Highlights
- •LCVA (2.5%) rather than HCVA is more sensitive marker of visual function recovery
- •LCVA (2.5%), 10-2 threshold perimetry and GCL thickness and thinning are potential recovery biomarkers after first event of acute demyelinating optic neuritis.
- •The 10-2 threshold perimetry as a novel strategy in demyelinating optic neuritis research better characterizes the outcome visual deficits.
Abstract
Background
Acute demyelinating optic neuritis is often a first episode of subsequent CNS demyelinating
disease, most frequently multiple sclerosis (MS). The majority of the patients have
substantial recovery of the high contrast visual acuity (HCVA) and 30-2 perimetry,
but reduced contrast sensitivity persists in 56% of eyes after an episode of optic
neuritis. Cross sectional studies of MS patients show low contrast visual acuity (LCVA)
correlates modestly with RNFL thickness and macula ganglion cell +IPL layer (GCL)
thickness. Considering the potential severity of the vision deficits at onset, and
GCL thinning at outcome, we hypothesized 10-2 perimetry and LCVA deficits would be
frequent following an episode of optic neuritis.
Methods
We prospectively studied 32 eyes of 32 patients (9 men, 23 women, age 34 years ± 10)
with first time acute optic neuritis. We measured LCVA 2.5% (# letters seen), GCL
thickness and loss, and 10-2 mean deviation (MD in decibels, dB) within 15 days from
symptoms onset and at six months. The 10-2 threshold perimetry, a novel assessment
in the MS research field, included to further characterize central vision function.
We used correlation analysis to assess associations between GCL thickness and thinning
and 10-2 perimetry as well as LCVA 2.5% at six months.
Results
Compared to fellow eyes we found significant residual LCVA deficits in 28/32 study
eyes at 6 months with 12.6 ± 15.8 letters seen, p=0.001). Similarly, 10-2 MD threshold
perimetry in the study eyes at 6 months showed significant difference relative to
the fellow eyes, p=0.01.
In regards to GCL changes at 6 months, we found statistically significant reduction
of the GCL thickness in the study eyes relative to the fellow eyes (study eyes 69.6
± 9.6 µm, fellow eyes 82.7 ± 4.7 µm, p=0.001), with thinning present in 29/32 eyes.
The mean GCL thinning at 6 months in the study eyes was 12.4 ± 8.4 µm.
Correlation analysis of associations between primary outcome measures at 6 months
showed significant relationship between GCL thickness and 10-2 MD threshold perimetry
(0.43, p = 0.015) but not with LCVA. At six months, the mean GCL thinning strongly
correlated with the 10-2 MD (-0.60, p=0.01) and moderately with LCVA (-0.46, p=0.008).
Conclusions
GCL thickness is the best structural and LCVA and 10-2 MD are sensitive functional
measures for determining residual deficits due to optic neuritis. The 10-2 MD correlates
best with the outcome GCL thickness and loss. Our findings also suggest that 10-2
threshold perimetry and macular GCL can provide functional and structural promising
biomarker signals to explore neuro-protective research.
Keywords
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Article info
Publication history
Published online: July 14, 2020
Accepted:
July 13,
2020
Received in revised form:
June 4,
2020
Received:
March 25,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
