title: Functional-structural correlations in the afferent visual pathway in pediatric demyelination.
abstract: OBJECTIVE
  We evaluated the relationship of optical coherence tomography (OCT)-measured ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness to other functional measures of afferent visual pathway competence including high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA), visual field sensitivity, and color vision perception in a pediatric population with demyelinating disorders.
  
  
  METHODS
  This was a cross-sectional evaluation of 37 children, aged 8-18 years, with pediatric demyelinating disorders (n = 74 eyes), and 18 healthy controls (n = 36 eyes), who were recruited from the University of Toronto, Hospital for Sick Children and the University of Calgary, Alberta Children's Hospital, Canada. A standardized visual battery, including spectral-domain OCT, visual fields, LCVA, and HCVA, was performed in all subjects.
  
  
  RESULTS
  Mean RNFL thickness was 26 µm (25.6%) lower in patients with demyelination (76.2 μm [3.7]) compared to controls (102.4 μm [2.1]) (p < 0.0001). Mean GCL thickness was 20% lower in patients as compared to controls (p < 0.0001). Mean GCL and RNFL thickness were strongly correlated (r = 0.89; p < 0.0001), yet in contrast to RNFL thickness, no differences in GCL thickness were noted between optic neuritis (ON) eyes and non-ON eyes of patients. HCVA and LCVA and visual field mean deviation scores decreased linearly with lower RNFL thickness.
  
  
  CONCLUSIONS
  GCL thickness was decreased in patients regardless of history of ON. The retina may be a site of primary neuronal injury in pediatric demyelination.
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada. ann.yeh@sickkids.ca.
authors.forename: E Ann
authors.initials: EA
authors.lastname: Yeh
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Y Arun
authors.initials: YA
authors.lastname: Reginald
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: J Raymond
authors.initials: JR
authors.lastname: Buncic
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Austin E
authors.initials: AE
authors.lastname: Noguera
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: O'Mahony
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Jean K
authors.initials: JK
authors.lastname: Mah
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
authors.affiliation: From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Costello
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D009412:Nerve Fibers / Q000473:pathology*; D009902:Optic Neuritis / Q000175:diagnosis / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods; D014794:Visual Fields / Q000502:physiology; D014795:Visual Pathways / Q000473:pathology*