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Retinal Nerve Fiber Layer and Future Risk of Multiple Sclerosis

Published online by Cambridge University Press:  02 December 2014

Fiona Costello ,
William Hodge ,
Y. Irene Pan ,
Luanne Metz  and
Randy H. Kardon
Fiona Costello*
Affiliation:
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta Department of Ophthalmology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
William Hodge
Affiliation:
Department of Ophthalmology, The University of Ottawa, Ottawa, Ontario, Canada
Y. Irene Pan
Affiliation:
Department of Ophthalmology, The University of Ottawa, Ottawa, Ontario, Canada
Luanne Metz
Affiliation:
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
Randy H. Kardon
Affiliation:
Veterans Administration Hospital, Department of Ophthalmology and Visual Sciences, The University of Iowa, UIHC, Iowa City, Iowa, USA
*
5th Floor, Holy Cross Ambulatory Care Centre, Rockyview Hospital, 7007 - 14th Street SW, Calgary, Calgary, Alberta, T2V 1P9, Canada.
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Abstract

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Background:

Optical coherence tomography (OCT) - measured retinal nerve fiber layer (RNFL) values may represent a surrogate biomarker for axonal integrity in multiple sclerosis (MS). The purpose of this study was to determine whether RNFL measurements obtained within two years of an optic neuritis (ON) event distinguish patients at increased risk of developing clinically-definite MS (CDMS).

Methods:

Fifty consecutively sampled patients who experienced a single ON event were followed prospectively for a mean period of 34 months with OCT testing. Values of RNFL in clinically-affected and non-affected eyes were compared between patients who developed CDMS and those that did not develop MS after ON.

Findings:

Twenty-one patients (42%) developed CDMS during the course of the study, with a mean conversion time of 27 months. Mean RNFL values were thinner in the clinically - affected eyes of non - MS patients than CDMS eyes after one year (p = 0.0462) due to more severe ON events in the former. By year two, CDMS patients manifested more recurrent ON events and RNFL thinning than non - MS patients. Temporal RNFL values were thinner in the non-affected eyes of CDMS patients with a trend towards significance (p = 0.1302).

Interpretation:

Our results indicate that RNFL thickness does not reliably distinguish patients at higher risk of converting to CDMS after ON. The severity of ON has a greater effect on RNFL thickness than risk of CDMS at one year. The CDMS patients demonstrate progressive RNFL thinning likely due to recurrent sub-clinical ON events, which may help differentiate them from non - MS patients over time.

Résumé:

RÉSUMÉ: Contexte:

La mesure de la couche de fibres nerveuses rétiniennes (CFNR) par tomographie en cohérence optique (TCO) pourrait constituer un biomarqueur–substitut de l’intégrité axonale dans la sclérose en plaques (SEP). Le but de cette étude était de déterminer si les mesures de la CFNR obtenues dans les deux années qui suivent un épisode de névrite optique (NO) peuvent identifier les patients à risque plus élevé de présenter une SEP certaine au point de vue clinique (SEPCC).

Méthodes:

Cinquante patients consécutifs ayant présenté un seul épisode de NO ont été suivis de fa9on prospective pendant en moyenne 34 mois au moyen de la TCO. Les mesures de la CFNR de l’ceil atteint et de l’ceil non atteint ont été comparées entre les patients qui ont éventuellement présenté une SEPCC et ceux qui n’en ont pas présenté après la NO.

Résultats:

Vingt et un patients (42%) ont présenté une SEPCC pendant la durée de l’étude. Le délai d’apparition moyen de la SEP était de 27 mois. Après un an, les mesures moyennes de la CFNR étaient plus basses dans les yeux atteints des patients sans SEP que dans les yeux des patients qui ont éventuellement présenté une SEPCC (p = 0,0462) à cause d’une NO plus sévère chez les patients sans SEP. La deuxième année, les patients atteints de SEPCC présentaient plus d’épisodes de NO récurrente et d’amincissement de la CFNR que les patients sans SEP. Les mesures de la CFNR temporale avaient tendance à ètre plus basses dans l’ceil non atteint des patients présentant une SEPCC, sans atteindre le seuil de la signification statistique (p = 0,1302).

Interprétation:

Nos résultats montrent que l’épaisseur de la CFNR n’identifie pas de fap.on fiable les patients à plus haut risque de présenter une SEPCC après une NO. La sévérité de la NO avait un effet plus important sur l’épaisseur de la CFNR que le risque de SEPCC un an plus tard. Les patients atteints de SEPCC présentent un amincissement progressif de la CFNR qui est probablement dü à des épisodes sub–cliniques récurrents de NO, ce qui pourrait avec le temps aider à les distinguer des patients non atteints de SEP.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 4 , September 2008 , pp. 482 - 487
Copyright
Copyright © The Canadian Journal of Neurological 2008

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