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Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography.

Publication ,  Journal Article
Saidha, S; Syc, SB; Ibrahim, MA; Eckstein, C; Warner, CV; Farrell, SK; Oakley, JD; Durbin, MK; Meyer, SA; Balcer, LJ; Frohman, EM; Newsome, SD ...
Published in: Brain
February 2011

Optical coherence tomography studies in multiple sclerosis have primarily focused on evaluation of the retinal nerve fibre layer. The aetiology of retinal changes in multiple sclerosis is thought to be secondary to optic nerve demyelination. The objective of this study was to use optical coherence tomography to determine if a subset of patients with multiple sclerosis exhibit primary retinal neuronopathy, in the absence of retrograde degeneration of the retinal nerve fibre layer and to ascertain if such patients may have any distinguishing clinical characteristics. We identified 50 patients with multiple sclerosis with predominantly macular thinning (normal retinal nerve fibre-layer thickness with average macular thickness < 5th percentile), a previously undescribed optical coherence tomography defined phenotype in multiple sclerosis, and compared them with 48 patients with multiple sclerosis with normal optical coherence tomography findings, 48 patients with multiple sclerosis with abnormal optical coherence tomography findings (typical for multiple sclerosis) and 86 healthy controls. Utilizing a novel retinal segmentation protocol, we found that those with predominant macular thinning had significant thinning of both the inner and outer nuclear layers, when compared with other patients with multiple sclerosis (P < 0.001 for both), with relative sparing of the ganglion cell layer. Inner and outer nuclear layer thicknesses in patients with non-macular thinning predominant multiple sclerosis were not different from healthy controls. Segmentation analyses thereby demonstrated extensive deeper disruption of retinal architecture in this subtype than may be expected due to retrograde degeneration from either typical clinical or sub-clinical optic neuropathy. Functional corroboration of retinal dysfunction was provided through multi-focal electroretinography in a subset of such patients. These findings support the possibility of primary retinal pathology in a subset of patients with multiple sclerosis. Multiple sclerosis-severity scores were also significantly increased in patients with the macular thinning predominant phenotype, compared with those without this phenotype (n = 96, P=0.006). We have identified a unique subset of patients with multiple sclerosis in whom there appears to be disproportionate thinning of the inner and outer nuclear layers, which may be occurring as a primary process independent of optic nerve pathology. In vivo analyses of retinal layers in multiple sclerosis have not been previously performed, and structural demonstration of pathology in the deeper retinal layers, such as the outer nuclear layer, has not been previously described in multiple sclerosis. Patients with inner and outer nuclear layer pathology have more rapid disability progression and thus retinal neuronal pathology may be a harbinger of a more aggressive form of multiple sclerosis.

Duke Scholars

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Published In

Brain

DOI

EISSN

1460-2156

Publication Date

February 2011

Volume

134

Issue

Pt 2

Start / End Page

518 / 533

Location

England

Related Subject Headings

  • Vision, Ocular
  • Tomography, Optical Coherence
  • Severity of Illness Index
  • Retrograde Degeneration
  • Retinal Diseases
  • Retina
  • Optic Nerve
  • Neurology & Neurosurgery
  • Multiple Sclerosis
  • Models, Biological
 

Citation

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Saidha, S., Syc, S. B., Ibrahim, M. A., Eckstein, C., Warner, C. V., Farrell, S. K., … Calabresi, P. A. (2011). Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. Brain, 134(Pt 2), 518–533. https://doi.org/10.1093/brain/awq346
Saidha, Shiv, Stephanie B. Syc, Mohamed A. Ibrahim, Christopher Eckstein, Christina V. Warner, Sheena K. Farrell, Jonathan D. Oakley, et al. “Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography.Brain 134, no. Pt 2 (February 2011): 518–33. https://doi.org/10.1093/brain/awq346.
Saidha S, Syc SB, Ibrahim MA, Eckstein C, Warner CV, Farrell SK, et al. Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. Brain. 2011 Feb;134(Pt 2):518–33.
Saidha, Shiv, et al. “Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography.Brain, vol. 134, no. Pt 2, Feb. 2011, pp. 518–33. Pubmed, doi:10.1093/brain/awq346.
Saidha S, Syc SB, Ibrahim MA, Eckstein C, Warner CV, Farrell SK, Oakley JD, Durbin MK, Meyer SA, Balcer LJ, Frohman EM, Rosenzweig JM, Newsome SD, Ratchford JN, Nguyen QD, Calabresi PA. Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. Brain. 2011 Feb;134(Pt 2):518–533.
Journal cover image

Published In

Brain

DOI

EISSN

1460-2156

Publication Date

February 2011

Volume

134

Issue

Pt 2

Start / End Page

518 / 533

Location

England

Related Subject Headings

  • Vision, Ocular
  • Tomography, Optical Coherence
  • Severity of Illness Index
  • Retrograde Degeneration
  • Retinal Diseases
  • Retina
  • Optic Nerve
  • Neurology & Neurosurgery
  • Multiple Sclerosis
  • Models, Biological