J Clin Neurol.  2018 Apr;14(2):200-205. 10.3988/jcn.2018.14.2.200.

Optical Coherence Tomography versus Visual Evoked Potentials for Detecting Visual Pathway Abnormalities in Patients with Neuromyelitis Optica Spectrum Disorder

• Kim NH
• Kim HJ
• Park CY
• Jeong KS
• Cho JY

• KMID: 2407947
• DOI: http://doi.org/10.3988/jcn.2018.14.2.200

Abstract

BACKGROUND AND PURPOSE
Optical coherence tomography (OCT) and visual evoked potentials (VEPs) can be used to detect optic neuritis (ON). However, the comparative sensitivities of OCT and VEPs for detecting ON in neuromyelitis optica spectrum disorder (NMOSD) are unclear, and so we assessed these sensitivities.
METHODS
This cross-sectional study included 73 patients with aquaporin-4 antibody-seropositive NMOSD, and 101 eyes with ON. The clinical characteristics, visual acuity (VA), Expanded Disability Status Scale (EDSS) scores, OCT peripapillary retinal nerve fiber layer (RNFL) thickness, and VEPs of the patients were evaluated.
RESULTS
OCT and VEPs were abnormal in 68% and 73% of eyes with a history of ON, respectively, and in 2% and 9% of eyes without ON. Test sensitivities were influenced by the number of ON episodes: the OCT RNFL thickness and VEPs were abnormal in 50% and 67% of the eyes with first-ever ON episode, respectively (p=0.041), with the combination of both tests detecting abnormalities in up to 75% of the eyes. The sensitivities of the OCT RNFL thickness and VEPs increased to 95% and 83%, respectively, after the second or subsequent ON episode (p=0.06), with the combination of both tests detecting abnormalities in 95% of cases. The OCT RNFL thickness and VEP latency/amplitude were correlated with EDSS scores and VA.
CONCLUSIONS
VEPs were superior for detecting subclinical or first-ever ON, while OCT was better for detecting eyes with multiple ON episodes. The correlations of OCT and VEPs with clinical disability measures indicate that these tests are potential markers of the disease burden in NMOSD.

Keyword

neuromyelitis optica; neuromyelitis optica spectrum disorder; optical coherence tomography; visual evoked potentials; optic neuritis

MeSH Terms

Cross-Sectional Studies
Evoked Potentials, Visual*
Humans
Nerve Fibers
Neuromyelitis Optica*
Optic Neuritis
Retinaldehyde
Tomography, Optical Coherence*
Visual Acuity
Visual Pathways*
Retinaldehyde

Figure

• 

  Fig. 1 Percentages of abnormal tests in all 101 eyes with a history of ON (A), in 60 eyes with first-ever ON (B), in 41 eyes with multiple ON episodes (C), and in 45 unaffected eyes (D). Abnormal findings in VEP tests were more frequent in eyes with subclinical or first-ever ON, while abnormal findings in OCT tests were more frequent in eyes with multiple ON episodes. OCT or VEP, eyes with at least one abnormal OCT or VEP finding; OCT only, eyes with abnormal OCT and normal VEP findings; VEP only, eyes with abnormal VEP and normal OCT findings; OCT and VEP, eyes with abnormal OCT and abnormal VEP findings. *p<0.05. OCT: optical coherence tomography, ON: optical neuritis, VEP: visual evoked potential.

• 

  Fig. 2 Correlations (in all eyes) between the RNFL thickness and VEP latency (r=−0.80, p<0.001) (A) and between the RNFL thickness and VEP amplitude (r=0.69, p<0.001) (B). RNFL: retinal nerve fiber layer, VEP: visual evoked potential.

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