Ganglion cell loss in relation to visual disability in multiple sclerosis

Scott D. Walter, Hiroshi Ishikawa, Kristin M. Galetta, Reiko E. Sakai, Daniel J. Feller, Sam B. Henderson, James A. Wilson, Maureen G. Maguire, Steven L. Galetta, Elliot Frohman, Peter A. Calabresi, Joel S. Schuman, Laura J. Balcer

Research output: Contribution to journalArticle

162 Citations (Scopus)

Abstract

Purpose: We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS). Design: Cross-sectional study. Participants: A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment. Methods: The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined. Main Outcome Measures: The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5% and 1.25% contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score. Results: Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (P<0.001 and P = 0.001) and in MS ON versus non-ON eyes (P<0.001 for both measures). Peripapillary RNFL, macular RNFL, GCL+IPL, and the combination of macular RNFL+GCL+IPL were significantly correlated with VA (P≤0.001), 2.5% LCLA (P<0.001), and 1.25% LCLA (P≤0.001). Among OCT measurements, reductions in GCL+IPL (P<0.001), macular RNFL (P = 0.006), and the combination (macular RNFL+GCL+IPL; P<0.001) were most strongly associated with lower (worse) NEI-VFQ-25 and 10-Item Supplement QOL scores; GCL+IPL thinning was significant even accounting for macular RNFL thickness (P = 0.03 for GCL+IPL, P = 0.39 for macular RNFL). Conclusions: We demonstrated that GCL+IPL thinning is most significantly correlated with both visual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)1250-1257
Number of pages8
JournalOphthalmology
Volume119
Issue number6
DOIs
StatePublished - Jun 2012

Fingerprint

Nerve Fibers
Ganglia
Multiple Sclerosis
Optic Neuritis
Neuritis
Quality of Life
Optical Coherence Tomography
Disclosure
Visual Acuity
National Eye Institute (U.S.)
Eye Diseases
Glaucoma
Nervous System
Cross-Sectional Studies
Magnetic Resonance Imaging
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Walter, S. D., Ishikawa, H., Galetta, K. M., Sakai, R. E., Feller, D. J., Henderson, S. B., ... Balcer, L. J. (2012). Ganglion cell loss in relation to visual disability in multiple sclerosis. Ophthalmology, 119(6), 1250-1257. https://doi.org/10.1016/j.ophtha.2011.11.032

Ganglion cell loss in relation to visual disability in multiple sclerosis. / Walter, Scott D.; Ishikawa, Hiroshi; Galetta, Kristin M.; Sakai, Reiko E.; Feller, Daniel J.; Henderson, Sam B.; Wilson, James A.; Maguire, Maureen G.; Galetta, Steven L.; Frohman, Elliot; Calabresi, Peter A.; Schuman, Joel S.; Balcer, Laura J.

In: Ophthalmology, Vol. 119, No. 6, 06.2012, p. 1250-1257.

Research output: Contribution to journalArticle

Walter, SD, Ishikawa, H, Galetta, KM, Sakai, RE, Feller, DJ, Henderson, SB, Wilson, JA, Maguire, MG, Galetta, SL, Frohman, E, Calabresi, PA, Schuman, JS & Balcer, LJ 2012, 'Ganglion cell loss in relation to visual disability in multiple sclerosis', Ophthalmology, vol. 119, no. 6, pp. 1250-1257. https://doi.org/10.1016/j.ophtha.2011.11.032
Walter SD, Ishikawa H, Galetta KM, Sakai RE, Feller DJ, Henderson SB et al. Ganglion cell loss in relation to visual disability in multiple sclerosis. Ophthalmology. 2012 Jun;119(6):1250-1257. https://doi.org/10.1016/j.ophtha.2011.11.032
Walter, Scott D. ; Ishikawa, Hiroshi ; Galetta, Kristin M. ; Sakai, Reiko E. ; Feller, Daniel J. ; Henderson, Sam B. ; Wilson, James A. ; Maguire, Maureen G. ; Galetta, Steven L. ; Frohman, Elliot ; Calabresi, Peter A. ; Schuman, Joel S. ; Balcer, Laura J. / Ganglion cell loss in relation to visual disability in multiple sclerosis. In: Ophthalmology. 2012 ; Vol. 119, No. 6. pp. 1250-1257.
@article{c6fbaa62e22044c481dc02468bdb2937,
title = "Ganglion cell loss in relation to visual disability in multiple sclerosis",
abstract = "Purpose: We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS). Design: Cross-sectional study. Participants: A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment. Methods: The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined. Main Outcome Measures: The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5{\%} and 1.25{\%} contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score. Results: Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (P<0.001 and P = 0.001) and in MS ON versus non-ON eyes (P<0.001 for both measures). Peripapillary RNFL, macular RNFL, GCL+IPL, and the combination of macular RNFL+GCL+IPL were significantly correlated with VA (P≤0.001), 2.5{\%} LCLA (P<0.001), and 1.25{\%} LCLA (P≤0.001). Among OCT measurements, reductions in GCL+IPL (P<0.001), macular RNFL (P = 0.006), and the combination (macular RNFL+GCL+IPL; P<0.001) were most strongly associated with lower (worse) NEI-VFQ-25 and 10-Item Supplement QOL scores; GCL+IPL thinning was significant even accounting for macular RNFL thickness (P = 0.03 for GCL+IPL, P = 0.39 for macular RNFL). Conclusions: We demonstrated that GCL+IPL thinning is most significantly correlated with both visual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
author = "Walter, {Scott D.} and Hiroshi Ishikawa and Galetta, {Kristin M.} and Sakai, {Reiko E.} and Feller, {Daniel J.} and Henderson, {Sam B.} and Wilson, {James A.} and Maguire, {Maureen G.} and Galetta, {Steven L.} and Elliot Frohman and Calabresi, {Peter A.} and Schuman, {Joel S.} and Balcer, {Laura J.}",
year = "2012",
month = "6",
doi = "10.1016/j.ophtha.2011.11.032",
language = "English (US)",
volume = "119",
pages = "1250--1257",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Ganglion cell loss in relation to visual disability in multiple sclerosis

AU - Walter, Scott D.

AU - Ishikawa, Hiroshi

AU - Galetta, Kristin M.

AU - Sakai, Reiko E.

AU - Feller, Daniel J.

AU - Henderson, Sam B.

AU - Wilson, James A.

AU - Maguire, Maureen G.

AU - Galetta, Steven L.

AU - Frohman, Elliot

AU - Calabresi, Peter A.

AU - Schuman, Joel S.

AU - Balcer, Laura J.

PY - 2012/6

Y1 - 2012/6

N2 - Purpose: We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS). Design: Cross-sectional study. Participants: A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment. Methods: The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined. Main Outcome Measures: The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5% and 1.25% contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score. Results: Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (P<0.001 and P = 0.001) and in MS ON versus non-ON eyes (P<0.001 for both measures). Peripapillary RNFL, macular RNFL, GCL+IPL, and the combination of macular RNFL+GCL+IPL were significantly correlated with VA (P≤0.001), 2.5% LCLA (P<0.001), and 1.25% LCLA (P≤0.001). Among OCT measurements, reductions in GCL+IPL (P<0.001), macular RNFL (P = 0.006), and the combination (macular RNFL+GCL+IPL; P<0.001) were most strongly associated with lower (worse) NEI-VFQ-25 and 10-Item Supplement QOL scores; GCL+IPL thinning was significant even accounting for macular RNFL thickness (P = 0.03 for GCL+IPL, P = 0.39 for macular RNFL). Conclusions: We demonstrated that GCL+IPL thinning is most significantly correlated with both visual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

AB - Purpose: We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS). Design: Cross-sectional study. Participants: A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment. Methods: The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined. Main Outcome Measures: The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5% and 1.25% contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score. Results: Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (P<0.001 and P = 0.001) and in MS ON versus non-ON eyes (P<0.001 for both measures). Peripapillary RNFL, macular RNFL, GCL+IPL, and the combination of macular RNFL+GCL+IPL were significantly correlated with VA (P≤0.001), 2.5% LCLA (P<0.001), and 1.25% LCLA (P≤0.001). Among OCT measurements, reductions in GCL+IPL (P<0.001), macular RNFL (P = 0.006), and the combination (macular RNFL+GCL+IPL; P<0.001) were most strongly associated with lower (worse) NEI-VFQ-25 and 10-Item Supplement QOL scores; GCL+IPL thinning was significant even accounting for macular RNFL thickness (P = 0.03 for GCL+IPL, P = 0.39 for macular RNFL). Conclusions: We demonstrated that GCL+IPL thinning is most significantly correlated with both visual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

UR - http://www.scopus.com/inward/record.url?scp=84862813804&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862813804&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2011.11.032

DO - 10.1016/j.ophtha.2011.11.032

M3 - Article

C2 - 22365058

AN - SCOPUS:84862813804

VL - 119

SP - 1250

EP - 1257

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 6

ER -