Patterns of retinal nerve fiber layer loss in multiple sclerosis patients with or without optic neuritis and glaucoma patients.
OBJECTIVE
Optical coherence tomography (OCT) has gained increasing attention in multiple sclerosis (MS) research and has been suggested as outcome measure for neuroprotective therapies. However, to date it is not clear whether patterns of retinal nerve fiber layer thickness (RNFLT) loss are different in MS compared to other diseases such as glaucoma and data on RNFLT loss in MS patients with or without optic neuritis (ON/NON) have remained inconsistent or even contradictory.


METHODS
In this large cross-sectional study we analyzed the patterns of axonal loss of retinal ganglion cells in MS eyes (n=262) with and without history of ON (MS/ON: 73 eyes; MS/NON: 189 eyes) and patients eyes with glaucomatous optic disc atrophy (GA: n=22; 39 eyes) in comparison to healthy control eyes (HC: n=406 eyes).


RESULTS
We found that significant average and quadrant RNFLT loss is detectable by OCT in both MS and GA patients compared to healthy controls (p<0.01). The age- and gender adjusted average and quadrant RNFLT did not differ significantly between MS and GA patients (p>0.05). Average (p<0.0001) and quadrant (p<0.05) RNFL thinning is significantly more severe in MS/ON versus MS/NON eyes, and the extent of RNFL thinning varies across quadrants in MS/ON eyes with the highest degree of RNFLT loss in the temporal quadrant (p<0.001).


CONCLUSIONS
RNFLT reduction across all four quadrants in MS patients as a whole as well as in MS/NON eyes argues for a diffuse neurodegenerative process. Superimposed inflammatory attacks to the optic nerve may cause additional axonal damage with a temporal preponderance. Future studies are necessary to further evaluate the capacity of OCT to depict disease specific damage patterns.
Bock
Markus
M
Cecilie Vogt Clinic, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Brandt
Alexander U
AU
Dörr
Jan
J
Kraft
Helga
H
Weinges-Evers
Nicholetta
N
Gaede
Gunnar
G
Pfueller
Caspar F
CF
Herges
Katja
K
Radbruch
Helena
H
Ohlraun
Stephanie
S
Bellmann-Strobl
Judith
J
Kuchenbecker
Jörn
J
Zipp
Frauke
F
Paul
Friedemann
F
D000328:Adult; D001284:Atrophy; D001369:Axons / Q000473:pathology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology*; D009410:Nerve Degeneration / Q000209:etiology / Q000473:pathology*; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology; D009902:Optic Neuritis / Q000150:complications / Q000473:pathology*; D012016:Reference Values; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence