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Ann Neurol. 2019 May;85(5):618-629. doi: 10.1002/ana.25462. Epub 2019 Apr 10.

Optimal intereye difference thresholds by optical coherence tomography in multiple sclerosis: An international study.

Author information

1
Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY.
2
Department of Neurology, New York University School of Medicine, New York, NY.
3
Department of Neurology, Johns Hopkins University, Baltimore, MD.
4
NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.
5
Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany.
6
Moorfields Eye Hospital, London, United Kingdom.
7
The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.
8
Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands.
9
Department of Neurology, University of California, Irvine, Irvine, CA.
10
Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
11
Dasman Institute, Kuwait City, Kuwait.
12
Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX.
13
Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany.
14
Data Integration for Future Medicine Consortium, Ludwig Maximilian University, Munich, Germany.
15
Munich Cluster for Systems Neurology, Munich, Germany.
16
Bascom Palmer Eye Institute, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL.
17
Technical University of Munich, Munich, Germany.
18
Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy.
19
Department of Neurology, University Hospital of Basel, Basel, Switzerland.
20
Department of Ophthalmology, New York University School of Medicine, New York, NY.
21
Department of Population Health, New York University School of Medicine, New York, NY.

Abstract

OBJECTIVE:

To determine the optimal thresholds for intereye differences in retinal nerve fiber and ganglion cell + inner plexiform layer thicknesses for identifying unilateral optic nerve lesions in multiple sclerosis. Current international diagnostic criteria for multiple sclerosis do not include the optic nerve as a lesion site despite frequent involvement. Optical coherence tomography detects retinal thinning associated with optic nerve lesions.

METHODS:

In this multicenter international study at 11 sites, optical coherence tomography was measured for patients and healthy controls as part of the International Multiple Sclerosis Visual System Consortium. High- and low-contrast acuity were also collected in a subset of participants. Presence of an optic nerve lesion for this study was defined as history of acute unilateral optic neuritis.

RESULTS:

Among patients (n = 1,530), receiver operating characteristic curve analysis demonstrated an optimal peripapillary retinal nerve fiber layer intereye difference threshold of 5μm and ganglion cell + inner plexiform layer threshold of 4μm for identifying unilateral optic neuritis (n = 477). Greater intereye differences in acuities were associated with greater intereye retinal layer thickness differences (p ≤ 0.001).

INTERPRETATION:

Intereye differences of 5μm for retinal nerve fiber layer and 4μm for macular ganglion cell + inner plexiform layer are robust thresholds for identifying unilateral optic nerve lesions. These thresholds may be useful in establishing the presence of asymptomatic and symptomatic optic nerve lesions in multiple sclerosis and could be useful in a new version of the diagnostic criteria. Our findings lend further validation for utilizing the visual system in a multiple sclerosis clinical trial setting. Ann Neurol 2019;85:618-629.

PMID:
30851125
DOI:
10.1002/ana.25462

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