Retinal nerve fiber layer axonal loss and visual dysfunction in optic neuritis

TLDR

Axonal loss is a likely cause of persistent disability after a multiple sclerosis relapse, highlighting the need for noninvasive in vivo markers. The study aimed to quantify retinal nerve fiber layer axonal loss and secondary retinal ganglion cell loss in optic neuritis using optical coherence tomography. Twenty‑five optic neuritis patients with incomplete recovery and fifteen controls underwent OCT measurement of RNFL thickness and macular volume, alongside quantitative visual testing and electrophysiological examination. RNFL thickness and macular volume were markedly reduced in affected eyes, correlated with visual acuity, field, color vision, and VEP amplitude, demonstrating functionally relevant axonal and ganglion cell loss that could inform therapeutic trials. Published in Annals of Neurology, 2005.

Abstract

Axonal loss is thought to be a likely cause of persistent disability after a multiple sclerosis relapse; therefore, noninvasive in vivo markers specific for axonal loss are needed. We used optic neuritis as a model of multiple sclerosis relapse to quantify axonal loss of the retinal nerve fiber layer (RNFL) and secondary retinal ganglion cell loss in the macula with optical coherence tomography. We studied 25 patients who had a previous single episode of optic neuritis with a recruitment bias to those with incomplete recovery and 15 control subjects. Optical coherence tomography measurement of RNFL thickness and macular volume, quantitative visual testing, and electrophysiological examination were performed. There were highly significant reductions (p < 0.001) of RNFL thickness and macular volume in affected patient eyes compared with control eyes and clinically unaffected fellow eyes. There were significant relationships among RNFL thickness and visual acuity, visual field, color vision, and visual-evoked potential amplitude. This study has demonstrated functionally relevant changes indicative of axonal loss and retinal ganglion cell loss in the RNFL and macula, respectively, after optic neuritis. This noninvasive RNFL imaging technique could be used in trials of experimental treatments that aim to protect optic nerves from axonal loss. Ann Neurol 2005