Sex differences and subclinical retinal injury in pediatric-onset MS

Graves, Jennifer; Chohan, Hardeep; Cedars, Benjamin; Arnow, Samuel; Yiu, Hao; Waubant, Emmanuelle; Green, Ari

doi:10.1177/1352458516652497

Cited by 16 publications

(22 citation statements)

References 31 publications

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“…62 As in adults, children exhibit temporal-predominant pRNFL atrophy both with and without a history of clinical optic neuritis. 32,63 Pediatric MS eyes also demonstrate macular volume loss and thinning of the GCL/IPL. 32,62 Unaffected MS eyes also seem to demonstrate thinner pRNFL and reduced macular volumes compared with control eyes.…”

Section: Pediatric Ms and Optic Neuritismentioning

confidence: 98%

“…32,63 Pediatric MS eyes also demonstrate macular volume loss and thinning of the GCL/IPL. 32,62 Unaffected MS eyes also seem to demonstrate thinner pRNFL and reduced macular volumes compared with control eyes. 32 More studies are needed to assess longitudinal subclinical axonal or cell soma loss in this population.…”

Section: Pediatric Ms and Optic Neuritismentioning

confidence: 98%

“…18,31 Macular volumes may be reduced by approximately 5 to 6% after an acute episode of ON. 32 In a large dataset of 712 patients from a baseline analysis of a phase-3 trial of fingolimod, Winges et al reported that 25% of MS patients had at least one eye with abnormally reduced total macular volume. 33 Most of these patients also had reduced pRNFL.…”

Section: Total Macular Volumesmentioning

confidence: 99%

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Optical Coherence Tomography in Multiple Sclerosis

Graves

2019

Semin Neurol

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Optical coherence tomography (OCT) grew out of a convergence of rapid advancements in femtoseconds optics research and fiber optic commercial technology. The basic concept of OCT is to “see” into tissues using light echoes, analogous to the sound echoes of ultrasonography. Multiple A-scans are assembled into a B-scan two-dimensional image of the tissue of interest. Retina is an ideal tissue for evaluation by OCT, since the eye is designed to minimize light scattering through the anterior chamber and vitreous. OCT has had a significant impact on the field of multiple sclerosis, where it has allowed direct imaging of the myelin-free segments of axons and cell bodies of retinal ganglion cells. Together with precise functional measurements of the afferent visual system, the addition of robust structural measurements of retinal injury has allowed for an unprecedented ability to correlate clinical effects with the degree of neuronal loss. In addition, OCT has proven helpful to distinguish different forms of demyelinating disease, such as multiple sclerosis (MS) and neuromyelitis optica, and has provided ideal outcome measures in remyelination and neuroprotection trials.

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Section: Pediatric Ms and Optic Neuritismentioning

confidence: 98%

Section: Pediatric Ms and Optic Neuritismentioning

confidence: 98%

Section: Total Macular Volumesmentioning

confidence: 99%

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Optical Coherence Tomography in Multiple Sclerosis

Graves

2019

Semin Neurol

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“…Graves et al (27) reviewed the OCT findings in pediatric patients with MS with and without a history of optic neuritis. Eyes with a history of optic neuritis showed reduced retinal nerve fiber layer (RNFL) thickness and ganglion cell layer (GCL) volumes compared with control eyes.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Pediatric Optic Neuritis: What Is New

Borchert

Liu

Pineles

et al. 2017

Journal of Neuro-Ophthalmology

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Few diseases blur the margins between their childhood and adult-onset varieties as much as optic neuritis. This report will review our state of knowledge of pediatric optic neuritis, as well as its relationship to the latest consensus definitions of neuroinflammatory disease. Current diagnostic and treatment options will be explored, as well as our potential to uncover an understanding of pediatric optic neuritis through systematic prospective studies. The risk of evolving multiple sclerosis is probably less than in adults, but pediatric optic neuritis is more likely to be an initial manifestation of acute disseminated encephalomyelitis. Steroids may hasten visual recovery, but they do not change visual outcome except in cases because of neuromyelitis optica. The role of puberty in modifying the presentation and risk associations is unknown. Prospective studies are required to resolve these diagnostic and management issues.

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“…Optic neuritis (ON) is a common feature of adult‐ and pediatric‐onset multiple sclerosis (POMS). Inflammatory damage of the optic nerves leads to retrograde retinal atrophy, as measured by thinning of the retinal nerve fiber (RNFL) and ganglion cell layer‐inner plexiform layer (GCL‐IPL) . This axonal loss in the afferent visual pathway could also lead to anterograde reduction in neuronal density, quantifiable as a reduction in visual cortical mantle thickness, as has been documented in adults with MS .…”

Section: Introductionmentioning

confidence: 97%

Effects of Optic Neuritis, T2 Lesions, and Microstructural Diffusion Integrity in the Visual Pathway on Cortical Thickness in Pediatric‐Onset Multiple Sclerosis

Datta

Sollee

Lavery

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: Pediatric-onset multiple sclerosis (POMS) is associated with focal inflammatory lesions and the loss of cortical and deep gray matter. Optic neuritis (ON) and white matter (WM) lesions in the visual pathway can directly contribute to visual cortical mantle thinning. We determine the relative contributions of MS insult on anterior and posterior visual pathway integrity. METHODS: High-and low-contrast visual acuity, optical coherence tomography (OCT), and 3T MRI scans were obtained from 20 POMS patients (10 with remote ON) and 22 age-and sex-matched healthy controls. Cortical mantle thickness was measured using FreeSurfer. Fractional anisotropy (FA) and mean diffusivity were calculated for postchiasmal optic radiations (with and without WM lesions). Groups were compared using Student's t-test (adjusted for multiple comparisons), and simple linear regression was used to investigate interrelationships between measures. RESULTS:Mean cortical thickness of the whole brain was reduced in patients (2.49 mm) versus controls (2.58 mm, P = .0432) and in the visual cortex (2.07 mm vs. 2.17 mm, P = .0059), although the foveal confluence was spared. Mean FA of the optic radiations was reduced in POMS (.40) versus controls (.43, P = .0042) and correlated with visual cortical mantle thickness in POMS (P = .017). Visual acuity, OCT measures, and lesion volumes in the optic radiations were not associated with cortical mantle thickness. CONCLUSIONS: POMS negatively impacts the integrity of the anterior visual pathway, but it is the loss of WM integrity that drives anterograde loss of the cortical mantle. Preserved visual acuity and foveal sparing imply some degree of functional and structural resilience. . (A) Relationship between fractional anisotropy in the optic radiations and visual cortical mantle thickness in pediatric-onset MS and healthy controls. Average fractional anisotropy in the optic radiations predicted visual cortex mantle thickness (mean of left and right hemispheres) after adjusting for case-control status. (B) Relationship between mean diffusivity in the optic radiations and visual cortical mantle thickness in pediatric-onset MS and healthy controls. Average mean diffusivity in the optic radiations decreased with increasing visual cortical thickness (mean of left and right hemispheres), although the relationship did not reach significance. HC = healthy control; MS = multiple sclerosis.

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Sex differences and subclinical retinal injury in pediatric-onset MS

Abstract: Subclinical retinal injury occurs in pediatric-onset MS patients without a history of ON. As in adult-onset MS, substantial GCL thinning is present in eyes with prior ON. Finally, greater retinal axonal injury occurs in boys compared to girls.

Cited by 16 publications

References 31 publications

Optical Coherence Tomography in Multiple Sclerosis

Optical Coherence Tomography in Multiple Sclerosis

Pediatric Optic Neuritis: What Is New

Effects of Optic Neuritis, T2 Lesions, and Microstructural Diffusion Integrity in the Visual Pathway on Cortical Thickness in Pediatric‐Onset Multiple Sclerosis

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