Baseline, one and three month changes in the peripapillary retinal nerve fiber layer in acute optic neuritis: Relation to baseline vision and MRI☆
Introduction
Swelling of the optic disc is seen on clinical examination in approximately one third of eyes at presentation of acute optic neuritis. Available methods for imaging of the optic disc and peripapillary retinal nerve fiber layer (RNFL) can be utilized to demonstrate and quantify RNFL swelling and subsequent thinning due to demyelination. An earlier small case series showed a trend of thickening in the RNFL in eyes with acute optic neuritis eyes when compared with fellow asymptomatic eyes [2]. OCT studies performed months or longer after the onset of optic neuritis revealed reduction in the global mean RNFL that was more prevalent in eyes with persistent visual deficits [3], [4]. Until recently, no large case series study of acute optic neuritis with ocular imaging at the time of presentation had been reported [5].
Although OCT is the most commonly used optical imaging modality to evaluate the RNFL, scanning laser polarimetry (SLP) studies also show RNFL losses in eyes with glaucoma and in multiple sclerosis (MS) patients [6], [7], [8]. Scaling differences between the two imaging techniques account for larger RNFL thickness measurements seen with OCT compared with SLP, but both are comparable for uncovering RNFL loss due to disease [9], [10]. The temporal RNFL, possibly the quadrant most often disturbed in optic neuritis, was difficult to image with older SLP methods, and is seen better using newer methodology, called enhanced corneal compensation [11], [12]. We prospectively investigated eyes with acute optic neuritis to further elaborate the RNFL changes at presentation, 1 and 3 months and to explore the relationship of these findings to changes in vision and MRI demonstrated lesions of affected optic nerves. Further, we sought to improve the sensitivity of uncovering more subtle abnormalities or alterations in the RNFL results by utilizing interocular comparisons and evaluating all 4 quadrants of collected data. We also explored whether additional or distinguishing features in RNFL alteration could be uncovered by comparing the measured OCT thickness and SLP retardation results at baseline 1 and 3 months.
Section snippets
Methods
We selected subjects with first-time unilateral acute demyelinating optic neuritis in the affected eye and vision loss less than 21 days. All study subjects had typical features of optic neuritis including a relative afferent pupillary defect in the affected eye [1]. None of the eyes had significant optic disc swelling or peripapillary hemorrhages or exudates on ophthalmoscopy. Mild swelling of the optic disc, noted by comparison to the fellow eye with smaller cup to disc ratio, was permitted.
Results
We studied 40 subjects, 6 men and 34 women, with a mean age 32 years (median 31.6 years) at an average of 6.4 days (sd 4.0) after the onset of vision loss. Twelve subjects had relapsing remitting MS, diagnosed by Poser criteria, for a mean of 1.4 years (sd .69, range 1–3 years) and 10 were taking interferon or glutarimer acetate. Prior optic neuritis in the fellow eye occurred in 9 subjects (7 of who had MS). Affected eye baseline and follow up visual performance are detailed in Table 1. Intravenous
Discussion
Quadrant analysis and comparison to fellow eye measurements revealed RNFL thickening, suggestive of swelling, in 82% by OCT and 62% by SLP of acutely affected eyes at presentation with first time optic neuritis. OCT was clearly superior to SLP in demonstrating the extent of RNFL baseline thickening. Interocular comparison of RNFL thickness is superior to the typically-used difference in quadrants from age-matched controls in industry databases for OCT and SLP and for OCT values obtained from
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Cited by (53)
Early neuroaxonal injury is seen in the acute phase of pediatric optic neuritis
2019, Multiple Sclerosis and Related DisordersCitation Excerpt :This lower RNFL thickness correlated strongly with lower GCIPL thickness in fellow eyes and, together with the GCIPL findings, supports the presence of pre-existing neuroaxonal injury in the afferent visual pathway within a subset of children in this cohort. RNFL swelling related to stasis of axoplasmic flow resulting from acute optic nerve inflammation may have masked the presence of early axonal loss in ON-affected eyes (Kupersmith et al., 2011). Thus, GCIPL thinning may be the more appropriate early marker of neuroaxonal injury after pediatric ON, as has been suggested from adult studies (Kupersmith et al., 2016).
Papilledema and disc swelling versus traction elevation
2019, Handbook of Pediatric Retinal OCT and the Eye-Brain ConnectionOptic neuritis and multiple sclerosis
2019, Handbook of Pediatric Retinal OCT and the Eye-Brain ConnectionSequential phases of RGC axonal and somatic injury in EAE mice examined using DTI and OCT
2019, Multiple Sclerosis and Related DisordersCitation Excerpt :As demonstrated in WT mice, this measurement showed high consistency between weekly, repeated measurements. Data from OCT findings reveal a sequence of events similar to what occurs in humans after episodes of optic neuritis (Kupersmith et al., 2011; Costello et al., 2006). The acute increases in GCC retinal thickness was found after 2 weeks of EAE, coincident with the onset of motor symptoms.
Emerging Applications of Optical Coherence Tomography in Pediatric Optic Neuropathies
2017, Seminars in Pediatric NeurologyCitation Excerpt :Longitudinal monitoring is important to detect signs of recurrence and progressive visual decline in these conditions.21 As in other diseases with ONH swelling, acute optic neuritis with ONH involvement will demonstrate thickening of the peripapillary RNFL on OCT22; however, RNFL thickening on OCT may also be seen in cases of retrobulbar optic neuritis without clinically apparent ONH swelling, potentially increasing the sensitivity of detecting optic neuritis flares in clinic.23 Optic atrophy typically begins to develop 4-6 weeks after the acute onset of symptoms, manifesting on OCT as RNFL thinning, which has been correlated with final visual outcome (Fig. 3).22
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Supported in part by grants from Pearle Vision Foundation, Teva Pharmaceutical, Veterans Administration (Merit Grant; Rehabilitation Division) and Research to Prevent Blindness (New York, New York). MJK had grants from Pearle Vision Foundation and Teva, neither of which designed, conducted or analyzed any aspect of this study. There are no conflicts of interest.