title: Decreased retinal sensitivity and loss of retinal nerve fibers in multiple system atrophy.
abstract: OBJECTIVE
  In a previous study, retinal nerve fiber layer thickness (RNFLT) loss was shown as part of the neurodegenerative process in multiple system atrophy (MSA). Here, we investigate in a larger cohort of MSA patients whether the RNFLT loss translates into respective visual field defects.
  
  
  METHODS
  Spectral domain optical coherence tomography was performed in 20 MSA patients (parkinsonian subtype = 12, cerebellar subtype = 8) to quantify peripapillary RNFLT. Visual field (90°) was analyzed by automated static perimetry to investigate retinal structure/function relationship. Eight data sets did not meet stringent quality criteria, and only 12 data sets were further analyzed.
  
  
  RESULTS
  Compared to healthy controls, MSA patients demonstrated a significant reduction of RNFLT in the nasal sectors (p ( nasal-superior ) = 0.02, p ( nasal ) = 0.03, p ( nasal-inferior ) < 0.01), while changes in temporal RNFLT measures (p ( temporal-superior ) = 0.42, p ( temporal ) = 0.34, p ( temporal-inferior ) = 0.25) were not statistically significant compared to healthy controls (ANOVA). MSA patients featured a significant global mean deviation (2.74 dB; p < 0.01) without predominant peripheral visual field defects. Statistical analysis of mean defect in the central (0-30°), peripheral (30-90°) or global (0-90°) visual field revealed no significant correlation (r (2) (central) = 0.11, r (2) (peripheral) = 0.04, r (2) (global) = 0.07) with nasal RNFLT in MSA patients.
  
  
  CONCLUSIONS
  MSA patients feature significant reduction in nasal RNFLT and global mean deviation when compared to healthy controls, consistent with the multi-systemic nature of this neurodegenerative disorder. This finding provides first evidence for two independent deteriorations of the visual system in MSA.
authors.affiliation: University Eye Clinic, Centre for Ophthalmology, Tübingen, Germany.
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Fischer
authors.forename: Matthis
authors.initials: M
authors.lastname: Synofzik
authors.forename: Christoph
authors.initials: C
authors.lastname: Kernstock
authors.forename: Janko
authors.initials: J
authors.lastname: Dietzsch
authors.forename: Robert
authors.initials: R
authors.lastname: Heidlauf
authors.forename: Julia
authors.initials: J
authors.lastname: Schicks
authors.forename: Karin
authors.initials: K
authors.lastname: Srulijes
authors.forename: Sarah
authors.initials: S
authors.lastname: Wiethoff
authors.forename: Oliver
authors.initials: O
authors.lastname: Menn
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
authors.forename: Ludger
authors.initials: L
authors.lastname: Schöls
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schiefer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000503:physiopathology; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult