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Retinal Nerve Fiber Layer Thickness, Brain Atrophy, and Disability in Multiple Sclerosis Patients

Abalo-Lojo, Jose Manuel MD; Limeres, Carmen Carollo MD; Gómez, Manuel Arias MD; Baleato-González, Sandra MD; Cadarso-Suárez, Carmen MD; Capeáns-Tomé, Carmen MD; Gonzalez, Francisco MD

Journal of Neuro-Ophthalmology: March 2014 - Volume 34 - Issue 1 - p 23–28
doi: 10.1097/WNO.0000000000000057
Original Contribution

Objective: To study the relationship between retinal nerve fiber layer (RNFL) thickness and brain atrophy using magnetic resonance imaging (MRI) with bicaudate ratio (BCR) in patients with multiple sclerosis (MS) with different levels of disease severity. We also assessed whether RNFL thickness correlated with Expanded Disability Status Scale (EDSS) score.

Methods: The participants consisted of 88 patients with MS and 59 age- and sex-matched healthy control subjects. Eleven patients had clinically isolated syndrome (CIS), 68 patients had relapsing-remitting MS (RR-MS), and 9 patients had secondary progressive MS. Patients and controls were evaluated using optical coherence tomography (OCT, Cirrus) and scanning laser polarimetry with variable corneal compensation (GDx VCC). Patients underwent the same brain MRI scanning protocol. Disability was evaluated according to the EDSS. The BCR was calculated by dividing the minimum intercaudate distance by brain width along the same level.

Results: The BCR was higher in patients with MS (0.12 ± 0.03) than in controls (0.08 ± 0.009) (P < 0.001). OCT average RNFL thickness in patients with MS was significantly lower (84.51 ± 14.27 μm) than in control subjects (98.44 ± 6.83 μm). BCR was correlated with OCT average RNFL thickness (r = −0.48, P = 0.002) in patients with MS without optic neuritis. Significant correlations were found between average RNFL thickness and EDSS (r = −0.43, P = 0.003). Additionally, there were correlations between BCR with GDx parameters in patients with MS without optic neuritis.

Conclusions: This study shows that RNFL thickness correlates with BCR and with MS subtypes. Additionally, our study indicates that OCT is better suited for MS assessment than GDx. We conclude that the damage of retinal axons appears related to brain damage in patients with MS.

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Service of Ophthalmology (JMA-L, CC-T, FG), Complexo Hospitalario Universitario de Santiago de Compostela, La Coruña, Spain; Department of Statistics (CCL, CC-S), School of Medicine, University of Santiago de Compostela, Spain; Service of Neurology (MAG), and Radiology (SBG), Complexo Hospitalario Universitario de Santiago de Compostela, Spain; Department of Surgery and CIMUS (FG), University of Santiago de Compostela, Spain; and Insituto de Investigacion Sanitaria (FG), Santiago de Compostela, Spain.

Address correspondence to Jose M. Abalo-Lojo, MD, Service of Ophthalmology, Complexo Hospitalario Universitario de Santiago de Compostela, E-15706 Santiago de Compostela, Spain; E-mail:

Supported by MCINN, Spain (BFU-2010-14968); Xunta de Galicia, Spain (10PXIB208126PR); and Ministerio de Industria y Competitividad (MTM2011-28285-C02-01).

The authors report no conflicts of interest.

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The data of this work are part of a doctoral thesis published in

© 2014 by North American Neuro-Ophthalmology Society