Optical Coherence Tomography in Multiple Sclerosis: a Structural & Functional analysis
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This document analyzes optical coherence tomography (OCT) as a potential biomarker for central nervous system degeneration in multiple sclerosis (MS). OCT and retinal nerve fiber layer (RNFL) thickness showed high sensitivity in detecting neurodegeneration in MS patients, correlating with visual functions and disability levels. RNFL thickness was significantly reduced in MS patients, especially those with optic neuritis, and correlated with disease severity measures. OCT may thus serve as a valuable tool to quantify neurodegeneration in MS for use in clinical trials, patient monitoring, and treatment assessment by providing a window into central nervous system changes.
Optical Coherence Tomography in Multiple Sclerosis: a Structural & Functional analysis
- 1. OCT in Multiple Sclerosis: a Structural & Functional Analysis. Manal Al-Romeih, MSc
- 2. Aim: To test the possibility of using OCT as a biological marker for central nervous system degenerative process in multiple sclerosis.
- 3. Multiple sclerosis: A neuro-degenrative disease Mylin sheath defect Affects stability and speed of nerve impulse conductivity Ophthalmological manifestation Systemic manifestation
- 4. Link between Oct & MS: Unmylinated retinal fibers Neural generation and protection Axonal damage
- 5. MS/ ON 22 patients 41 eyes MS/ NO-ON 19 patients 38 eyes 36 subjects 72 eyes Normal Control 151 eyes 77 subjects Subjects: Ophthalmologic disorders. Neurologic disorders. Systemic diseases. Refractive error ≥±6 DS.
- 6. Materials & Methods: EDSS: a method of quantifying disability in MS based on eight Functional Systems (FS)
- 8. Results: MS/ NO-ON MS/ ON P value Visual acuity, mean ± SD 0.92±0.17 0.9± 0.2 0.83 Contrast Sensitivity, mean ± SD (48) 32.7±4.9 30.6±6.6 0.11 Low contrast, mean ± SD (25) 15.2±6.5 14.2±5.4 0.45 Color vision (affected) 6 (1:3) 7 (1:3) 1.0 Color confusion index (CCI) 1.1±0.31 1.1± 0.2 0.55 Disease duration (months), mean 60.2 76.6 0.36 EDSS, mean ± SD 1±1.7 1±1.9 0.81
- 9. 102.5±6.7 92.4±12.8 Results, cont., : R N F L /N C R N F L /M S 0 5 0 1 0 0 1 5 0 G C C /N C G C C /M S 0 5 0 1 0 0 1 5 0 ANOVA p= 0.001 ANOVA p<0.0001 Comparison between the groups in OCT parameters 102.5±6.7 92.4±12.8 90.5±6.8 85.5±9.5 Unpaired t, p<0.001 Unpaired t, p= 0.0004
- 10. Correlations OCT & VA OCT & CS OCT & CCI Results, cont., : r= 0.46 p= 0.002r= 0.14 p= 0.38 r= 0.62 p< 0.0001 r= 0.61 p< 0.0001
- 11. * MS induced other ocular affections 47.6% * Visual field: 50% of the MS/ON 50% had VF defects 33.3% of the MS/ NO-ON MS/ONMS/NO-ON 3.32.7Mean PSD r= 0.4, p= 0.16r= -0.57, p= 0.004Correlation of RNFL to PSD r= 0.17, p= 0.55r= -0.68, p= 0.0004Correlation of GCC to PSD Results, cont., :
- 12. VEP VEP: * No significant relation to visual functions, EDSS. * *Sensitivity of VEP 92% Sensitivity of OCT 81% Results, cont., : GCC vs Lat. r=-0.213, p=0.381
- 13. Results, cont., : EDSS EDSS (MS/NO-ON) EDSS (MS/ON) RNFL r= -0.28, p= 0.09 r=-0.44, p=0.004 GCC r= -0.313, p= 0.06 r= -0.06, p= 0.7 FLV r= 0.52, p=0.001 r= 0.38, p=0.014 GLV r=0.44, p=0.006 r= 0.23, p=0.14
- 15. Discussion, cont., Henderson, 2008 Saidha, 2011 Villoslada,2011 Laron,2010 Montero, 2004 Parisie, 1999 Gundogan, 2007 Naismith, 2009 Fatehi, 2012 VA CV VEPVF
- 16. Conclusion: Due to its high sensitivity and correlation to visual functions; OCT- and RNFL in particular- is a very valuable diagnostic tool in multiple sclerosis. It can be used to: quantify the degree of neuro-degeneration: - In clinical trials - In the follow up of the MS patients. - To assess the success of the treatment. The eye can serve as a window to what is happening in the central nervous system.
- 17. Reference: • Fatehi, Farzad, Shaygannejad, Vahid, Mehr, Lida Kiani, Dehghani, Alireza. Optical coherence tomography versus visual evoked potential in multiple sclerosis patients. Ir J neurol 2012; 11(1): 12- 15. • Gundogan, Fatih C., Demirkaya, Seref and Sobaci, Gungor. Is Optical Coherence Tomography Really a New Biomarker Candidate in Multiple Sclerosis?—A Structural and Functional Evaluation. Invest Ophthalmol Vis Sci. 2007; 48:5773–5781. • Henderson AP, Trip SA, Schlottmann PG, et al. An investigation of the retinal nerve fibre layer in progressive multiple sclerosis using optical coherence tomography. Brain. 2008;131:277–287. • Laron, Michal, Cheng, Han, Zhang, Bin, Schiffman, Jade S, Tang, Rosa A and Frishman, Laura J. Comparison of multifocal visual evoked potential, standard automated perimetry and optical coherence tomography in assessing visual pathway in multiple sclerosis patients. Multiple Sclerosis 2010; 16(4) 412–426. • Monteiro ML, Leal BC, Rosa AA, Bronstein MD. Optical coherence tomography analysis of axonal loss in band atrophy of the optic nerve. Br J Ophthalmol. 2004;88:896–9. • Naismith, R.T., Tutlam, N.T., Xu, J., Shepherd, J.B., Klawiter, E.C., Song, S.-K., Cross, A.H. Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis. Neurology 2009;73:46–52. • Parisi V, Manni G, Spadaro M, et al. Correlation between morphological and functional retinal impairment in multiple sclerosis patients. Invest Ophthalmol Vis Sci 1999;40: 2520–7. • Saidha, Shiv, B. Syc, Stephanie, Durbin, Mary K., Eckstein, Christopher, Oakley, Jonathan D., Meyer, Scott A., … , Calabresi, Peter A. Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness. Multiple Sclerosis Journal 2011; 17(12) 1449–1463. • Villoslada P, Cuneo A, Gelfand J, Hauser SL, Green A. Color vision is strongly associated with retinal thinning in multiple sclerosis. Mult Scler. 2012;18(7): 991-999.
- 18. Acknowledgment: Dr. Samah Fawzi, MD Assistant professor, KSU, CAMS, Optometry. Prof. Abdulkader Daif, MD Head of neurology department, KKUH. Prof. Hani Al-Mezaine, MD Head of ophthalmology department, KKUH. Prof. Ahmad Bahammam, MD Head of institutional Review Board (IRB), KKUH. All the staff of Multiple sclerosis clinic & ophthalmology department in KKUH.
- 19. Thank You!