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Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis
Author(s) -
Talman Lauren S.,
Bisker Esther R.,
Sackel David J.,
Long David A.,
Galetta Kristin M.,
Ratchford John N.,
Lile Deacon J.,
Farrell Sheena K.,
Loguidice Michael J.,
Remington Gina,
Conger Amy,
Frohman Teresa C.,
Jacobs Dina A.,
Markowitz Clyde E.,
Cutter Gary R.,
Ying GuiShuang,
Dai Yang,
Maguire Maureen G.,
Galetta Steven L.,
Frohman Elliot M.,
Calabresi Peter A.,
Balcer Laura J.
Publication year - 2010
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.22005
Subject(s) - nerve fiber layer , medicine , ophthalmology , optic neuritis , visual acuity , retinal , contrast (vision) , optical coherence tomography , multiple sclerosis , optics , physics , psychiatry
Abstract Objective Cross‐sectional studies of optical coherence tomography (OCT) show that retinal nerve fiber layer (RNFL) thickness is reduced in multiple sclerosis (MS) and correlates with visual function. We determined how longitudinal changes in RNFL thickness relate to visual loss. We also examined patterns of RNFL thinning over time in MS eyes with and without a prior history of acute optic neuritis (ON). Methods Patients underwent OCT measurement of RNFL thickness at baseline and at 6‐month intervals during a mean follow‐up of 18 months at 3 centers. Low‐contrast letter acuity (2.5%, 1.25% contrast) and visual acuity (VA) were assessed. Results Among 299 patients (593 eyes) with ≥6 months follow‐up, eyes with visual loss showed greater RNFL thinning compared to eyes with stable vision (low‐contrast acuity, 2.5%: p < 0.001; VA: p = 0.005). RNFL thinning increased over time, with average losses of 2.9μm at 2 to 3 years and 6.1μm at 3 to 4.5 years ( p < 0.001 vs 0.5–1‐year follow‐up interval). These patterns were observed for eyes with or without prior history of ON. Proportions of eyes with RNFL loss greater than test‐retest variability (≥6.6μm) increased from 11% at 0 to 1 year to 44% at 3 to 4.5 years ( p < 0.001). Interpretation Progressive RNFL thinning occurs as a function of time in some patients with MS, even in the absence of ON, and is associated with clinically significant visual loss. These findings are consistent with subclinical axonal loss in the anterior visual pathway in MS, and support the use of OCT and low‐contrast acuity as methods to evaluate the effectiveness of putative neuroprotection protocols. ANN NEUROL 2010;67:749–760