Evaluation of optical coherence tomography angiography findings in patients with multiple sclerosis

Abstract

Purpose: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS). Methods: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients. Results: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value <0.001. The retinal nerve fiber layer (RNFL) thickness showed a significant decrease in the average thickness and in all quadrants, notably the temporal quadrant in group 1 ( P < 0.001). Ganglion cell layer thickness was diminished in average thickness and in all quadrants in both groups of MS, but only the first group showed statistical significance with P value <0.001). In respect to optic disc perfusion, Average, superficial, and deep vascular density index (AVDI, VDI 1, VDI 2) were statistically significantly lower in groups 1, 2 with ( P -value < 0.001). Conclusion: Decreased vascular perfusion of the optic nerve in MS patients, especially in those with ON is strongly correlated with the damage of RNFL and ganglion cell layer detected by OCT.

Optical coherence tomography angiography measurements in multiple sclerosis: a systematic review and meta-analysis

“…The study selection process, which is depicted in Fig. 2 , yielded the final inclusion of 18 studies with a total of 1552 evaluated eyes in MS cases (673 MSON eyes, 741 MSNON eyes, and 138 eyes without specification for the presence of ON) in addition to 1107 evaluated control eyes [ 22 , 29 , 31 , 36 , 43 , 45 – 57 ]. Two studies did not report the data on the MS group as a whole, so the data on the MSON group of these studies were used in the MS vs. HC analyses [ 43 , 56 ].…”

“…All of the 18 studies had observational designs, five of which were conducted in the United States [ 22 , 46 , 48 , 49 , 57 ], three in Italy [ 31 , 52 , 54 ], three in Turkey [ 45 , 47 , 55 ], one in China [ 29 ], one in Korea [ 50 ], one in Poland [ 43 ], one in Germany [ 56 ], one in Portugal [ 51 ], one in Egypt [ 36 ] and one in Spain [ 53 ]. In regard to MS diagnosis criteria, eight articles used the 2010 revised McDonald Criteria [ 22 , 31 , 45 , 47 , 48 , 53 , 55 , 57 ], eight articles used the 2017 revised McDonald Criteria [ 29 , 36 , 43 , 49 – 51 , 54 , 56 ], a single study used the 2005 revised McDonald Criteria [ 46 ], and finally, one study did not report any specific criteria [ 52 ]. Nine studies selected their case exclusively from the RRMS subtype of patients [ 19 , 36 , 43 , 45 , 47 , 49 , 53 , 54 , 56 ].…”

“…In regard to MS diagnosis criteria, eight articles used the 2010 revised McDonald Criteria [ 22 , 31 , 45 , 47 , 48 , 53 , 55 , 57 ], eight articles used the 2017 revised McDonald Criteria [ 29 , 36 , 43 , 49 – 51 , 54 , 56 ], a single study used the 2005 revised McDonald Criteria [ 46 ], and finally, one study did not report any specific criteria [ 52 ]. Nine studies selected their case exclusively from the RRMS subtype of patients [ 19 , 36 , 43 , 45 , 47 , 49 , 53 , 54 , 56 ]. The rest of the studies did not specify the subtype of MS cases.…”

“…In seven studies, OCT-A measurements were conducted using the Optovue RTVue XR Avanti (Optovue Inc., Fremont, CA) with AngioVue software [ 31 , 43 , 47 , 52 , 54 – 56 ]. Moreover, three studies used the Zeiss Cirrus (Carl Zeiss Meditec, Inc., Dublin, CA) with AngioPlex software [ 29 , 36 , 57 ], three studies used Heidelberg Spectralis OCT-A (Heidelberg Engineering, Heidelberg, Germany) with internal Heidelberg software [ 22 , 49 , 51 ], two studies used prototype Axsun Swept Source (SS)–OCT Engine (Excelitas Technologies Corp., Billerica, MA) with OCT Host software [ 46 , 48 ], two studies used Topcon DRI OCT Triton Plus (Topcon Corp., Tokyo, Japan) with Topcon IMAGEnet software [ 50 , 53 ], and one study used Nidek Advance RS-3000 (Nidek Co., Gamagori, Japan) with AngioScan software [ 45 ]. Two studies employed ImageJ software ( https://imagej.nih.gov/ij/ ) as well as automated internal software of OCT-A device for quantitative analysis of images [ 22 , 51 ].…”

“…Since there are differences in the nomenclature used by the articles for the measured layers, for the sake of consistency in the current review, we referred to the superficial (retinal) capillary plexus (layer) as the “superficial capillary plexus” (SCP) and the deep (retinal) capillary plexus (layer) as “deep capillary plexus” (DCP). The study by Khader et al defined an outer retina layer stretching from the outer boundary of the outer plexiform layer to an end at Bruch’s membrane lever [ 36 ]. However, it should be noted that diverse boundary definitions may be provided by each study for these layers, thus limiting the comparability of the results (Additional file 2 : Table S2; Fig.…”