Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography

Shiv Saidha, Stephanie B. Syc, Mohamed A. Ibrahim, Christopher Eckstein, Christina V. Warner, Sheena K. Farrell, Jonathan D. Oakley, Mary K. Durbin, Scott A. Meyer, Laura J. Balcer, Elliot M. Frohman, Jason M. Rosenzweig, Scott D. Newsome, John N. Ratchford, Quan Dong Nguyen, Peter A. Calabresi

Research output: Contribution to journalArticle

197 Citations (Scopus)

Abstract

Optical coherence tomography studies in multiple sclerosis have primarily focused on evaluation of the retinal nerve fibre layer. The aetiology of retinal changes in multiple sclerosis is thought to be secondary to optic nerve demyelination. The objective of this study was to use optical coherence tomography to determine if a subset of patients with multiple sclerosis exhibit primary retinal neuronopathy, in the absence of retrograde degeneration of the retinal nerve fibre layer and to ascertain if such patients may have any distinguishing clinical characteristics. We identified 50 patients with multiple sclerosis with predominantly macular thinning (normal retinal nerve fibre-layer thickness with average macular thickness <5th percentile), a previously undescribed optical coherence tomography defined phenotype in multiple sclerosis, and compared them with 48 patients with multiple sclerosis with normal optical coherence tomography findings, 48 patients with multiple sclerosis with abnormal optical coherence tomography findings (typical for multiple sclerosis) and 86 healthy controls. Utilizing a novel retinal segmentation protocol, we found that those with predominant macular thinning had significant thinning of both the inner and outer nuclear layers, when compared with other patients with multiple sclerosis (P<0.001 for both), with relative sparing of the ganglion cell layer. Inner and outer nuclear layer thicknesses in patients with non-macular thinning predominant multiple sclerosis were not different from healthy controls. Segmentation analyses thereby demonstrated extensive deeper disruption of retinal architecture in this subtype than may be expected due to retrograde degeneration from either typical clinical or sub-clinical optic neuropathy. Functional corroboration of retinal dysfunction was provided through multi-focal electroretinography in a subset of such patients. These findings support the possibility of primary retinal pathology in a subset of patients with multiple sclerosis. Multiple sclerosis-severity scores were also significantly increased in patients with the macular thinning predominant phenotype, compared with those without this phenotype (n=96, P=0.006). We have identified a unique subset of patients with multiple sclerosis in whom there appears to be disproportionate thinning of the inner and outer nuclear layers, which may be occurring as a primary process independent of optic nerve pathology. In vivo analyses of retinal layers in multiple sclerosis have not been previously performed, and structural demonstration of pathology in the deeper retinal layers, such as the outer nuclear layer, has not been previously described in multiple sclerosis. Patients with inner and outer nuclear layer pathology have more rapid disability progression and thus retinal neuronal pathology may be a harbinger of a more aggressive form of multiple sclerosis.

Original languageEnglish (US)
Pages (from-to)518-533
Number of pages16
JournalBrain
Volume134
Issue number2
DOIs
StatePublished - Feb 1 2011

Fingerprint

Optical Coherence Tomography
Multiple Sclerosis
Pathology
Nerve Fibers
Retrograde Degeneration
Optic Nerve
Phenotype
Electroretinography
Optic Nerve Diseases
Demyelinating Diseases
Ganglia

Keywords

  • multiple sclerosis
  • multiple sclerosis-severity score
  • optical coherence tomography
  • outer nuclear layer
  • retinal segmentation

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Saidha, S., Syc, S. B., Ibrahim, M. A., Eckstein, C., Warner, C. V., Farrell, S. K., ... Calabresi, P. A. (2011). Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. Brain, 134(2), 518-533. https://doi.org/10.1093/brain/awq346

Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. / Saidha, Shiv; Syc, Stephanie B.; Ibrahim, Mohamed A.; Eckstein, Christopher; Warner, Christina V.; Farrell, Sheena K.; Oakley, Jonathan D.; Durbin, Mary K.; Meyer, Scott A.; Balcer, Laura J.; Frohman, Elliot M.; Rosenzweig, Jason M.; Newsome, Scott D.; Ratchford, John N.; Nguyen, Quan Dong; Calabresi, Peter A.

In: Brain, Vol. 134, No. 2, 01.02.2011, p. 518-533.

Research output: Contribution to journalArticle

Saidha, S, Syc, SB, Ibrahim, MA, Eckstein, C, Warner, CV, Farrell, SK, Oakley, JD, Durbin, MK, Meyer, SA, Balcer, LJ, Frohman, EM, Rosenzweig, JM, Newsome, SD, Ratchford, JN, Nguyen, QD & Calabresi, PA 2011, 'Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography', Brain, vol. 134, no. 2, pp. 518-533. https://doi.org/10.1093/brain/awq346
Saidha S, Syc SB, Ibrahim MA, Eckstein C, Warner CV, Farrell SK et al. Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. Brain. 2011 Feb 1;134(2):518-533. https://doi.org/10.1093/brain/awq346
Saidha, Shiv ; Syc, Stephanie B. ; Ibrahim, Mohamed A. ; Eckstein, Christopher ; Warner, Christina V. ; Farrell, Sheena K. ; Oakley, Jonathan D. ; Durbin, Mary K. ; Meyer, Scott A. ; Balcer, Laura J. ; Frohman, Elliot M. ; Rosenzweig, Jason M. ; Newsome, Scott D. ; Ratchford, John N. ; Nguyen, Quan Dong ; Calabresi, Peter A. / Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. In: Brain. 2011 ; Vol. 134, No. 2. pp. 518-533.
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