Highlights
- •More than 80% of patients suffer ganglion cell damage from first-time optic neuritis.
- •This finding relies on inter-ocular difference in ganglion cell layer thickness.
- •Optical coherence tomography is a feasible method to assess damage in first-time optic neuritis.
- •Predictive for more severe optic neuritis is worse visual field impairment at presentation.
Abstract
Background
To identify the extent of ganglion cell damage after first-time optic neuritis (ON)
using the inter-ocular difference between affected and fellow eyes, and whether this
approach is able to detect more patients suffering from ganglion cell damage than
using absolute values.
Methods
Thirty-four patients with first-time unilateral ON were followed for a median 413
days. Patients underwent optical coherence tomography testing to determine ganglion
cell plus inner plexiform layer thickness (GCIP). Ganglion cell loss was quantified
as GCIP difference between ON-affected and fellow eyes (inter-GCIP) and was compared
against measurements from 93 healthy controls (HC). Visual function was assessed with
high contrast visual acuity; and standard automated perimetry-derived measures of
mean deviation and foveal threshold.
Results
At clinical presentation after median 19 days from symptom onset, 47.1% of patients
showed early GCIP thinning in the ON-affected eye based on inter-GCIP. At the last
visit acute ON was associated with 16.1 ± 10.0 µm GCIP thinning compared to fellow
eyes (p = 3.669e-06). Based on inter-GCIP, 84.9% of ON patients sustained GCIP thinning
in their affected eye at the last visit, whereas using absolute values only 71.0%
of patients suffered from GCIP thinning (p = 0.002076). Only 32.3% of these patients
had abnormal visual function. The best predictor of GCIP thinning as a measure of
ON severity at the last visit was worse visual field mean deviation at clinical presentation.
Conclusion
Inter-ocular GCIP identifies significantly more eyes suffering damage from ON than
absolute GCIP, visual fields or visual acuity loss. Effective interventional options
are needed to prevent ganglion cell loss.
Keywords
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Article info
Publication history
Published online: April 09, 2018
Accepted:
April 7,
2018
Received in revised form:
March 7,
2018
Received:
July 18,
2017
Identification
Copyright
© 2018 Published by Elsevier B.V.
