Previous History Of Optic Neuritis Research Articles

Magnetization transfer saturation reveals subclinical optic nerve injury in pediatric-onset multiple sclerosis

Background: The presence of subclinical optic nerve (ON) injury in youth living with pediatric-onset MS has not been fully elucidated. Magnetization transfer saturation (MTsat) is an advanced magnetic resonance imaging (MRI) parameter sensitive to myelin density and microstructural integrity, which can be applied to the study of the ON. Objective: The objective of this study was to investigate the presence of subclinical ON abnormalities in pediatric-onset MS by means of magnetization transfer saturation and evaluate their association with other structural and functional parameters of visual pathway integrity. Methods: Eleven youth living with pediatric-onset MS (ylPOMS) and no previous history of optic neuritis and 18 controls underwent standardized brain MRI, optical coherence tomography (OCT), Magnetoencephalography (MEG)-Visual Evoked Potentials (VEPs), and visual battery. Data were analyzed with mixed effect models. Results: While ON volume, OCT parameters, occipital MEG-VEPs outcomes, and visual function did not differ significantly between ylPOMS and controls, ylPOMS had lower MTsat in the supratentorial normal appearing white matter (−0.26 nU, p = 0.0023), and in both in the ON (−0.62 nU, p < 0.001) and in the normal appearing white matter of the optic radiation (−0.56 nU, p = 0.00071), with these being positively correlated (+0.57 nU, p = 0.00037). Conclusions: Subclinical microstructural injury affects the ON of ylPOMS. This may appear as MTsat changes before being detectable by other currently available testing.

Multifocal Electroretinogram Photopic Negative Response: A Reliable Paradigm to Detect Localized Retinal Ganglion Cells' Impairment in Retrobulbar Optic Neuritis Due to Multiple Sclerosis as a Model of Retinal Neurodegeneration.

The measure of the full-field photopic negative response (ff-PhNR) of light-adapted full-field electroretinogram (ff-ERG) allows to evaluate the function of the innermost retinal layers (IRL) containing primarily retinal ganglion cells (RGCs) and other non-neuronal elements of the entire retina. The aim of this study was to acquire functional information of localized IRL by measuring the PhNR in response to multifocal stimuli (mfPhNR). In this case-control observational and retrospective study, we assessed mfPhNR responses from 25 healthy controls and from 20 patients with multiple sclerosis with previous history of optic neuritis (MS-ON), with full recovery of visual acuity, IRL morphological impairment, and absence of morpho-functional involvement of outer retinal layers (ORL). MfPhNR response amplitude densities (RADs) were measured from concentric rings (R) with increasing foveal eccentricity: 0–5° (R1), 5–10° (R2), 10–15° (R3), 15–20° (R4), and 20–25° (R5) from retinal sectors (superior-temporal (ST), superior-nasal (SN), inferior-nasal (IN), and inferior-temporal (IT)); between 5° and 20° and from retinal sectors (superior (S), temporal (T), inferior (I), and nasal (N)); and within 5° to 10° and within 10° and 20° from the fovea. The mfPhNR RAD values observed in all rings or sectors in MS-ON eyes were significantly reduced (p < 0.01) with respect to control ones. Our results suggest that mfPhNR recordings may detect localized IRL dysfunction in the pathologic condition of selective RGCs neurodegeneration.

Inner and outer retina findings determined by optical coherence tomography in different subtypes of multiple sclerosis.

Integrity of outer retinal bands among multiple sclerosis (MS) subtypes remains unclear, however alterations of thickness in retinal layers is well described. The objective of the study was to determine the alterations in the thickness of the inner and outer layers of the retina and the findings in both layers detected by optical coherence tomography (OCT) among patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). A total of 132 eyes from 66 patients with multiple sclerosis (MS) (70 eyes from 35 patients with RRMS and 62 eyes from 31 patients with SPMS) and 72 eyes from 36 healthy controls were included in the study. The external structures of the retina, including the outer limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ), were examined using OCT in RRMS, SPMS, and healthy control groups. The correlation of neurological disability expressed by the Expanded Disability Study Scale (EDSS) score, best-corrected visual acuity, and duration of disease among OCT parameters was also analyzed. In eyes, with no history of previous optic neuritis (ON), the macular nerve fiber layer, the internal plexiform layer of ganglion cells (GCIPL), and the total thickness of the retinal layer were thinner in the SPMS group than in the RRMS group (P < 0.05, in each comparison). EZ was more vulnerable among the three hyperreflective external retinal zones in the retina of patients with SPMS than in patients with RRMS (P = 0.016). Alterations in retinal thickness in MS are not limited to the inner layers of the retina and also occur in the outer structures of the retina.

Is retinal nerve fibre layer thickness correlated with visual function in individuals having optic neuritis?

ABSTRACT Clinical relevance The existence of a correlation between the results of paraclinical retinal imaging and clinical tests such as contrast sensitivity can reduce time and cost in diagnosing optic neuritis (ON). Background To demonstrate whether changes of peripapillary retinal nerve fibre layer (RNFL) thickness are correlated with the results of visual acuity, contrast sensitivity and colour vision in eyes with acute ON. Methods Thirty patients with acute ON, 23 females and seven males, who had no previous history of ON in neither eye, were examined. Inclusion criteria were: subjects had spherical refraction of less than ±5D, no prior ON or optic disc swelling, no history of amblyopia or colour blindness, and no history or ophthalmoscopic evidence of glaucoma, diabetic retinopathy, or maculopathies. Visual acuity, contrast sensitivity and colour vision were tested and optical coherence tomography was performed for all patients after complete ophthalmologic examinations including refraction, biomicroscopy, and funduscopy with a 90D lens by a neuro-ophthalmologist. Results Thirty patients who were 18–45 years old entered the study. There was an inverse correlation between contrast sensitivity and nasal (r = −0.430, p = 0.018), inferior (r = −0.503, p = 0.005) and mean (r = −0.510, p = 0.004) RNFL thickness. The multiple linear regression model, after adjustment for age and sex, showed a significant association between visual acuity and nasal RNFL thickness (coefficient = 0.025, p = 0.032). There was also a significant inverse correlation between contrast sensitivity and nasal (coefficient = −0.003, p = 0.036), inferior (coefficient = −0.006, p = 0.010) and mean (coefficient = −0.007, p = 0.012) RNFL thickness. No significant correlation was found between colour vision and RNFL thickness. Conclusion Contrast sensitivity is more correlated with changes in RNFL thickness in comparison with visual acuity and colour vision. Contrast sensitivity measurement therefore can be used as one of the first assessments in patients with ON.

Bruch's membrane opening-minimum rim width: An alternative OCT biomarker study for multiple sclerosis.

Bruch's membrane opening-minimum rim width (BMO-MRW) and RNFL measured using anatomic positioning system (APS-RNFL) are novel OCT methods and remained unexplored in MS patients.To investigate the novel parameters of spectral-domain OCT as an alternative biomarker in patients with multiple sclerosis (MS). Retrospective cohort study; participants consisted of relapsing-remitting MS (RRMS) patients and healthy controls (HC). Eyes were classified according to the presence of MS and previous optic neuritis (ON). Measurements of standard peripapillary RNFL (S-RNFL), BMO-MRW, and APS-RNFL were performed. A total of 244 eyes of 122 participants (MS-patients: 63, HC: 59) were included in the study. Fifty-one eyes had a history of previous ON. In almost all measured parameters, neuroretinal rim thicknesses were observed the thinnest in eyes with ON history between all subgroups. S-RNFL and APS-RNFL techniques showed the difference in neuroretinal rim thickness in all three subjects (ON+, ON-, and HC). However, BMO-MRW, on the other hand, could not distinguish between ON(-) patients and HC. The relationship between OCT parameters and EDSS were observed only in eyes with an ON history in all three techniques. A meaningful model with 78% accuracy was obtained by using only the OCT parameters as risk factors. In the ROC analysis, no parameters were found to have acceptable high sensitivity and specificity. BMO-MRW was statistically weaker in every aspect than other RNFL techniques. The novel APS-RNFL technique appears to be a bit more reliable alternative to S-RNFL technique to support therapeutic decision-making in MS. BMO-MRW has not been found as a successful alternative to S-RNFL.

Serum neurofilament levels reflect outer retinal layer changes in multiple sclerosis.

Background:Serum neurofilament light chain (sNfL) and distinct intra-retinal layers are both promising biomarkers of neuro-axonal injury in multiple sclerosis (MS). We aimed to unravel the association of both markers in early MS, having identified that neurofilament has a distinct immunohistochemical expression pattern among intra-retinal layers.Methods:Three-dimensional (3D) spectral domain macular optical coherence tomography scans and sNfL levels were investigated in 156 early MS patients (female/male: 109/47, mean age: 33.3 ± 9.5 years, mean disease duration: 2.0 ± 3.3 years). Out of the whole cohort, 110 patients had no history of optic neuritis (NHON) and 46 patients had a previous history of optic neuritis (HON). In addition, a subgroup of patients (n = 38) was studied longitudinally over 2 years. Support vector machine analysis was applied to test a regression model for significant changes.Results:In our cohort, HON patients had a thinner outer plexiform layer (OPL) volume compared to NHON patients (B = −0.016, SE = 0.006, p = 0.013). Higher sNfL levels were significantly associated with thinner OPL volumes in HON patients (B = −6.734, SE = 2.514, p = 0.011). This finding was corroborated in the longitudinal subanalysis by the association of higher sNfL levels with OPL atrophy (B = 5.974, SE = 2.420, p = 0.019). sNfL levels were 75.7% accurate at predicting OPL volume in the supervised machine learning.Conclusions:In summary, sNfL levels were a good predictor of future outer retinal thinning in MS. Changes within the neurofilament-rich OPL could be considered as an additional retinal marker linked to MS neurodegeneration.

Latency of Multifocal Visual Evoked Potential in Multiple Sclerosis: A Visual Pathway Biomarker for Clinical Trials of Remyelinating Therapies.

Acute focal demyelination is the characteristic feature of multiple sclerosis, with the majority of damaged axons undergoing limited remyelination and forming chronic lesions. Potential remyelinating agents are currently under development and there is therefore an urgent need for reliable in vivo biomarkers of remyelination. This study aimed to investigate potential changes in multifocal visual evoked potentials' (mfVEPs) latency in a cohort of relapsing-remitting multiple sclerosis (RRMS) patients. The potential sample size required for a remyelination-based clinical trial using different treatment effect sizes and the mfVEP latency as an outcome measure was also estimated. A total of 50 RRMS consecutive patients with no previous history of optic neuritis in at least one eye and 15 normal controls of similar age and gender composition were prospectively enrolled. Fifteen patients had a history of unilateral ON more than 12 months earlier, whereas 41 patients demonstrated optic radiations lesions on MRI at baseline. Most patients were on disease modifying therapy. A mfVEP was recorded at baseline and 12 months later. At baseline, the mfVEP latency in RRMS patients was delayed compared with normal controls in both optic neuritis and nonoptic neuritis eyes. Latency delay was significantly correlated to optic radiation lesion volume (R2 = 0.38, P < 0.001). There was no significant latency change in multiple sclerosis patients' eyes or optic neuritis and nonoptic neuritis eyes over the follow-up period with latency remaining remarkably constant. This was despite the fact that 46 of 50 patients were on disease-modifying therapies, implying current treatments do not affect myelination in chronic RRMS cases. Sample size calculations to evaluate an additional or alternative remyelinating agent, based on a 40% treatment effect, revealed that a relatively small sample size (78 patients) would be required to demonstrate efficacy in future trials of remyelination therapies. Given its known sensitivity for latency changes and the stability found in this RRMS population, the mfVEP represents an ideal biomarker to assess the degree of latency recovery that may be achieved by remyelination in multiple sclerosis.

Optical Coherence Tomography in Neuromyelitis Optica spectrum disorder and Multiple Sclerosis: A population-based study

Background: The aim of this study was to identify and compare the characteristics of retinal nerve layers using spectral domain-optical coherence tomography (SD-OCT) in neuromyelitis optica spectrum disorder (NMOSD), relapsing-remitting multiple sclerosis (RRMS) and healthy controls (HCs). Methods: It is a cross-sectional population-based study in Isfahan, Iran. We enrolled 98 participants including 45 NMOSD patients (90 eyes), 35 RRMS patients (70 eyes) and 18 HCs (36 eyes). Evaluation criteria were thickness of different sectors in peripapillary retinal nerve fiber layer (pRNFL) and intra-retinal layers around the macula. History of previous optic neuritis (ON) was obtained through chart review and medical record. Results: Without considering ON, total macular, ganglion cell layer (GCL) and pRNFL were significantly thinner in both groups of patients compared to HCs. On macular examination, GCL and total macular thickness were significantly thinner than HCs in all NMOSD and RRMS eyes with and without history of ON. While there was no significant difference between MS-ON and MS without a history of ON in the macular measures, the reduction in total macular and GCL thickness was significantly greater in NMOSD-ON compared to NMOSD without a history of ON. Also in NMOSD-ON eyes, the RNFL, GCL, IPL and GCIPL layers were significantly thinner than that of MS-ON. On the other hand, the pRNFL study showed significant thinning of all quadrants in the RRMS and NMOSD groups relative to HCs. While the decrease of pRNFL thickness in the eyes of NMOSD-ON and MS with and without a previous history of ON was significantly greater than that of HCs, no difference was observed between NMOSD without ON and HCs. In addition, in NMOSD patients, pRNFL was significantly thinner in eyes with history of ON compared to non ON-eyes. Furthermore, in patients with a history of ON, reduction in all sectors of pRNFl (except in T) was significantly greater in NMOSD compared to MS patients. Conclusion: Our findings showed that although macular and retinal damage occurred in both NMOSD and RRMS patients without significant differences, the severity of injury in eyes with history of ON was significantly higher in NMOSD compared to MS patients, that could be considered as a marker to distinguish them. In addition, our results confirmed the absence of subclinical optic nerve involvement in NMOSD unlike MS patients.

Vestibulo ocular reflex in multiple sclerosis patients without any optic neuritis

PurposeTo investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. Methods26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. ResultsMean spherical equivalent (SE) was – 0.40 ± 0.93 D and – 0.04 ± 0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ± 75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). ConclusionOur study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups.

Atrophy of optic nerve detected by transorbital sonography in patients with demyelinating diseases of the central nervous system.

Transorbital sonography (TOS) has emerged as promising imaging method for the diagnosis and follow-up of acute optic neuritis (ON). Available studies report an increase in the optic nerve diameter (OND) and the optic nerve sheath diameter (ONSD) in the case of a first episode of ON in the affected eye compared to either the contralateral unaffected eye or controls. However, the utility of TOS in the case of recurrent episodes of ON has never been assessed. In our prospective cohort study, the diagnostic utility of TOS in patients with demyelinating diseases of the central nervous system was assessed, and the association between TOS, optical coherence tomography (OCT) and visual evoked potentials was examined further. Seventy-eight patients with a history of demyelinating disorders of the central nervous system (mean age 38.2±14.2years; 24% with acute ON) were included. No differences in the OND (3.2±0.5mm vs. 3.2±0.4mm) and ONSD (5.1±0.8mm vs. 5.1±0.7mm) measurements were found between patients with and without acute ON. Papillary swelling was more frequent in patients with acute ON (14.2% vs. 1.5%, P=0.002). Patients with a history of previous ON were found to have lower OND (P<0.001) and ONSD (P=0.007) compared to patients without a history of previous ON. TOS measurements were inversely associated with disease duration and positively correlated with OCT findings. No association with visual evoked potential measurements was found. No evidence was found for TOS-sensitive differences in the OND and ONSD of patients with demyelinating diseases, according to the presence of acute ON. The association between TOS and OCT measurements deserves further investigation.

Diagnostic ability of multifocal electroretinogram in early multiple sclerosis using a new signal analysis method.

PurposeTo determine if a novel analysis method will increase the diagnostic value of the multifocal electroretinogram (mfERG) in diagnosing early-stage multiple sclerosis (MS).MethodsWe studied the mfERG signals of OD (Oculus Dexter) eyes of fifteen patients diagnosed with early-stage MS (in all cases < 12 months) and without a history of optic neuritis (ON) (F:M = 11:4), and those of six controls (F:M = 3:3). We obtained values of amplitude and latency of N1 and P1 waves, and a method to assess normalized root-mean-square error (FNRMSE) between model signals and mfERG recordings was used. Responses of each eye were analysed at a global level, and by rings, quadrants and hemispheres. AUC (area under the ROC curve) is used as discriminant factor.ResultsThe standard method of analysis obtains further discrimination between controls and MS in ring R3 (AUC = 0.82), analysing N1 waves amplitudes. In all of the retina analysis regions, FNRMSE value shows a greater discriminating power than the standard method. The highest AUC value (AUC = 0.91) was in the superior temporal quadrant.ConclusionBy analysing mfERG recordings and contrasting them with those of healthy controls it is possible to detect early-stage MS in patients without a previous history of ON.

The clinical spectrum and prognosis of idiopathic acute optic neuritis: A longitudinal study in Southern Finland

BackgroundTo analyse in a population-based setting the clinical features, prognostic factors, and seasonality of patients diagnosed with acute idiopathic optic neuritis (ON). MethodsRetrospective analysis of ophthalmological records, laboratory parameters, and magnetic resonance imaging (MRI) of patients with symptoms suggestive of ON referred to the Helsinki University Hospital (serving a population of 1.53 million in Southern Finland) were analysed between May 1, 2008 and April 14, 2012. ResultsOf the 291 patients with suspected ON, 184 (63%) were diagnosed with ON (mean age 34 years, 76% females). Intravenous methylprednisolone treatment was administered in 131 (71%) patients. First ON was diagnosed in 123 patients (67%), 55 (30%) had a previous diagnosis of multiple sclerosis (MS) and two patients with their first ON were diagnosed with neuromyelitis optica. Evolution of best corrected visual acuity (BCVA) was analysed in 132 (72%) patients, who were reviewed median of 38 days after onset. Median and mean BCVAs in these reviewed patients were 0.4 and 0.2 at the time of diagnosis and 1.0 and 0.5 at the time of the review. Recovery was relatively good in the majority of patients; 82% (n = 108) had reached BCVA of ≥0.5 and 70% (n = 92) and BCVA of ≥0.8 at the time of the review, while thirteen (10%) had poor prognosis, BCVA ≤0.1 at review. Accessory clinical features included optic disc swelling (21%), colour vision impairment (75%), and pain with eye movements (65%). Relative afferent pupillary defect was abnormal in 76% of the patients with their first ON. Baseline visual acuity was most strongly associated with visual outcome at review (P < 0.001, linear regression). Optic disc swelling and the presence of lesions in the optic nerve on MRI had a more modest association with poorer recovery (P = 0.033 and P = 0.049, respectively), while age, sex, previous history of ON, and previous diagnosis of multiple sclerosis were not associated with outcome at review. Incidence of ON showed a clear seasonal pattern; there were two times more cases in April to June versus October to December (P = 0.03), confirming previous results from Sweden. ConclusionsOur data suggest that besides baseline visual acuity, optic disc swelling and lesions in the optic nerve on MRI are associated with poorer prognosis. As in previous studies, we observed that diagnostics of ON is difficult, accessory clinical findings such as pain and RAPD are not always present. Although the diagnosis of ON is clinical, the role of MRI should be considered in differential diagnostics and in defining potential prognostic markers.

Cognitive and physical disability in Egyptian patients with multiple sclerosis: genetic and optical coherence tomography study

ABSTRACTObjectives: The aim of this study was to explore the relationship between cognitive dysfunction, neurodegeneration, and genetic factors among multiple sclerosis (MS) patients.Methods: Fifty patients of definite MS were included. Physical disability was assessed by expanded disability status scale (EDSS). Cognitive functions were assessed by using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). For each eye, optical coherence tomography (OCT) was used to track thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), respecting the previous history of optic neuritis (ON). All patients were genotyped for glutamate N-methyl-D-aspartate receptors (NMDARs).Results: A statistically significant negative correlation was found between scores of EDSS and each of neuropsychological tests scores and thickness of both RNFL and GCC. The predictor for progressive disability assessed by EDSS was Symbol Digit Modalities Test (SDMT) (P = 0.021), that is dependent on the educational level of the patients (P = 0.016). A statistically significant positive correlation was found between scores of all neuropsychological tests and the thickness of both RNFL and GCC. Eighty-three percent of MS patients with CC genotype reported previous attacks of ON with significant thinning in RNFL and GCC despite their higher cognitive performance in comparison to other genotypes.Discussion: Deficit in information processing speed measured by SDMT is a predictor of early progressive disability in MS patients. Thinning of RNFL and GCC is a potential biomarker for cognitive and physical disability in MS. The CC genotype of glutamate NMDAR gene has a divergent effect on visual and cognitive functions.

Transorbital ultrasonography for measuring optic nerve atrophy in multiple sclerosis

we aimed to evaluate the utility of transorbital ultrasonography (TOS) in optic nerve assessment and quantification of ON atrophy in MS patients, and to determine whether ON atrophy correlates with the disease duration and disability measured on the Kurtzke Expanded Disability Status Scale (EDSS). Prospective, multicentre, blinded cohort study of 59 patients diagnosed with relapsing-remitting MS and 36 controls. When measured with TOS, the diameter of both the right (2.69±0.30mm in cases; 3.20±0.19mm in controls, P<.0001) and left (2.71±0.26mm in cases; 3.24±0.15mm controls, P<.0001) ON of study patients was smaller than controls. We observed a negative correlation between EDSS and both right (ρ=.524) and left (ρ=.469) ON diameter. We also observed a negative correlation between disease duration and both right (r=.602) and left (r=.538) ON diameter. No difference was observed in the diameter of both ON among patients with a history of optic neuritis (right OND 2.68±0.29mm; left OND 2.69±0.25mm) and patients with no history of optic neuritis (right OND 2.70±0.30mm; left OND 2.73±0.27mm) (P=.805; P=.651). The thickness of ON measured with TOS is correlated with EDSS and the duration of the disease without being interfered by the previous history of optic neuritis. TOS could be a reliable technique for measuring ON atrophy in MS.

T109. Diagnostic value of transorbital ultrasound in acute optic neuritis

Introduction Visual evoked potentials (VEP), magnetic resonance imaging, and the optical coherence tomography (OCT) have been used to evaluate the functional and morphologic status of the afferent visual pathway. However, these utilities have some limitation to evaluate optic nerve pathology in the early stage. Recently transorbital ultrasound (US) has been introduced as a promising tool to evaluate optic bulb and nerve. We performed this study to assess the practical diagnostic value of US in patients with optic neuritis (ON). Methods Transorbital US, OCT, and VEP were performed in both eyes of patients with symptoms suggesting acute ON. The optic nerve diameter was measured using the US at point 3 mm posterior to eye globe with and without nerve sheath. The diameter was analyzed to see any correlation with parameters in VEP and OCT. All measured parameters were compared between affected and non-affected side. Results Of 33 patients who were enrolled in this study, seven patients with the previous history of ON were excluded from analysis. Of 26 patients, nine patients were confirmed as the other disorder or no definite evidence of ON. Only data of 17 patients (9 men, median age 44.4 years) were finally included in the analysis. The median diameter of the optic nerve with and without sheath on the affected side (5.36 and 3.28 mm) was significantly larger compared to the non-affected side (5.22 and 3.08 mm; p = 0.018 and p = 0.003). However, the diameters of optic nerve with or without sheath were not correlated with VEP and OCT parameters on the same side. Conclusion Optic nerve diameter in the transorbital US was significantly increased in acute ON. US could be considered in patients with ON in the early stage as supportive tools for assessment of optic nerve.

Longitudinal quantitative assessment of macula during therapy with fingolimod in relapsing-remitting multiple sclerosis.

Fingolimod is the first oral drug approved for treatment of relapsing-remitting multiple sclerosis (RR-MS), and it has potential macular side effects. Despite the qualitative evidence of macular oedema under treatment, longitudinal quantitative assessment is lacking. To address this issue, we measured macular volume and central foveal thickness in a cohort of MS patients on fingolimod over 12months of treatment. Central foveal thickness (CFT) and total macular volume (TMV) were longitudinally recorded with spectral-domain optical coherence tomography in a cohort of 23 RR-MS patients treated with fingolimod at baseline, 3, 6 and 12months. OCT parameters were analysed considering previous history of optic neuritis (ON). Comparison of means was performed with variance analysis (ANOVA). Macular oedema occurred in none of the patients. Comparing both groups of patients (with and without previous ON), no statistically significant difference was found during the follow-up both for CFT and TMV (p=0.99 and p=0.96, respectively) although a slight early but not significant TMV reduction was detected. In our cohort, therapy with fingolimod did not cause any change in CFT and TMV in MS patients during a 12-month follow-up independent of previous ON.

Long-term structural retinal changes in patients with optic neuritis related to multiple sclerosis.

PurposeTo evaluate the long-term structural and functional outcome in patients with multiple sclerosis (MS) with and without a history of optic neuritis (ON).MethodsThis was a cross-sectional study of 82 patients diagnosed with MS between 2000 and 2006 from a tertiary hospital center in Denmark. Patients gave a self-reported history of ON, and functional (visual acuity and color vision) and structural (spectra domain optical coherence tomography) markers of vision were tested.ResultsMedian age and MS duration at the time of the clinical examination were 49.9 years (range 30.7–72.6 years) and 13 years (range 9–15 years), respectively. ON was not associated with impairment of visual acuity or color vision. Twenty-three patients had a history of ON in at least one eye. Compared to non-affected patients, these had a lower inferior (109 vs 113 μm, P=0.04) and temporal retinal nerve fiber layer (RNFL) thickness (56 vs 67 μm, P=0.01). In an age- and sex-adjusted logistic regression model, lower inferior and temporal RNFL were associated with a higher risk of ON (odds ratio [OR] 1.56 [95% confidence interval {CI} 1.01–2.41] and OR 1.74 [95% CI 1.10–2.77] per 10 μm decrement in RNFL thickness, respectively). Twenty patients had a history of ON in one eye. Compared to the non-affected eye, this eye had a lower RNFL (109 vs 115 μm, P=0.04) and a higher central retinal thickness/mean RNFL ratio (2.7 vs 2.4, P=0.04).ConclusionAlthough patients with long-term MS and a previous history of ON did not have any functional loss of vision, structural neurodegeneration could be demonstrated in the affected eye.

12. Sensitivity and predictive value of OCT and VEP in multiple sclerosis

Aim of the study was to evaluate the role of optical coherence tomography (OCT) and visual evoked potentials (VEPs) in patients with multiple sclerosis (MS), on 121 consecutive subjects with MS. Of 242 eyes, 166 had no previous history of optic neuritis (ON), 22 had a single recent ON episode (<3 months); 54 had chronic ON (at least 1 episode >3 months before). All patients underwent assessment of EDSS, OCT retinal nerve fiber layer (RNFL) thickness and VEP (checkerboard, size 15′); 77 subjects underwent a second EDSS (EDSS2) evaluation after a mean time of 2 ± 0.69) years (median EDSS 2, range 0–7). In eyes with recent ON, the sensitivity of OCT was 38.9% with a higher sensitivity of VEP (77.3%; McNemar p < 0.02). In eyes with chronic ON, no significant difference was found between OCT (68.5%) and VEP (81.5%) sensitivity. In asymptomatic eyes, VEPs had a higher sensitivity (31.7%) vs OCT (19.9%; p = 0.005); VEP/OCT combined detected abnormalities in 39.2%. In follow up evaluation, OCT alterations were associated with development of disability after 2 years (p = 0.013). VEP alterations did not predict future disability development neither in patients with previous ON nor in those without. The present findings confirm a higher sensitivity of VEPs in the subacute phases of optic neuritis (less than 3 months) and in asymptomatic eyes. In eyes without previous optic neuritis, early asymptomatic OCT abnormalities are associated with short-term worsening of disability. Further longitudinal studies are needed to confirm our findings.

ID 275 – OCT and VEP in Multiple Sclerosis: Sensitivity and predictive value

To evaluate the role of optical coherence tomography (OCT) and visual evoked potentials (VEPs) in patients with multiple sclerosis (MS). Study of 121 consecutive subjects with MS. Of 242 eyes, 166 had no previous history of optic neuritis (ON), 22 had a single recent ON episode (3 months before). All patients underwent assessment of EDSS, OCT retinal nerve fiber layer (RNFL) thickness and VEP. 77 subjects underwent to a second EDSS (EDSS2) evaluation after a mean time of 1, 94 years. In eyes with recent ON, the sensitivity of OCT was 38.9% with a higher sensitivity of VEP (77.3%; McNemar p

55. VEPS and OCT in acute and chronic optic neuritis associated with multiple sclerosis

To evaluate the relative value of optical coherence tomography (OCT) and visual evoked potentials (VEPs) in assessing visual involvement in patients with multiple sclerosis (MS). Cross-sectional study of 121 consecutive subjects with MS. Of 242 eyes, 166 had no previous history of optic neuritis (ON), 22 had a single recent ON episode (<3 months); 54 had chronic ON (at least 1 episode >3 months before). All patients underwent assessment of EDSS, visual acuity (VA), OCT retinal nerve fiber layer (RNFL) thickness and VEP. In eyes with recent ON, the sensitivity of OCT was 5.6% considering only RNFL thickness increase, 38.9% considering also RNFL reduction, with a higher sensitivity of VEP (77.3%; McNemar p < 0.0001 and 0.02). In eyes with chronic ON, no significant difference was found between OCT (68.5%) and VEP (81.5%) sensitivity (VEP/OCT 88.9%). In asymptomatic eyes, VEPs had a higher sensitivity (31.7%) vs OCT (19.9%; p = 0.005); VEP/OCT combined detected abnormalities in 39.2%. In this subgroup, VEP score and global RNFL thickness were significantly correlated with EDSS, disease duration, not with VA. The present findings confirm a higher sensitivity of VEPs in the subacute phases of optic neuritis and in asymptomatic eyes. This discrepancy fades off after more than 3 months from the ON episode. Finally, the correlation with disability and DD favours the usefulness of both techniques in monitoring MS patients, to be verified through longitudinal studies.