title: Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis.
abstract: OBJECTIVE
  Determine the utility of optical coherence tomography (OCT) to detect clinical and subclinical remote optic neuritis (ON), its relationship to clinical characteristics of ON and visual function, and whether the retinal nerve fiber layer (RNFL) thickness functions as a surrogate marker of global disease severity.
  
  
  METHODS
  Cross-sectional study of 65 subjects with at least 1 clinical ON episode at least 6 months prior. Measures included clinical characteristics, visual acuity (VA), contrast sensitivity (CS), OCT, and visual evoked potentials (VEP).
  
  
  RESULTS
  Ninety-six clinically affected optic nerves were studied. The sensitivity of OCT RNFL after ON was 60%, decreasing further with mild onset and good recovery. VEP sensitivity was superior at 81% (p = 0.002). Subclinical ON in the unaffected eye was present in 32%. VEP identified 75% of all subclinically affected eyes, and OCT identified <20%. RNFL thickness demonstrated linear correlations with VA (r = 0.65) and CS (r = 0.72) but was unable to distinguish visual categories <20/50. RNFL was thinner with severe onset and disease recurrence but was unaffected by IV glucocorticoids. OCT measurements were not related to overall disability, ethnicity, sex, or age at onset. The greatest predictor for RNFL in the unaffected eye was the RNFL in the fellow affected eye.
  
  
  CONCLUSIONS
  Visual evoked potentials (VEP) remains the preferred test for detecting clinical and subclinical optic neuritis. Optical coherence tomography (OCT) measures were unrelated to disability and demographic features predicting a worse prognosis in multiple sclerosis. OCT may provide complementary information to VEP in select cases, and remains a valuable research tool for studying optic nerve disease in populations.
authors: Department of Neurology, Washington University, St Louis, MO 63110, USA. naismithr@neuro.wustl.edu
authors: R T
authors: RT
authors: Naismith
authors: N T
authors: NT
authors: Tutlam
authors: J
authors: J
authors: Xu
authors: J B
authors: JB
authors: Shepherd
authors: E C
authors: EC
authors: Klawiter
authors: S-K
authors: SK
authors: Song
authors: A H
authors: AH
authors: Cross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D009431:Neural Conduction / Q000502:physiology; D009900:Optic Nerve / Q000473:pathology / Q000503:physiopathology*; D009902:Optic Neuritis / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012160:Retina / Q000473:pathology / Q000503:physiopathology; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D014795:Visual Pathways / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult