title: Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning.
abstract: OBJECTIVE
  To investigate whether fibromyalgia induces axonal damage in the optic nerve that can be detected using optical coherence tomography (OCT), as the retinal nerve fiber layer (RNFL) is atrophied in patients with fibromyalgia compared with controls.
  
  
  METHODS
  Fibromyalgia patients (n = 116) and age-matched healthy controls (n = 144) were included in this observational and prospective cohort study. All subjects underwent visual acuity measurement and structural analysis of the RNFL using two OCT devices (Cirrus and Spectralis). Fibromyalgia patients were evaluated according to Giesecke's fibromyalgia subgroups, the Fibromyalgia Impact Questionnaire (FIQ), and the European Quality of Life-5 Dimensions (EQ5D) scale. We compared the differences between fibromyalgia patients and controls, and analyzed the correlations between OCT measurements, disease duration, fibromyalgia subgroups, severity, and quality of life. The impact on quality of life in fibromyalgia subgroups and in patients with different disease severity was also analyzed.
  
  
  RESULTS
  A significant decrease in the RNFL was detected in fibromyalgia patients compared with controls using the two OCT devices: Cirrus OCT ganglion cell layer analysis registered a significant decrease in the minimum thickness of the inner plexiform layer (74.99±16.63 vs 79.36±3.38 μm, respectively; p = 0.023), nasal inferior, temporal inferior and temporal superior sectors (p = 0.040; 0.011 and 0.046 respectively). The Glaucoma application of the Spectralis OCT revealed thinning in the nasal, temporal inferior and temporal superior sectors (p = 0.009, 0.006, and 0.002 respectively) of fibromyalgia patients and the Axonal application in all sectors, except the nasal superior and temporal sectors. The odds ratio (OR) to estimate the size effect of FM in RNFL thickness was 1.39. RNFL atrophy was detected in patients with FIQ scores <60 (patients in early disease stages) compared with controls in the temporal inferior sector (78.74±17.75 vs 81.65±3.61; p = 0.020) and the temporal superior sector (78.20±14.50 vs 80.74±3.88; p = 0.039) with Cirrus OCT; in the temporal inferior sector (145.85±24.32 vs 150.18±19.71; p = 0.012) and temporal superior sector (131.54±20.53 vs 138.13±16.67; p = 0.002) with the Glaucoma application of the Spectralis OCT; and in all sectors, except the average, nasal superior, and temporal sectors, and parameters with the Axonal application of the Spectralis OCT. Temporal inferior RNFL thickness was significantly reduced in patients with severe fibromyalgia (FIQ≥60) compared with patients with mild fibromyalgia (FIQ<60; 145.85±24.32 vs 138.99±18.09 μm, respectively; 145.43±13.21 vs 139.85±13.09 μm, p = 0.032 with the Glaucoma application and p = 0.021 with the Axonal application). The subgroup with biologic fibromyalgia exhibited significant thinning in the temporal inferior and superior sectors (115.17±20.82 μm and 117.05±24.19 μm, respectively) compared with the depressive (130.83±22.97 μm and 127.71±26.10 μm, respectively) and atypical (128.60±26.54 μm and 125.55±23.65 μm, respectively) subgroups (p = 0.005 and 0.001 respectively).
  
  
  CONCLUSIONS
  Fibromyalgia causes subclinical axonal damage in the RNFL that can be detected using innocuous and non-invasive OCT, even in the early disease stages. The impact on the RNFL in the temporal sectors is greater in patients with biologic fibromyalgia, suggesting the presence of neurodegenerative processes in this subgroup of patients with fibromyalgia.
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Elena
authors: E
authors: Garcia-Martin
authors: Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.|Psychiatry Department, Red de Investigación en Atención primaria (REDIAPP), Miguel Servet University Hospital, Zaragoza, Spain.
authors: Javier
authors: J
authors: Garcia-Campayo
authors: Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.|Psychiatry Department, Red de Investigación en Atención primaria (REDIAPP), Miguel Servet University Hospital, Zaragoza, Spain.
authors: Marta
authors: M
authors: Puebla-Guedea
authors: Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.|Ophthalmology Department, Lozano Blesa University Hospital, Zaragoza, Spain.
authors: Francisco J
authors: FJ
authors: Ascaso
authors: Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain.
authors: Miguel
authors: M
authors: Roca
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Fernando
authors: F
authors: Gutierrez-Ruiz
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Elisa
authors: E
authors: Vilades
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Vicente
authors: V
authors: Polo
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Jose M
authors: JM
authors: Larrosa
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Luis E
authors: LE
authors: Pablo
authors: Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.|Aragones Institute of Health Research, IIS-Aragon, Zaragoza, Spain.
authors: Maria
authors: M
authors: Satue
mesh_terms: D000328:Adult; D000368:Aged; D001369:Axons / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005356:Fibromyalgia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology* / Q000502:physiology; D012160:Retina / Q000473:pathology* / Q000503:physiopathology; D041623:Tomography, Optical Coherence