Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis
Article first published online: 19 FEB 2010
Copyright © 2010 American Neurological Association
Annals of Neurology
Volume 67, Issue 6, pages 749–760, June 2010
How to Cite
Talman, L. S., Bisker, E. R., Sackel, D. J., Long, D. A., Galetta, K. M., Ratchford, J. N., Lile, D. J., Farrell, S. K., Loguidice, M. J., Remington, G., Conger, A., Frohman, T. C., Jacobs, D. A., Markowitz, C. E., Cutter, G. R., Ying, G.-S., Dai, Y., Maguire, M. G., Galetta, S. L., Frohman, E. M., Calabresi, P. A. and Balcer, L. J. (2010), Longitudinal study of vision and retinal nerve fiber layer thickness in multiple sclerosis. Ann Neurol., 67: 749–760. doi: 10.1002/ana.22005
- Issue published online: 25 MAY 2010
- Article first published online: 19 FEB 2010
- Accepted manuscript online: 19 FEB 2010 12:00AM EST
- Manuscript Accepted: 29 JAN 2010
- Manuscript Revised: 10 DEC 2009
- Manuscript Received: 10 SEP 2009
- National Multiple Sclerosis Society. Grant Number: PP1115
- National Multiple Sclerosis Society Tissue Repair Partnership. Grant Number: TR 3760-A-3
- NIH/ National Eye Institute. Grant Number: K24 EY 014136
- DAD's Foundation
- McNeill Foundation
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).
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.
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).
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