Use of retinal optical coherence tomography to differentiate suspected neuromyelitis optica spectrum disorder from multiple sclerosis: A cross-sectional study

Nabil K El Ayoubi; Hussein Moussa; Antoine Younes; Ribal Haddad; Samia J Khoury

doi:10.1016/j.msard.2022.104160

Use of retinal optical coherence tomography to differentiate suspected neuromyelitis optica spectrum disorder from multiple sclerosis: A cross-sectional study

Mult Scler Relat Disord. 2022 Dec:68:104160. doi: 10.1016/j.msard.2022.104160. Epub 2022 Sep 7.

Authors

Nabil K El Ayoubi¹, Hussein Moussa², Antoine Younes¹, Ribal Haddad³, Samia J Khoury⁴

Affiliations

¹ Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon.
² Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD, USA.
³ Department of Neurology, the University of Chicago, Chicago, IL, USA.
⁴ Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon. Electronic address: sk88@aub.edu.lb.

PMID: 36113276
DOI: 10.1016/j.msard.2022.104160

Abstract

Background: Retinal optical coherence tomography (OCT) can differentiate definite NMOSD (dNMOSD) from multiple sclerosis (MS), but has not been evaluated in patients with a high clinical suspicion of NMOSD and not fulfilling the current consensus diagnostic criteria, referred in this paper as "potential" NMOSD (pNMOSD).

Aim: To compare the retinal OCT measurements between patients with pNMOSD, dNMOSD, MS, and reference healthy controls (HC).

Material and methods: In this cross-sectional study, clinical and demographic characteristics, as well as OCT measurements of peripapillary retinal nerve fiber layer (pRNFL), inner nuclear layer (INL), macular retinal nerve fiber layer (mRNFL), outer nuclear layer (ONL) ganglion cell/inner plexiform layer (GCIPL), and macular volume (MV) were compared between groups. Mixed-effects regression models adjusting for within-patient inter-eye correlations, controlling for age, gender, disease duration and history of optic neuritis per eye were explored. Subgroup analyses were performed on eyes with previous optic neuritis.

Results: 234 eyes (20 pNMOSD, 33 dNMOSD, 138 MS, and 43 HC) were included. Controlling for age, gender, disease duration, and history of optic neuritis per eye, pNMOSD eyes showed decreased GCIPL, pRNFL, mRNFL and MV thicknesses, similar to eyes with dNMOSD, but significantly thinner than MS and HC subjects' eyes. Similar results were obtained for the pRNFL, mRNFL, GCIPL, INL and MV thickness in the subgroup analysis exploring only eyes with history of optic neuritis (12 pNMOSD, 15 dNMOSD, and 27 MS).

Conclusion: Retinal OCT measurements in patients with pNMOSD were similar to dNMOSD, but significantly lower than patients with MS and healthy controls. This suggests that retinal OCT measures could be helpful markers supportive of NMOSD diagnosis and should be explored in larger studies as a valuable addition to the current consensus diagnostic criteria.

Keywords: GCIPL; INL; MS; Macular volume; NMOSD; OCT; ONL; mRNFL; pRNFL.

MeSH terms

Cross-Sectional Studies
Humans
Multiple Sclerosis* / diagnostic imaging
Neuromyelitis Optica* / diagnostic imaging
Optic Neuritis* / diagnostic imaging
Retinal Ganglion Cells
Tomography, Optical Coherence / methods