Previous Episodes Of Optic Neuritis Research Articles

Binocular, accommodative and oculomotor alterations in multiple sclerosis

AbstractMultiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. Among them, oculomotor, accommodative and binocular alterations have been reported in MS. Our research group has conducted a complete analysis of the visual and oculomotor function in several researches with MS patients conducted in the last 4 years, obtaining a characterization of some visual aspects of the patient with MS. Concerning the binocular function, several alterations have been detected in MS patients, with divergence at near distance and stereopsis the most affected parameters. Likewise, MS patients with previous optic neuritis present worse binocular vision. Symptomatology compatible with convergence insufficiency measured with the CISS (Convergence Insufficiency Symptom Survey) is frequently reported by MS patients, but not supported by signs that show clear trend to esophoria at near. This discrepancy between the signs and symptoms could be due to the peculiarities of the CISS questionnaire, including items that are also related to the cognitive function and other ocular abnormalities.Oculomotor alterations have been reported also in patients with multiple sclerosis (MS), especially saccadic dysfunctions. The indirect analysis of horizontal saccades with the Developmental Eye Movement (DEM) and King‐Devick tests shows that are affected by MS, with more level of alteration if there has been a previous episode of optic neuritis. Similar findings have been also reported by other authors using objective eye tracking or video‐oculographic systems. Specifically, the most reported saccadic alterations in advanced MS and clinically isolated syndrome (CIS) are saccadic dysmetry (41.7%) and impaired smooth pursuit (42.3%), which relates to prolonged saccadic latency, no matter if they have suffered or not optic neuritis or internuclear ophthalmoplegia (INO). An increase in saccadic latency has been even found in children with MS. Saccadic initiation time (SI time) and average inter‐saccadic intervals (ISI) are also higher in patients with MS. Furthermore, the first cause of acquired pendular nystagmus is MS.Finally, macular sensitivity measured by microperimetry has been found to be altered in MS patients, especially in eyes with previous optic neuritis. Likewise, a fixational instability characterized also my microperimetry is present in MS patients with optic neuritis, with more increase of the vertical axis of the fixation area than of the horizontal. The ratio of the disease also affects the patient fixation pattern.

OCT Variability Prevents Their Use as Robust Biomarkers in Multiple Sclerosis.

ObjectiveTo evaluate the agreement between the peripapillary retinal nerve fiber layer (pRNFL) and foveal thickness (FT) measurements among three different spectral domain-optical coherence tomography (SD-OCT) instruments in a sample of multiple sclerosis (MS) patients and a healthy age-matched control group.MethodsAn observational cross-sectional study with three groups: healthy subjects and MS patients w/w a previous clinical diagnosis of optic neuritis (ON) was conducted. The pRNFL and FT were measured using three different SD-OCT instruments (OCT PRIMUS 200 and OCT CIRRUS 500 SD-OCT [Carl Zeiss Meditec] and OCT 3D 2000 [Topcon]).ResultsTwenty eyes from 10 healthy subjects matched in age with MS patients without a previous history of eye disease and 62 MS eyes from 31 MS patients (29 eyes without history of ON and 33 eyes with history of ON) were enrolled. Healthy subjects and MS patients without ON did not show differences between the pRNFL and FT thickness (P>0.99) with any of the instruments. However, MS eyes with a previous episode of ON showed thinner pRNFL and FT (P<0.01). PRIMUS and CIRRUS OCT showed better agreement of the pRNLF and FT in both healthy and MS eyes. However, 3D OCT showed less agreement in the pRNFL measurement with CIRRUS in both healthy and MS eyes.InterpretationAlthough OCT is a valuable technology to improve MS patient assessment, differences between devices must be taken into account. It is necessary to create an international group that standardizes the measurement conditions and above all that provides reference bases for normal subjects.

OCT Analysis in Patients with Relapsing-Remitting Multiple Sclerosis during Fingolimod Therapy: 2-Year Longitudinal Retrospective Study

Many studies have demonstrated the usefulness of some optical coherence tomography (OCT) parameters, like total macular volume (TMV) and retinal nerve fiber layer thickness (RNFL-T), for monitoring patients with multiple sclerosis (MS). However, there are no real-world, long-term studies on patients with relapsing-remitting MS (RR-MS) treated with fingolimod. Therefore, the purpose of this study was to describe retinal changes associated with fingolimod therapy during a two-year follow-up while considering previous episodes of optic neuritis (ON). Patients diagnosed with RR-MS and treated with fingolimod (46 in total) underwent a two-year follow-up. Based on previous ON history, we identified 16 ON+ and 30 ON− patients. The ophthalmological evaluations, including visual field (VF) examination and OCT, were performed at a baseline at 3–6, 12 and 24 months to evaluate the progression rate for each parameter. When analyzing the whole sample, OCT showed no cases of macular edema. Instead, we observed a significant reduction rate in the central retinal thickness (CRT) (p &lt; 0.001), TMV (p &lt; 0.001) and RNFL (p &lt; 0.05). Moreover, we observed a significant difference in the progression rate between ON+ and ON− patients, relative to the VF and RNFL (p &lt; 0.05) examinations. OCT highlighted a significant progression rate of retinal damage in MS patients despite fingolimod therapy, especially in MS ON+ patients.

Homonymous visual field defects in patients with multiple sclerosis: results of computerised perimetry and optical coherence tomography.

Visual dysfunction is frequent in multiple sclerosis, usually resulting from retrobulbar optic neuritis or papillitis. Less frequently, demyelinating lesions can affect the retrochiasmal pathways. There are few reports of homonymous visual field defects (HVFD) in multiple sclerosis and little is known about their evolution. The purpose of this study was to better define both the clinical profile and the evolution of HVFD in patients with multiple sclerosis. We performed a retrospective study of all multiple sclerosis patients who presented HVFD and were examined by automated static perimetry. A subset of patients benefited from macular assessment with optical coherence tomography (OCT). We also reviewed the worldwide literature on the subject. Twenty patients were retrieved from the neuro-ophthalmology database of the H&ocirc;pital Ophtalmique Jules-Gonin. There were 11 women and 9 men, and their average age was 35 &plusmn; 11 years. The relapsing-remitting form of multiple sclerosis was most common (18/20; 90%), the primary progressive form (1/20; 5%) and the secondary progressive form (1/20; 5%) were rare. HVFD were the presenting symptom of multiple sclerosis in seven patients (35%). The recovery was complete in 12/20 patients (60%), and the median time to recovery was 10 weeks (2-13 weeks). An incomplete recovery was found in 5/20 subjects (25%) and no recovery occurred in 3/20 subjects (15%). Magnetic resonance imaging disclosed a definite lesion explaining the HVFD in 7/11 patients: five within the optic radiations (71.4%), one within the optic tract (14.3%) and one within the lateral geniculate nucleus (14.3%). Our results were comparable to those compiled from our literature search (29 publications, totalling 70 cases). A recurrent episode of HVFD occurred in three patients (15%). OCT was performed in 10/20 patients. Retinal ganglion cell layer thickness was assessed and revealed a homonymous thinning in three patients, diffuse unilateral or bilateral thinning (resulting from previous episodes of optic neuritis) in six patients, and normal retinal ganglion cell layer thickness in one patient. HVFD in multiple sclerosis are found mostly in young patients with relapsing-remitting multiple sclerosis, which is consistent with the epidemiology of multiple sclerosis. HVFD can be the first manifestation of multiple sclerosis and have a relatively good prognosis. Like optic neuritis, HVFD can recur. The incidence of HVFD in multiple sclerosis is unknown, as it is probably underdiagnosed. Systematic automated static perimetry and OCT could help to determine the true incidence of HVFD in multiple sclerosis. &nbsp.

Optical coherence tomography angiography in multiple sclerosis: A cross-sectional study.

ObjectivesTo evaluate retinal axonal density and retinal capillary flow density (CFD) variations in patients affected by multiple sclerosis (MS) as documented by Optical Coherence Tomography Angiography (OCT-A).Material and methodsA cross-sectional study was performed in a tertiary university eye hospital on 94 eyes from 48 MS patients compared to 37 eyes from 23 matched controls. MS patients were divided in two groups: those with previous episodes of optic neuritis (MS ON+, 71.4%) and those without any previous visual complaint (no optic neuritis group, MS ON, 28.6%). Patients underwent macular and optic nerve head OCT-A with Optovue XR Avanti (Optovue, Freemont, California) after that preliminary evaluation of the ganglion cell complex (GCC) and of the retinal nerve fiber layer (RNFL) was achieved for each single eye by SD-OCT. CFD was evaluated in three different retinal layers of MS patients and controls: superficial capillary plexus (SCP), deep capillary plexus (DCP) and the choriocapillaris layer (CL). Each layer was analyzed in 18 preset subregions automatically detected by the system. CFD values were then correlated to the RNFL thickness and GCC thickness in the groups: p values were computed by t-tests between each group of MS patients and controls. A p-value of <0.05 was considered significant.ResultsA significant difference in the overall CFD values was found between ON+ and ON- patients when compared to controls in 18 subregions of SCP. Furthermore, a significant difference was found between MS patients and controls in 16 subregions analyzed corresponding to the CL layer without difference between the two MS subgroups (ON+ and ON-)ConclusionsOCT-A when performed at the optic nerve head level and at the macular region is characterized by a reduction of retinal perfusion in a significant portion of MS patients independently if they had a previous history of optic nerve inflammation or not.

Neuro‐retinal alteration in dizygotic twins with multiple sclerosis

AbstractPurposeThe aim was to evaluate the retina and the optic nerve in two dizygotic twins suffering from multiple sclerosis (MS).MethodThe neuroretinal structures were analysed at diagnosis from only the right eyes of both two (A and B) dizygotic twins by the optical coherence tomography (OCT) device Heidelberguffered in her left eye. The protocol used was Posterior Pole (with an area of examin Spectralis®, in order to avoid bias due to a previous optic neuritis that the twin A sation 30° × 25°) that measured the thickness in microns (μm) of the whole retina, the ganglion cell layer (GCL) by segmentation in the macular area and the peripapilar retinal nerve fibre layer (RNFL). The functional situation of the disease was evaluated with the Expanded Disability Status Scale (EDSS) by neurologist.ResultsThe onset of the disease of twin A was with an episode of left optic neuritis in 2017, whereas twin B with a cerebellar syndrome in 2013. Both twins were diagnosed of MS in 2018. At that moment, the twin B showed worse systemic functional status than twin A (EDSS: 3.5 versus 0 respectively), lower thickness in the peripapilar RNFL at temporal (54 versus 96 μm) and inferior temporal (109 versus 180 μm) sectors and also in GCL specifically at the inferior (31 versus 45 μm) and temporal (30 versus 40 μm) sectors.ConclusionsThe analysis of the posterior pole retinal thickness with segmentation could be a useful tool for the management of MS. The GCL showed an early and more intense damage than RNFL at the earliest years of the disease without previous episodes of optic neuritis in this case of two dizygotic twins.

Relationship between retinal thinning, disease duration and disability status in multiple sclerosis patients

AbstractPurposeTo assess changes in the pattern of the neuro‐retina thinning during the evolution of multiple sclerosis (MS).Method64 eyes of healthy controls and 89 eyes of patients with MS without previous episode of optic neuritis were included in the study. Measurements were performed using the Posterior Pole Retinal Thickness Map protocol [shows the thickness of the retina throughout the posterior pole (volumetric examination of 30° × 25° OCT]) with the Heidelberg Spectralis optical coherence tomography (OCT) device. We analysed the 8 × 8 grid placed along the fovea symmetrically with the papilla, dividing patients with MS into 5 different groups at intervals of 5 years of disease duration and a group of patients with a few months of diagnosis.ResultsMS patients presented a significant thinning of the retinal nerve fibre layer (RNFL) and the ganglion cell layer (GCL). This thinning is visible and significant even in the first year after symptoms onset in RNFL and GCL. In addition, an inverse relationship between the thickness of these layers and the time of disease evolution was found, existing cells with a moderate‐strong relationship mainly in the GCL and RNFL. In contrast there is negative but poor correlation between retinal thinning of these 2 retinal layers and Expanded Disability Status Scale (EDSS).ConclusionAlthough there is no significant peripapillary damage in the first months of the disease, we can find a significant thinning in the RNFL and GCL around the macula. GCL seems to be the layer that presents a significant thinning earlier than the RNFL and stronger relationship with disease duration. On the other hand, EDSS does not seems to be so influent on retinal thinning than disease duration.

Optical Coherence Tomography Angiography of a Pale Optic Disc in Demyelinating Optic Neuritis and Ischemic Optic Neuropathy.

In the setting of a pale optic disc, distinguishing a previous episode of optic neuritis (ON) from that of nonarteritic anterior ischemic optic neuropathy (NAION) may be difficult on clinical examination. Differences in peripapillary vascular network structures, if present, might be of diagnostic utility. Thirty-five eyes with demyelinating ON, 33 eyes with NAION, and 81 eyes of normal subjects were imaged with optical coherence tomography angiography (OCT-A) to assess peripapillary vascular density (VD). In addition, OCT was used to measure peripapillary retinal nerve fiber layer (RNFL) thickness. Areas under the receiver operating characteristic curves were used to differentiate ON vs NAION. NAION eyes had significantly thinner RNFL thickness than ON eyes. Age-adjusted analysis showed that the peripapillary VD values were significantly reduced in NAION (48.3 ± 7.4%) and ON eyes (54.7 ± 6.1%) compared with healthy controls (62.1 ± 4.6%); pairwise comparisons showed statistically significant differences among all 3 groups. After adjustment for severity of optic nerve injury according to mean RNFL thickness, all VD parameters were not significantly different between ON and NAION eyes. The area under the receiver operating characteristic curves for differentiating NAION from ON eyes was similar for VD (0.75) and RNFL thickness (0.74). Peripapillary VD measurement performs as well as RNFL thickness for distinguishing previous episodes ON and NAION. VD decline might be secondary to RNFL damage and, therefore, VD data have a limited role differentiating these 2 disorders.

Correlation between electrophysiological test and visual dysfunction in multiple sclerosis patients

PurposeEvaluate best corrected visual acuity (BCVA), contrast sensitivity (SC), pattern electroretinogram (pERG), multifocal electroretinogram (mfERG), and multifocal visual evoked potentials (mfVEP) in multiple sclerosis (MS) and compare with healthy controls.MethodsFifty‐eight eyes were included: 14 of healthy controls and 44 of subjects with MS (of whom 17 presented a previous episode of optic neuritis). The BCVA ETDRS was recorded at 100% contrast, 2.5% and 1.25%, CS with CSV1000 test (at 3, 6, 9 and 12 cycles per degree) and Pelli Robson. The pERG, mfERG and mfVEP electrophysiology tests were performed with the Roland Consult's Reti‐port / scan device.ResultsPatients with MS showed a significant reduction of VA at 100% contrast (p = 0.013), 2.5% (p &lt;0.001) and 1.25% (p = 0.008), CSV‐1000 was also affected at 3 (p = 0.017), 9 (p = 0.017), and 12 cycles per degree (p = 0.048), and also Pelli Robson (p &lt;0.001). The mfERG showed in MS patients a significant affectation for amplitude and latency at the inferonasal and superonasal quadrants (p = 0.045 and 0.042 respectively), and the overall values of the mfPEV sown abnormalities at N1 and P1 amplitudes (p = 0.019 and p = 0.039, respectively).ConclusionsPatients with MS have a clear impairment of visual function in both psychophysical and electrophysiological tests.

Multifocal electroretinogram and optical coherence tomography to evaluate parafoveal fixation

PurposeSpatial resolution of the human visual field changes depending on the distance from the fovea and fixation point. The visual field is divided in three areas: foveal, parafoveal and peripheral. The highest visual acuity (AV) is obtainded at the foveal area, covering approximately 2 °, then parafoveal area covers 2 ° to 5 °, and the peripheral vision from 5 ° to the edge of the visual field, but the AV decreases progressively in each area .MethodsWe analyzed two cases of parafoveal fixation by SD‐Spectralis OCT (Heidelberg Engineering), Triton Swept‐Source OCT (Topcon) and multifocal electroretinogram (mfERG) with RetiPort / Scan (Roland Consult). The structure and function of retinal cells have been correlated using OCT images and the three‐dimensional map of mfERG.ResultsCase 1: Patient with 100% ETDRS VA equal to 0,0 in both eyes (OU), contrast sensitivity (CS) Pelli Robson 1,35 in right eye (OD) and 1,20 in left eye (OS), presents Parafoveal fixation &lt;1º.Case 2: Patient with previous episode of optic neuritis in OD and parafoveal fixation of 3º in OS, which presents VA ETDRS 100% of 0.7 in OD and 0.1 in OS, CS PelliRobson of 1,05 in OD and 1,20 OS.Both cases present a reduced macular peak seen at the mfERG, and a fixation point out of the foveal at the OCT.ConclusionsWe can see how VA and CS decreases as the fixation eccentricity increases, as can be clearly seen in the three‐dimensional mfERG map. CS seems to be the quickest parameter to be affected.

Time is vision in recurrent optic neuritis

In optic neuritis (ON) inflammation precedes onset of demyelination and axonal loss. The anti-inflammatory properties of corticosteroids may be most effective in the early inflammatory phase, but rapid patient recruitment remains a logistic challenge. The aim of the study was to review the effect of time to initiation of treatment on visual outcome in recurrent ON.A retrospective case note review of patients known to our centre with recurrent ON. The primary clinical outcome was change of best corrected high contrast visual acuity (BCVA). The secondary outcome was the change of optical coherence tomography (OCT) thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell layer (mGCL) from baseline and after a minimum of 3months following the episode of recurrent ON.Of 269 patients with a previous episode of ON, 54 experienced recurrent ON. In total 40 OCT documented episodes of relapsing ON were captured in 19 patients. Treatment within <2days led to better recovery of the BCVA (+0.02) and mGCL (−2.4µm) if compared to delayed treatment (BCVA −0.2, p=0.036, mGCL −25.6µm, p=0.019) or no corticosteroids treatment (BCVA −0.2, p=0.045, GCL −5.0µm, p=0.836).These data suggest a beneficial effect of hyperacute corticosteroid treatment. A pragmatic approach for a prospective treatment trial should consider patients with recurrent ON for logistic reasons.

Effectiveness of Time Domain and Spectral Domain Optical Coherence Tomograph to Evaluate Eyes with And Without Optic Neuritis in Multiple Sclerosi Patients

Abstract Purpose: To compare the macular assessment and retinal nerve fiber layer (RNFL) thickness by using two different optical coherence tomographies (OCTs): a time domain (TD) and a spectral domain (SD) OCT, in multiple sclerosis (MS) patients with and without unilateral optic neuritis (ON). Methods: We enrolled 34 patients (13 males and 21 females): 18 without previous episodes of ON and16 with a previous monolateral episode of ON occurred at least 3 months prior to examination. Patients underwent ophthalmological examination, TD OCT and SD OCT scans. We compared the outcomes of eyes with and without ON by using Student’s t test. Results: In the affected eye group a reduction of the average RNFL was found using TD OCT (reduction of 22.8%) with the difference between the two groups being statistically significant (p<0.05) in almost all the investigated retina areas. Similar results were found when eyes were analysed with SD OCT, also when the ganglion cell layer (GCC) was considered: a reduction of 18.1% of GCC average thickness was found. No significant difference was found when the outer retina was considered. Conclusions: In MS patients both OCT systems were able to detect a difference between eyes with an outcome of optic neuritis and those without optic neuritis.

Reduced retinal nerve fibre layer thickness in multiple sclerosis patients with and without history of optic neuritis

PurposeCompare the retinal nerve fibre layer (RNFL) thickness in multiple sclerosis (MS) patients, with and without previous episodes of optic neuritis (ON), to disease‐free controls, using optical coherence tomography (OCT).MethodsThe RNFL was measured with a spectral domain OCT (Canon HS‐100) in 433 MS patients and in 70 controls. The MS eyes were sorted into three groups: MS non ON eyes (MSON−), MS ON eyes (MSON+) and the fellow eye of MS ON (MSON_fellow). One eye of each patient in the MSON‐group and in the control group was selected randomly for analysis.ResultsSeventy control eyes, 327 MSON‐ eyes, 106 MSON+ eyes and 106 MSON_fellow eyes were analysed in a linear regression adjusting for age. The average RNFL thickness was found to be statistically thinner in the MSON− group (88.2 ± 13.0 µm) compared to the controls (98.1 ± 9.0 µm; p &lt; 0.00).The average RNFL was thinner in the MSON+ group (77.3 ± 15.2 µm) compared to MSON− eyes and the controls (p &lt; 0.00). A paired t‐test showed a significant decrease in RNFL thickness in the MSON+ eyes compared to MSON_fellow.ConclusionsMultiple sclerosis causes RNFL loss. A mean reduction of ~10 µm was found in MS patients without history of ON and a mean reduction of 20 µm was found in MS patients with history of ON compared to healthy controls. This study showed that OCT is a useful tool that provides evidence of neural degeneration in MS patients, with or without the presence of ON.

Functional plasticity of the visual system in multiple sclerosis.

OPINION article Front. Neurol., 08 April 2015Sec. Multiple Sclerosis and Neuroimmunology Volume 6 - 2015 | https://doi.org/10.3389/fneur.2015.00079

Three-Dimensional Geometries Representing the Retinal Nerve Fiber Layer in Multiple Sclerosis, Optic Neuritis, and Healthy Eyes

Background: To represent and interpret the three-dimensional (3D) geometry and the distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON). Methods: MS patients (n = 122) and age-matched healthy subjects (n = 108) were enrolled. The Spectralis optical coherence tomography system was used to determine the circumpapillary RNFL thickness. The 768 RNFL thickness measurements were used to evaluate thickness measurements in patients with or without antecedent ON and to design a 3D reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes. Results: RNFL thickness was decreased in MS patients, and was higher in the MS group with previous ON. Statistical analysis and 3D RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area (101.77 µm in MS vs. 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in MS eyes and 149.26 µm in healthy eyes). Conclusions: The 3D representation of RNFL thickness based on measurements allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.

Three‐dimensional geometries representing the retinal nerve fiber layer in multiple sclerosis, optic neuritis, and healthy eyes

AbstractPurpose To represent and interpret the three‐dimensional geometry and distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON).Methods MS patients (n=122) and age‐matched healthy subjects (n=108) were enrolled in this observational cross‐sectional study. The Spectralis OCT system (Heidelberg Engineering) was used to determine the circumpapillary RNFL thickness in both eyes of each participant. The 768 RNFL thickness measurements provided by the Spectralis OCT were used to evaluate thickness measurements in MS patients with or without antecedent ON and to design a three‐dimensional reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes.Results RNFL thickness was decreased in MS patients, and higher in the MS group with previous ON. Statistical analysis and three‐dimensional RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area in MS eyes (101.77 µm in MS vs 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in healthy eyes vs. 149.26 previous‐ON MS eyes) in MS eyes with previous ON.Conclusion The three‐dimensional representation of RNFL thickness based on measurements provided by the Spectralis OCT allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.

Transsynaptic Retinal Degeneration in Optic Neuropathies: Optical Coherence Tomography Study

Recently demonstrated neuronal loss in the inner nuclear layer of the retina in multiple sclerosis (MS) and glaucoma raises the question of a primary (possibly immune-mediated) or secondary (transsynaptic) mechanism of retinal damage in these diseases. In the present study we used optical coherence tomography to investigate retrograde retinal transsynaptic degeneration in patients with long-standing and severe loss of ganglion cells due to optic neuropathy. Fifteen eyes of glaucoma patients with visual field defect limited to upper hemifield and 15 eyes of MS patients with previous episode of optic neuritis (ON) and extensive loss of ganglion cells were imaged using spectral-domain optical coherence tomography and compared with two groups of age-matched controls. Combined retinal ganglion cell layer/inner plexiform layer (GCL/IPL) thickness and inner nuclear layer (INL) thickness were analyzed. In the glaucoma group there was a significant (P = 0.0005) reduction of GCL/IPL thickness in the lower (affected) retina compared with normal controls; however INL thickness was not statistically reduced (P = 0.49). In the MS group reduction of GCL/IPL thickness in both hemifields of ON eyes was also significant (P = 0.0001 and P < 0.0001 for inferior and superior retina respectively). However, similar to the glaucomatous eyes, there was no significant reduction of INL thickness in both hemifields (P = 0.25 and P = 0.45). This study demonstrates no significant loss of INL thickness in parts of the retina with long-standing and severe loss of retinal ganglion cells.

Independent patterns of damage to retinocortical pathways in multiple sclerosis without a previous episode of optic neuritis

Asymptomatic visual loss is a feature of multiple sclerosis (MS) but its relative impact on distinct retinocortical pathways is still unclear. The goal of this work was to investigate patterns of subclinical visual impairment in patients with MS with and without clinically associated previous optic neuritis (ON). We have used functional methods that assess parvo-, konio- and magnocellular pathways in order to compare pathophysiological mechanisms of damage in a population of 44 subjects with MS (87 eyes), with and without a previous episode of ON. These methods included chromatic contrast sensitivity across multiple chromatic axes (Cambridge Colour Test-parvo/konio pathways), perimetric achromatic contrast sensitivity for the magno pathway [frequency doubling technique (FDT)] and pattern visual evoked potentials (VEP). These measures were correlated with field sensitivity measures obtained using conventional automated static perimetry (ASP) and were also compared with conventional clinical chromatic/achromatic contrast sensitivity chart-based measures. We have found evidence for uncorrelated damage of all retinocortical pathways only in patients with MS without ON. VEP evidence for axonal damage was found in this group supporting the emerging notion of axonal damage even in sub-clinical stages of ON/MS pathophysiology. Only in this group was significant correlation of functional measures with disease stage observed, suggesting that distinct pathophysiological milestones are present before and after ON has occurred.

Optical coherence tomography evaluation of retinal nerve fiber layer in longitudinally extensive transverse myelitis

To compare optical coherence tomography (OCT) measurements on the retinal nerve fiber layer (RNFL) of healthy controls and patients with longitudinally extensive transverse myelitis (LETM) without previous optic neuritis. Twenty-six eyes from 26 patients with LETM and 26 control eyes were subjected to automated perimetry and OCT for comparison of RNFL measurements. The mean deviation values from perimetry were significantly lower in patients with LETM than in controls (p<0.0001). RNFL measurements in the nasal quadrant and in the 3-o'clock segment were significantly smaller in LETM eyes than in controls. (p=0.04 and p=0.006, respectively). No significantly differences in other RNFL measurements were found. Patients with LETM may present localized RNFL loss, particularly on the nasal side of the optic disc, associated with slight visual field defects, even in the absence of previous episodes of optic neuritis. These findings emphasize the fact that patients with LETM may experience attacks of subclinical optic nerve damage.

Retinal venous sheathing in optic neuritis: its significance for the pathogenesis of multiple sclerosis. By S. Lightman, W. I. McDonald, A. C. Bird, D. A. Francis, A. Hoskins, J. R. Batchelor and A. M. Halliday. Brain 1987: 110; 405-414

Although the perivenous localization of cellular cuffing and plaque formation in multiple sclerosis is well known, and vascular abnormalities of the retinal vessels detected by ophthalmoscopy have also been reported, no one is yet clear on the frequency and significance of these findings. The aim is to document the presence of vascular changes and cells in the ocular media in a series of patients presenting with isolated optic neuritis, and to assess the significance of these findings for subsequent conversion to multiple sclerosis. Patients diagnosed with acute optic neuritis and without previous ocular disease or possible manifestations of multiple sclerosis are recruited from the Physicians’ Clinic at Moorfields Eye Hospital. Of the 50 participants (31 females and 19 males, aged 14–49 years), of whom 3 have had one previous episode of optic neuritis, none are treated and all but 1 make a spontaneous recovery, eventually achieving visual acuity in the affected eye of 6/9 or better. After routine neurological and ophthalmological examination, the pupils are dilated and fluorescein angiography performed. The results are clear. Fourteen patients have an abnormal retina (Fig. 1): vascular sheathing (two), fluorescein leakage (six) or cells in the ocular media (two) as the only abnormality; combinations of vascular sheathing and fluorescein leakage (4); or …