Associations between retinal nerve fiber layer abnormalities and optic nerve examination

D. Cettomai, G. Hiremath, J. Ratchford, A. Venkatesan, Benjamin Greenberg, J. McGready, C. A. Pardo, D. A. Kerr, Elliot Frohman, L. J. Balcer, J. C. McArthur, P. A. Calabresi

Research output: Contribution to journalArticle

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Abstract

Objective:: Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied. Methods:: Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs. Results:: Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n = 63) vs those without (97.0 ± 15 μm; n = 417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n = 44) than without an APD (95.8 ± 17 μm; n = 436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity = 0.56; specificity = 0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73% (sensitivity = 0.30; specificity = 0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists. Conclusions:: OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.

Original languageEnglish (US)
Pages (from-to)1318-1325
Number of pages8
JournalNeurology
Volume75
Issue number15
DOIs
StatePublished - Oct 12 2010

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Optic Nerve
Nerve Fibers
Pupil Disorders
Optical Coherence Tomography
Optic Atrophy
Pallor
Sensitivity and Specificity
Visual Pathways
Neurology
Nervous System
Multiple Sclerosis
Atrophy
Physicians
Wounds and Injuries

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Cettomai, D., Hiremath, G., Ratchford, J., Venkatesan, A., Greenberg, B., McGready, J., ... Calabresi, P. A. (2010). Associations between retinal nerve fiber layer abnormalities and optic nerve examination. Neurology, 75(15), 1318-1325. https://doi.org/10.1212/WNL.0b013e3181f735bd

Associations between retinal nerve fiber layer abnormalities and optic nerve examination. / Cettomai, D.; Hiremath, G.; Ratchford, J.; Venkatesan, A.; Greenberg, Benjamin; McGready, J.; Pardo, C. A.; Kerr, D. A.; Frohman, Elliot; Balcer, L. J.; McArthur, J. C.; Calabresi, P. A.

In: Neurology, Vol. 75, No. 15, 12.10.2010, p. 1318-1325.

Research output: Contribution to journalArticle

Cettomai, D, Hiremath, G, Ratchford, J, Venkatesan, A, Greenberg, B, McGready, J, Pardo, CA, Kerr, DA, Frohman, E, Balcer, LJ, McArthur, JC & Calabresi, PA 2010, 'Associations between retinal nerve fiber layer abnormalities and optic nerve examination', Neurology, vol. 75, no. 15, pp. 1318-1325. https://doi.org/10.1212/WNL.0b013e3181f735bd
Cettomai D, Hiremath G, Ratchford J, Venkatesan A, Greenberg B, McGready J et al. Associations between retinal nerve fiber layer abnormalities and optic nerve examination. Neurology. 2010 Oct 12;75(15):1318-1325. https://doi.org/10.1212/WNL.0b013e3181f735bd
Cettomai, D. ; Hiremath, G. ; Ratchford, J. ; Venkatesan, A. ; Greenberg, Benjamin ; McGready, J. ; Pardo, C. A. ; Kerr, D. A. ; Frohman, Elliot ; Balcer, L. J. ; McArthur, J. C. ; Calabresi, P. A. / Associations between retinal nerve fiber layer abnormalities and optic nerve examination. In: Neurology. 2010 ; Vol. 75, No. 15. pp. 1318-1325.
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abstract = "Objective:: Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied. Methods:: Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs. Results:: Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n = 63) vs those without (97.0 ± 15 μm; n = 417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n = 44) than without an APD (95.8 ± 17 μm; n = 436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79{\%} (sensitivity = 0.56; specificity = 0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73{\%} (sensitivity = 0.30; specificity = 0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists. Conclusions:: OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.",
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AU - Cettomai, D.

AU - Hiremath, G.

AU - Ratchford, J.

AU - Venkatesan, A.

AU - Greenberg, Benjamin

AU - McGready, J.

AU - Pardo, C. A.

AU - Kerr, D. A.

AU - Frohman, Elliot

AU - Balcer, L. J.

AU - McArthur, J. C.

AU - Calabresi, P. A.

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N2 - Objective:: Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied. Methods:: Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs. Results:: Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n = 63) vs those without (97.0 ± 15 μm; n = 417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n = 44) than without an APD (95.8 ± 17 μm; n = 436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity = 0.56; specificity = 0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73% (sensitivity = 0.30; specificity = 0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists. Conclusions:: OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.

AB - Objective:: Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied. Methods:: Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs. Results:: Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n = 63) vs those without (97.0 ± 15 μm; n = 417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n = 44) than without an APD (95.8 ± 17 μm; n = 436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity = 0.56; specificity = 0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73% (sensitivity = 0.30; specificity = 0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists. Conclusions:: OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.

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