In Vivo Evaluation of Retinal Neurodegeneration in Patients with Multiple Sclerosis

Abstract

ObjectiveTo evaluate macular morphology in the eyes of patients with multiple sclerosis (MS) with or without optic neuritis (ON) in previous history.MethodsOptical coherence tomography (OCT) examination was performed in thirty-nine patients with MS and in thirty-three healthy subjects. The raw macular OCT data were processed using OCTRIMA software. The circumpapillary retinal nerve fiber layer (RNFL) thickness and the weighted mean thickness of the total retina and 6 intraretinal layers were obtained for each eye. The eyes of MS patients were divided into a group of 39 ON-affected eyes, and into a group of 34 eyes with no history of ON for the statistical analyses. Receiver operating characteristic (ROC) curves were constructed to determine which parameter can discriminate best between the non-affected group and controls.ResultsThe circumpapillary RNFL thickness was significantly decreased in the non-affected eyes compared to controls group only in the temporal quadrant (p = 0.001) while it was decreased in the affected eyes of the MS patients in all quadrants compared to the non-affected eyes (p<0.05 in each comparison). The thickness of the total retina, RNFL, ganglion cell layer and inner plexiform layer complex (GCL+IPL) and ganglion cell complex (GCC, comprising the RNFL and GCL+IPL) in the macula was significantly decreased in the non-affected eyes compared to controls (p<0.05 for each comparison) and in the ON-affected eyes compared to the non-affected eyes (p<0.001 for each comparison). The largest area under the ROC curve (0.892) was obtained for the weighted mean thickness of the GCC. The EDSS score showed the strongest correlation with the GCL+IPL and GCC thickness (p = 0.007, r = 0.43 for both variables).ConclusionsThinning of the inner retinal layers is present in eyes of MS patients regardless of previous ON. Macular OCT image segmentation might provide a better insight into the pathology of neuronal loss and could therefore play an important role in the diagnosis and follow-up of patients with MS.

Quantitative analysis of the intraretinal layers and optic nerve head using ultra-high resolution optical coherence tomography

“…24 Although manual grading of intraretinal layers is time consuming, it may provide some advantage for repeatability testing. Commercial and custom software, such as the one used by Cabrera DeBuc et al, [15][16][17] often requires manual correction of segmentation failure, which may not be necessarily related to the accuracy of the measurement. 16,17,54 Segmentation algorithms used in OCT reading centers often require visual inspection after automatic segmentation.…”

“…The custom-built software, which has been described elsewhere, [15][16][17][18] was used to manually and automatically segment these layers. Because the manual segmentation is labor intensive and time consuming, a particular approach was used to outline the boundaries of these layers in a small area nasally from the fovea.…”

“…Our custom automatic segmentation software [15][16][17][18] was also used to automatically detect boundaries on OCT images from this subset. Segmentation errors were identified in all images by visual inspection, and a total of five automatically segmented layers [namely as RNFL, GCL þ IPL complex, INL, OPL and ONL, Fig.…”

The clinical perspective: How to personalise treatment in MS and how may biomarkers including imaging contribute to this?

“…55 Some studies have shown an inverse relationship between inner nuclear layer thickness and EDSS (progression). 56,57 Recently, a strong correlation between ganglion cell/inner plexiform atrophy and whole-brain, especially GM, atrophy, was established, particularly in patients with progressive MS, suggesting that it mirrors underlying disease progression. 58 Despite promising results, more large longitudinal studies are needed to evaluate the prognostic value of optical coherence tomography (OCT) in MS. A limitation of OCT is that measurements are affected by a history of ON, lesions elsewhere in the visual pathway and non-MS ocular conditions.…”

Two-dimensional fractal analysis of retinal tissue of healthy and diabetic eyes with optical coherence tomography

“…By employing the OCT technique, the thickness and volume measurements of the retinal tissue can be obtained from OCT scans. Particularly, the structural alterations revealed by changes in thickness and volume of the cellular layers of the retina can be measured to characterize the neurodegeneration in patients with diabetes [2][3][4][5][6][7]. The most significant retinal pathology caused by diabetes is diabetic retinopathy (DR), which is characterized by blood vessel damage and neurodegenerative changes.…”