title: Retinal layer segmentation in patients with multiple sclerosis using spectral domain optical coherence tomography.
abstract: OBJECTIVE
  To evaluate the thickness of the 10 retinal layers in the paramacular area of patients with multiple sclerosis (MS) compared with healthy subjects using the new segmentation technology of spectral domain optical coherence tomography (OCT). To examine which layer has better sensitivity for detecting neurodegeneration in patients with MS.
  
  
  METHODS
  Observational, cross-sectional study.
  
  
  METHODS
  Patients with MS (n = 204) and age-matched healthy subjects (n = 138).
  
  
  METHODS
  The Spectralis OCT system (Heidelberg Engineering, Inc., Heidelberg, Germany) was used to obtain automated segmentation of all retinal layers in a parafoveal scan in 1 randomly selected eye of each participant, using the new segmentation application prototype.
  
  
  METHODS
  The thicknesses of 512 parafoveal points in the 10 retinal layers were obtained in each eye, and the mean thickness of each layer was calculated and compared between patients with MS and healthy subjects. The analysis was repeated, comparing patients with MS with and without previous optic neuritis. Correlation analysis was performed to evaluate the association between each retinal layer mean thickness, duration of disease, and functional disability in patients with MS. A logistic regression analysis was performed to determine which layer provided better sensitivity for detecting neurodegeneration in patients with MS.
  
  
  RESULTS
  All retinal layers, except the inner limiting membrane, were thinner in patients with MS compared with healthy subjects (P < 0.05). Greater effects were observed in the inner retinal layers (nerve fiber, ganglion cells, inner plexiform, and inner nuclear layers) of eyes with previous optic neuritis (P < 0.05). The retinal nerve fiber layer and ganglion cell layer thicknesses were inversely correlated with the functional disability score in patients with MS. The ganglion cell layer and inner plexiform layer thicknesses could predict axonal damage in patients with MS.
  
  
  CONCLUSIONS
  Analysis based on the segmentation technology of the Spectralis OCT revealed retinal layer atrophy in patients with MS, especially of the inner layers. Reduction of the ganglion cell and inner plexiform layers predicted greater axonal damage in patients with MS.
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain. Electronic address: egmvivax@yahoo.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Garcia-Martin
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Polo
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Larrosa
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain; Instituto de Moléstias Oculares, São Paulo, Brazil.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Marques
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Herrero
authors.affiliation: Aragones Institute of Health Sciences, Zaragoza, Spain; Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Martin
authors.affiliation: Aragones Institute of Health Sciences, Zaragoza, Spain; Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Ara
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain; Aragones Institute of Health Sciences, Zaragoza, Spain.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Pablo
mesh_terms: D000328:Adult; D001284:Atrophy; D001369:Axons / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000503:physiopathology; D009902:Optic Neuritis / Q000175:diagnosis* / Q000503:physiopathology; D012160:Retina / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D055815:Young Adult