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Published on: April 14, 2014
Interocular Difference in Retinal Nerve Fiber Layer Thickness Predicts Optic Neuritis in Pediatric-Onset Multiple
Amy T Waldman1, Leslie Benson, John R Sollee
1Division of Neurology (ATW, JRS, AML, GWL), Children's Hospital of Philadelphia and Departments of Neurology and Pediatrics (ATW), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Departments of Neurology (LB) and Ophthalmology (GH), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Neuroimmunology and Glial Biology (AJG, EW), Department of Neurology, Weill Institute of Neurosciences, University of California San Francisco, San Francisco, California; Department of Neurology and Neurotherapeutics (DC, BG), University of Texas Southwestern Medical Center, Dallas, Texas; Department of Neurology, University of California San Diego, San Diego, California; and Department of Ophthalmology (AJG), University of California San Francisco, San Francisco, California.
Interocular difference in retinal nerve fiber layer thickness can help identify remote optic neuritis in pediatric-onset multiple sclerosis patients, even when individual eye scans appear normal. This finding enhances diagnostic capabilities for early disease detection.
Area of Science:
- Ophthalmology
- Neurology
- Medical Imaging
Background:
- Optical coherence tomography (OCT) quantifies retinal damage, crucial for assessing anterior visual pathway injury in multiple sclerosis (MS).
- Retinal nerve fiber layer (RNFL) thickness is a key indicator, with low values suggesting damage.
- Interocular difference (IOD) in RNFL thickness can indicate prior optic neuritis (ON), particularly in adults.
Purpose of the Study:
- To investigate if RNFL IOD can identify remote optic neuritis in pediatric-onset MS (POMS) patients.
- To evaluate the diagnostic utility of RNFL IOD in a multicenter POMS cohort.
Main Methods:
- Recruited 157 POMS patients (onset <18 years) from 4 centers.
- Confirmed remote ON (>6 months prior) via medical records.
- Measured RNFL thickness using Spectralis OCT; defined abnormal RNFL (<86 μm) and abnormal IOD (>5 μm) based on healthy controls and adult findings.
Main Results:
- Remote ON was present in 67 (43%) of POMS participants.
- An abnormal RNFL IOD (>5 μm) was significantly associated with a history of remote ON (P < 0.001).
- IOD criteria identified ON in 42% of patients with normal RNFL thickness in both eyes.
Conclusions:
- RNFL IOD enhances OCT's diagnostic yield for confirming remote ON in POMS.
- An IOD >5 μm suggests a history of remote ON, especially in patients with prior visual symptoms.
- This method is valuable for detecting subclinical injury and establishing a baseline in early MS.
