Associations between retinal nerve fiber layer abnormalities and optic nerve examination

Area of Science:

• Ophthalmology
• Neurology
• Medical Imaging

Background:

• Retinal nerve fiber layer (RNFL) abnormalities on optical coherence tomography (OCT) are indicators of axonal loss and visual dysfunction in multiple sclerosis (MS).
• The clinical utility of OCT-detected RNFL abnormalities in routine MS management remains understudied.

Purpose of the Study:

• To investigate the role of OCT-measured RNFL thickness in identifying visual pathway damage in MS patients.
• To compare OCT findings with clinical assessments of optic atrophy and afferent pupillary defect (APD).

Main Methods:

• 240 MS patients underwent clinical and OCT examinations.
• Abnormal RNFL thickness was defined using the OCT 5th percentile.
• RNFL thickness and RNFL thickness ratios were compared between eyes with and without clinical signs of optic atrophy and APD.

Main Results:

• Eyes with clinically diagnosed optic atrophy or APD showed significantly reduced mean RNFL thickness compared to unaffected eyes (p < 0.001).
• Physicians' accuracy in detecting optic atrophy and RAPD using clinical examination was moderate, with varying sensitivity and specificity.
• OCT identified RNFL abnormalities in many patients without clinical signs of optic atrophy.

Conclusions:

• OCT detects RNFL abnormalities in a significant number of MS patients who do not exhibit clinical signs of optic atrophy.
• Further research is required to integrate OCT measures into neuro-ophthalmological assessments for optic atrophy and APD.
• OCT-measured RNFL thickness is expected to play a crucial role in future clinical MS management.