Background: Neuromyelitis optica (NMO) is a demyelinating syndrome of the central nervous system. NMO might be underdiagnosed at early stages when patients have not yet developed the full spectrum of disease. The aim of this study was to analyze the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT) and to compare RNFL measurements between NMO patients, patients with relapsing–remitting multiple sclerosis (RRMS), and healthy controls to determine whether differences in RNFL thickness could be an early diagnostic marker for NMO.
Methods: In a cross-sectional study, eyes of 25 NMO patients, 25 RRMS patients, and 50 healthy controls underwent RNFL measurements by OCT. Clinical parameters were collected by history and chart review. Pairwise Wilcoxon rank sum tests with Holm correction were used to compare means of RNFL thickness among 6 groups (NMO, RRMS, and healthy control) of patients [without or with 1 or more episode of optic neuritis (ON)]. The association between RNFL thickness and patient characteristics for NMO group was examined via linear mixed-effects models (adjusting for within-patient intereye correlations and history of ON, where appropriate).
Results: Based on the pairwise Wilcoxon rank sum tests with Holm correction, significant differences were found between NMO with 1 episode of ON and non-ON eyes (mean RNFL 63.7 vs 97.0 µm, P < 0.0001), multiple sclerosis (MS) non-ON eyes, and controls (RNFL 93.2 vs 98.4 µm, P = 0.03). No significant differences were found between NMO and MS with 1 attack of ON eyes (RNFL 63.7 vs 73.9 µm, P = 0.46), NMO non-ON eyes and healthy controls (RNFL 97.0 vs 98.4 µm, P = 0.56), and NMO non-ON and MS non-ON (RNFL 97.0 vs 93.2 µm, P = 0.56). For NMO group, RNFL thickness was associated with a history of ON (P < 0.001) but not with disability or disease duration when adjusting for the history of ON (P > 0.1).
Conclusions: RNFL in NMO is not different enough to distinguish NMO ON from MS ON eyes, but the intereye difference in RFNL with a history of unilateral ON may be a better diagnostic marker for NMO.
Neuro-Ophthalmology, Department of Ophthalmology (APL), University of British Columbia, British Columbia, Canada; Department of Medicine (RS, FZ, SA, ALT), Division of Neurology, University of British Columbia, British Columbia, Canada; Departments of Clinical Neurosciences and Surgery (FC), University of Calgary, Hotchkiss Brain Institute, Alberta, Canada; and Vista Klinik (APL), Vista Diagnostics and Laser Vista, Binnigen, Switzerland.
Address correspondence to Alex P. Lange, MD, Department of Ophthalmology, VGH Eye Care Center, 2550 Willow Street, Vancouver, British Columbia, Canada V5Z 3N9; E-mail: firstname.lastname@example.org
A. Lange was supported by the Swiss National Science Foundation and the UBC Hospital NMO Research Program. This project was supported by the UBC Hospital NMO Research Program.
The authors report no conflicts of interest.