.03±15.54 μm, p=0.004). The central total retinal layer thickness did not significantly change from baseline (396.07±64.86 μm) to month 24 (392.04±72.72 μm, p=0.570). Even in low-stage ERM, inner retinal changes, including GCIPL thickness, occurred during follow-up periods, which might be owing to degenerative changes or centrifugal movement.

OCT and VEP correlate to disability in secondary progressive multiple sclerosis

BackgroundThe afferent visual pathway provides a unique opportunity to monitor clinical and subclinical optic neuritis and features of neuroaxonal degeneration in secondary progressive MS. ObjectiveTo investigate the usefulness of visual evoked potentials (VEP) and optical coherence tomography (OCT) in evaluating SPMS, and the association between these modalities and clinical course and lesion load on the magnetic resonance imaging (MRI) in patients with SPMS with or without a history of optic neuritis (ON). MethodsSPMS patients (n = 27) underwent clinical assessment with Expanded Disability Status Scale (EDSS) grading, visual acuity, OCT, and VEP examination. MRI of the brain and spinal cord were evaluated. Ordinal scores of VEP and MRI findings were used in the statistical analyses. ResultsThe ganglion cell and inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) thickness correlated with VEP latency. VEP P100 score correlated with EDSS. Linear regression showed an association between GCIPL thickness and EDSS as well as VEP P100 latency and EDSS. The MRI analyses were negative. ConclusionVEP latency and GCIPL thickness correlated with disability measured as EDSS in patients with SPMS and are useful in monitoring SPMS patients.

Comparison of the retinal vascular network and structure in patients with optic neuritis associated with myelin oligodendrocyte glycoprotein or aquaporin-4 antibodies: an optical coherence tomography angiography study.

To compare the retinal vascular network and structure of optic neuritis associated with myelin oligodendrocyte glycoprotein antibodies (MOG-ON) or aquaporin-4 antibodies (AQP4-ON). Nineteen patients with MOG-ON (29 eyes), 24 patients with AQP4-ON (43 eyes), and 25 healthy participants (50 eyes) were enrolled. The best-corrected visual acuity (BCVA), mean deviation (MD), retinal nerve fiber layer (RNFL) thickness, parafoveal ganglion cell and inner plexiform layer (GCIPL) thickness, and vessel densities in the peripapillary and parafoveal areas were measured. The BCVA, RNFL thickness, GCIPL thickness, and vessel densities in the peripapillary and parafoveal areas were significantly decreased in the AQP4-ON and MOG-ON eyes compared with healthy controls (all P < 0.05). There were no significant differences in the MD, RNFL thickness, GCIPL thickness, or vessel densities between the AQP4-ON and MOG-ON eyes (all P > 0.05). However, the BCVA was significantly worse in AQP4-ON eyes than in MOG-ON eyes (P = 0.001). The peripapillary vessel density was significantly correlated with the BCVA and MD in AQP4-ON eyes and with MD in MOG-ON eyes (all P < 0.05). MOG-ON and AQP4-ON are associated with severe visual dysfunction, as well as retinal structural and vascular damage. The extent of visual dysfunction was strongly correlated with the peripapillary vessel density. Although we found no significant difference in the MD between MOG-ON and AQP4-ON, which are characterized by comparable vascular and structural damage within the peripapillary and parafoveal areas, the BCVA was worse in AQP4-ON eyes than in MOG-ON eyes.

Longitudinal changes in the macula and optic nerve in familial dysautonomia.

Familial Dysautonomia (FD) disease, lacks a useful biomarker for clinical monitoring. In this longitudinal study we characterized the structural changes in the macula, peripapillary and the optic nerve head (ONH) regions in subjects with FD. Data was consecutively collected from subjects attending the FD clinic between 2012 and 2019. All subjects were imaged with spectral-domain Optical Coherence Tomography (OCT). Global and sectoral measurements of mean retinal nerve fiber layer (RNFL) and macular ganglion cell and inner plexiform layer (GCIPL) thickness, and ONH parameters of rim area, average cup-to-disc (C:D) ratio, and cup volume were used for the analysis. The best fit models (linear, quadratic and broken stick linear model) were used to describe the longitudinal change in each of the parameters. 91 subjects (149 eyes) with FD of ages 5-56years were included in the analysis. The rate of change for average RNFL and average GCIPL thicknesses were significant before reaching a plateau at the age of 26.2 for RNFL and 24.8 for GCIPL (- 0.861µm/year (95% CI - 1.026, - 0.693) and - 0.553µm/year (95% CI - 0.645, - 0.461), respectively). Significant linear rate of progression was noted for all ONH parameters, except for a subset of subjects (24%), with no cupping that did not show progression in any of the ONH parameters. The rapidly declining RNFL and GCIPL can explain the progressive visual impairment previously reported in these subjects. Among all structural parameters, ONH parameters might be most suitable for longitudinal follow-up, in eyes with a measurable cup.

Long term change of the optic disc and OCT parameters during myopic shift in children with large cup to disc ratio.

PurposeThis observational case series was to determine long term optic disc changes in eyes with large cup to disc ratio (CDR) and compare the changes induced by myopic shift during childhood with normal control eyes.MethodsChildren under 15 years of age who developed myopia with serial optic disc photographs and spectral domain (SD)-optical coherence tomography (OCT) images with a minimal interval of three years were evaluated. Children with average CDR ≥ 0.6 on SD-OCT were classified as having large CDR. The ratios of vertical disc diameter (VDD), horizontal disc diameter (HDD), and maximum peripapillary atrophy (PPA) width (PPW) were measured to quantify morphologic changes of optic discs and SD-OCT parameters, such as peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell and inner plexiform layer (GCIPL) thickness were measured.ResultsOf the 82 eyes (82 patients) analyzed, 42 eyes had large CDR and 40 eyes were normal controls. The mean age and refractive error at initial examination were not different between groups (P = 0.33, P = 0.76, respectively). The changes in HDD/VDD and PPW/VDD ratios during follow-up showed no significant difference among the groups (P = 0.45, P = 0.62, respectively). No statistical significance was found in changes in RNFL and GCIPL thickness between the two groups (P = 0.74, P = 0.79, respectively).ConclusionsChildren with enlarged CDR showed changes in optic disc morphology and RNFL/GCIPL thickness similar to normal children during myopic shift.

Comparing Structure-Function Relationships Based on Drasdo's and Sjöstrand's Retinal Ganglion Cell Displacement Models.

PurposeTo compare structure-function relationships based on the Drasdo and Sjöstrand retinal ganglion cell displacement models.MethodsSingle eyes from 305 patients with glaucoma and 55 heathy participants were included in this multicenter, cross-sectional study. The ganglion cell and inner plexiform layer (GCIPL) thickness was measured using spectral domain optical coherence tomography. Visual field measurements were performed using the Humphrey 10-2 test. All A-scan pixels (128 × 512 pixels) were allocated to the closest 10-2 location with both displacement models using degree and millimeter scales. Structure-function relationships were investigated between GCIPL thickness and corresponding visual sensitivity in nonlong (160 eyes) and long (200 eyes) axial length (AL) groups.ResultsIn both the nonlong and long AL groups, compared with the no-displacement model, both the Drasdo and the Sjöstrand models showed that the structure-function relationship around the fovea improved (P < 0.05). The magnitude of improvement in the area was either comparable between the model or was larger for the Drasdo model than the Sjöstrand model (P < 0.05). Meanwhile, structure-function relationships outside the innermost retinal region that were based on the Drasdo and Sjöstrand models were comparable to or were even worse than (in the case of the Drasdo model) those obtained using the no-displacement model.ConclusionsStructure-function relationships evaluated based on both the Drasdo and Sjöstrand models significantly improved around the fovea, particularly when using the Drasdo model. This was not the case in other areas.

The Detection of Retina Microvascular Density in Subclinical Aquaporin-4 Antibody Seropositive Neuromyelitis Optica Spectrum Disorders

Purpose: To use optical coherence tomography (OCT) and OCT angiography (OCT-A) to measure changes in the retinal structure and microvasculature of patients with aquaporin-4 antibody-positive, neuromyelitis optica spectrum disorder (NMOSD) with a history of optic neuritis (NMOSD+ON) and those without it (NMOSD–ON).Methods: A total of 27 aquaporin-4 antibody-positive NMOSD patients and 31 age- and gender-matched healthy control (HC) participants were included. In 27 NMOSD patients, 19 of them had a history of optic neuritis (ON) and 8 of them had no history of ON. Peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell and inner plexiform layer (GCIPL) thickness were measured by OCT. Radial peripapillary capillary density (RPCD) and macular superficial vessel density (MSVD) were measured by OCT-A. Comparisons of retinal structural and microvascular parameters between the cohorts were performed using generalized estimating equation (GEE) models. Diagnostic accuracy was evaluated by the area under the receiver operating characteristics curve (AROC).Results: In NMOSD+ON eyes, the GCIPL and pRNFL thicknesses, 48.6 ± 7.1 and 61.7 ± 25.1 μm, respectively, were significantly thinner than in HC eyes (P < 0.001 for both). However, in NMOSD–ON eyes, the GCIPL and pRNFL thicknesses were not significantly thinner than in HC eyes (P > 0.05 for both). In NMOSD+ON eyes, the RPCD and MSVD, 37.8 ± 7.1 and 36.7 ± 5.0%, respectively, were significantly less dense than HC eyes (P < 0.001 for both). Similarly, the RPCD and MSVD in NMOSD–ON eyes, 49.0 ± 2.8 and 43.9 ± 4.2%, respectively, were also less dense than in HC eyes (P < 0.029 for RPCD, P < 0.023 for MSVD). The highest AROC, 0.845 (sensitivity = 88.5%, specificity = 78.0%), was achieved by the logistic regression combination of all of the variables, i.e., pRNFL, GCIPL, RPCD, and MSVD.Conclusions: Retinal microvascular changes were present in NMOSD–ON eyes. The combination of retinal structural and microvascular parameters might be helpful to discriminate NMOSD–ON eyes from HC eyes.

Author response: Optical coherence tomography for diagnosing optic neuritis: Are we there yet?

We thank Dr. Avasarala for his comments on our editorial regarding the corresponding study by Xu et al.,1,2 in which the sensitivity of optical coherence tomography (OCT) measures for detecting previous optic neuritis (ON) was examined. Although Naismith et al. reported that OCT was less sensitive than visual evoked potentials (VEP) in detecting previous ON,3 this study used older third-generation time domain OCT. Undoubtedly, the greatest advance in OCT in the past decade has been the development of fourth-generation spectral domain OCT. Current commercially available spectral domain OCT has extremely high resolution (3–5 μm). Moreover, peripapillary retinal nerve fiber layer (RNFL) and composite ganglion cell and inner plexiform layer (GCIPL) thicknesses have excellent reliability and reproducibility, with the intervisit intraclass correlation coefficient for GCIPL thickness being 0.99.4 Furthermore, OCT measures provide invaluable information regarding the global multiple sclerosis (MS) disease process, including mirroring brain atrophy, disease activity, predicting future disability, and conversion to clinically definite MS.5

Association between Visual Acuity and Retinal Layer Metrics in Diabetics with and without Macular Edema

Purpose Diabetes is known to cause alterations in retinal microvasculature and tissue that progressively lead to visual impairment. Optical coherence tomography (OCT) is useful for assessment of total retinal thickening due to diabetic macular edema (DME). In the current study, we determined associations between visual acuity (VA) and retinal layer thickness, reflectance, and interface disruption derived from enface OCT images in subjects with and without DME. Materials and Methods Best corrected VA was measured and high-density OCT volume scans were acquired in 149 diabetic subjects. A previously established image segmentation method identified retinal layer interfaces and locations of visually indiscernible (disrupted) interfaces. Enface thickness maps and reflectance images of the nerve fiber layer (NFL), combined ganglion cell and inner plexiform layer (GCLIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor outer segment layer (OSL), and retinal pigment epithelium (RPE) were generated in the central macular subfield. The associations among VA and retinal layer metrics were determined by multivariate linear regressions after adjusting for covariates (age, sex, race, HbA1c, diabetes type, and duration) and correcting for multiple comparisons. Results In DME subjects, increased GCLIPL and OPL thickness and decreased OSL thickness were associated with reduced VA. Furthermore, increased NFL reflectance and decreased OSL reflectance were associated with reduced VA. Additionally, increased areas of INL and ONL interface disruptions were associated with reduced VA. In subjects without DME, increased INL thickness was associated with reduced VA, whereas in subjects without DME but with previous antivascular endothelium growth factor treatment, thickening of OPL was associated with reduced VA. Conclusions Alterations in retinal layer thickness and reflectance metrics derived from enface OCT images were associated with reduced VA with and without presence of DME, suggestive of their potential for monitoring development, progression, and treatment of DME.

Ganglion cell and inner plexiform layer thickness determined by spectral domain optical coherence tomography in patients with brain lesions

PurposeTo evaluate the thickness of the macular ganglion cell and inner plexiform layer (GCIPL) using spectral domain optical coherence tomography (SD OCT) in patients with brain lesions.MethodsThis case-control study included...