J Clin Neurol.  2015 Jul;11(3):241-247. 10.3988/jcn.2015.11.3.241.

Benign Multiple Sclerosis is Associated with Reduced Thinning of the Retinal Nerve Fiber and Ganglion Cell Layers in Non-Optic-Neuritis Eyes

• Huang-Link YM
• Fredrikson M
• Link H

• KMID: 1894558
• DOI: http://doi.org/10.3988/jcn.2015.11.3.241

Abstract

BACKGROUND AND PURPOSE
It is exceedingly difficult to differentiate benign multiple sclerosis (BMS) from relapsing-remitting multiple sclerosis (RRMS) based on clinical characteristics, neuroimaging, and cerebrospinal fluid tests. Optical coherence tomography (OCT) allows quantification of retinal structures, such as the retinal nerve fiber layer (RNFL) thickness, at the optic disc and the ganglion cell layer (GCL) at the macula, on a micrometer scale. It can also be used to trace minor alterations and the progression of neurodegeneration, help predict BMS, and influence the choice of therapy. To utilize OCT to detect the extent of changes of the optic disk and macular microstructure in patients with BMS and RRMS compared to healthy controls (HCs), with special focus on changes related to the presence/absence of optic neuritis (ON).
METHODS
Spectral-domain OCT was applied to examine eyes from 36 patients with multiple sclerosis (MS), comprising 11 with BMS and 25 with RRMS, and 34 HCs.
RESULTS
The RNFL and GCL were significantly thinner in eyes previously affected by ON, irrespective of the type of MS (i.e., BMS or RRMS), than in HCs. Significant thinning of the GCL was also observed in non-ON RRMS (and not non-ON BMS) compared to HCs. Correspondingly, a significant association between disease duration and thinning rates of the RNFL and GCL was observed only in non-ON RRMS (-0.54+/-0.24 and -0.43+/-0.21 microm/year, mean+/-SE; p<0.05 for both), and not in non-ON BMS (-0.11+/-0.27 and -0.24+/-0.24 microm/year).
CONCLUSIONS
The RNFL and GCL were thinner in both ON- and non-ON MS, but the change was more pronounced in ON MS, irrespective of the MS subtype studied herein. GCL thinning and the thinning rate of both the GCL and RNFL were less pronounced in non-ON BMS than in non-ON RRMS. These findings may help to predict the course of BMS.

Keyword

benign multiple sclerosis; optic neuritis; optical coherence tomography; retinal nerve fiber layer; macular ganglion cell layer

MeSH Terms

Cerebrospinal Fluid
Ganglion Cysts*
Humans
Multiple Sclerosis*
Multiple Sclerosis, Relapsing-Remitting
Nerve Fibers*
Neuroimaging
Optic Disk
Optic Neuritis
Retinaldehyde*
Tomography, Optical Coherence
Retinaldehyde

Figure

• 

  Fig. 1 Optical coherence tomography (OCT) measurements in a healthy subject. A: Peripapillary measures centered on the optic disc. B: Macular measures centered on the fovea. C: High-resolution OCT image of the retinal microstructure. ELM: external limiting membrane, GCL: ganglion cell layer, ILM: inner limiting membrane, INL: inner nuclear layer, IPL: inner plexiform layer, IS/OS: inner/outer photoreceptor segments, NFL: nerve fiber layer, ONL: outer nuclear layer, OPL: outer plexiform layer, RPE: retinal pigment epithelium.

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