Associations between retinal nerve fiber layer abnormalities and optic nerve examination.
OBJECTIVE
Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied.


METHODS
Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs.


RESULTS
Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n=63) vs those without (97.0 ± 15 μm; n=417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n=44) than without an APD (95.8 ± 17 μm; n=436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity=0.56; specificity=0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73% (sensitivity=0.30; specificity=0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists.


CONCLUSIONS
OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.
Cettomai
D
D
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Hiremath
G
G
Ratchford
J
J
Venkatesan
A
A
Greenberg
B M
BM
McGready
J
J
Pardo
C A
CA
Kerr
D A
DA
Frohman
E
E
Balcer
L J
LJ
McArthur
J C
JC
Calabresi
P A
PA
D000328:Adult; D005123:Eye / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology*; D011237:Predictive Value of Tests; D011681:Pupil Disorders / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D014786:Vision Disorders
Graefes Arch Clin Exp Ophthalmol. 2006 Nov;244(11):1480-4
16628417
Surv Ophthalmol. 2008 Nov;53 Suppl1:S17-32
19038620
Neuroimaging Clin N Am. 2008 Nov;18(4):589-622, ix-x
19068404
Brain. 2008 Jan;131(Pt 1):277-87
18056739
Lancet Neurol. 2006 Oct;5(10):853-63
16987732
J Neurol. 1998 Sep;245(9):573-83
9758294
Ophthalmology. 2006 Feb;113(2):324-32
16406539
Nat Clin Pract Neurol. 2008 Dec;4(12):664-75
19043423
Trans Am Ophthalmol Soc. 1983;81:1034-91
6203209
Invest Ophthalmol Vis Sci. 2007 Oct;48(10):4748-52
17898300
Ann Neurol. 2005 Sep;58(3):383-91
16075460
Ital J Neurol Sci. 1987 Dec;8(6):529-35
3323129
Neurology. 2009 Jul 7;73(1):46-52
19564583
Korean J Ophthalmol. 2008 Jun;22(2):115-22
18612230
Invest Ophthalmol Vis Sci. 2006 Mar;47(3):1008-15
16505035
Br J Ophthalmol. 2007 May;91(5):633-7
17050576
Neurology. 2007 Oct 16;69(16):1603-9
17938370
Eur J Neurol. 2007 Aug;14(8):841-9
17662003
Science. 1991 Nov 22;254(5035):1178-81
1957169
J Neurol. 2008 Oct;255(10):1555-60
18825432
Neuroimage. 2006 May 15;31(1):286-93
16446103
Arch Ophthalmol. 2001 Sep;119(9):1333-41
11545640
Ophthalmology. 2007 Jun;114(6):1046-52
17210181
J Neurol Neurosurg Psychiatry. 1992 Sep;55(9):747-52
1402963
Neurology. 2007 Nov 27;69(22):2085-92
18040015
Prog Brain Res. 2008;173:139-48
18929106
Neurology. 2007 May 1;68(18):1488-94
17470751