April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
High-resolution assessment of cone photoreceptor structure in patients with multiple sclerosis
Author Affiliations & Notes
  • Ami Cuneo
    Department of Neurology, University of California, San Francisco, San Francisco, CA
  • Shiri Zayit-Soudry
    Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
  • Christopher Songster
    Department of Neurology, University of California, San Francisco, San Francisco, CA
  • Sam Arnow
    Department of Neurology, University of California, San Francisco, San Francisco, CA
  • Austin Roorda
    School of Optometry and Vision Science Graduate Group, University of California, Berkeley, Berkeley, CA
  • Ari Green
    Department of Neurology, University of California, San Francisco, San Francisco, CA
  • Jacque L Duncan
    Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
  • Footnotes
    Commercial Relationships Ami Cuneo, None; Shiri Zayit-Soudry, None; Christopher Songster, None; Sam Arnow, None; Austin Roorda, US 6,890,076 (P) (P), US 7,118,216 (P) (P); Ari Green, Accorda- Advisor (C), Biogen/IDEC and Applied Clinical Intelligence - End point adjudication committee service (C), Bionure- Scientific Advisory Board (C), Medimmune: End point adjudication committee (C), Mylan - Expert Counsel and advisor (C), Novartis - ADONIS study chair and OCTIMS steering committee, BAF Advisory committee (C), Prana Pharmaceuticals- PHTIIb Advisor (C), Roche- Advisor Opera and Oratorio (C); Jacque Duncan, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 1589. doi:
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      Ami Cuneo, Shiri Zayit-Soudry, Christopher Songster, Sam Arnow, Austin Roorda, Ari Green, Jacque L Duncan; High-resolution assessment of cone photoreceptor structure in patients with multiple sclerosis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1589.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To evaluate cone structure in regions correlated with central scotomas in patients with multiple sclerosis.

Methods: Adaptive optics scanning laser ophthalmoscopy (AOSLO) was used to evaluate the structure of macular cones within 3 deg of the fovea in 2 patients with relapsing remitting multiple sclerosis (MS), each of whom had central scotomas within 3 deg of fixation due to prior episodes of optic neuritis (ON) occurring more than 7 years prior to imaging. Cone spacing was estimated using a histogram analysis of contiguous subsets of cones at locations along the horizontal and vertical meridians separated by 1 deg intervals. Cone spacing was measured at locations where cones were unambiguous, and compared with values from 27 healthy eyes. Registered spectral domain optical coherence tomography (SD-OCT) data was used to confirm retinal anatomy consistent with cone structures in analyzed regions; images were segmented to analyze the average thickness of the outer retinal (ONL+ and OS+) layers and retinal ganglion cell layer in the central 20 degrees of the macula and compared with 20 normal eyes.

Results: Cone spacing was within the 95% confidence intervals around the normal mean at all locations where unambiguous cones were observed. In regions associated with loss of visual field sensitivity ranging from 2-21 dB, cone spacing was normal and comparable to measures from the contralateral eye at similar retinal locations with normal sensitivity. Qualitatively, cone packing and reflectivity appeared no different from normal. Although the mean retinal ganglion cell layer thickness (P = 0.008) was significantly lower than normal in eyes with a history of prior ON, the outer nuclear plus Henle’s fibers and the outer plexiform layer, and inner and outer segment layers were not significantly different from controls.

Conclusions: AOSLO revealed normal cone spacing and appearance throughout the macula in eyes of patients with MS with persistent central scotomas from prior episodes of ON. The findings suggest that visual deficits in patients with MS can be attributed to ganglion and inner nuclear layer injury, and demonstrate no evidence of cone loss in scotomatous regions, suggesting that trans-synaptic neuronal degeneration does not extend from the ganglion cells to the photoreceptors. The ability to assess individual cone structure and function may provide insight into mechanisms of visual loss in MS.

Keywords: 648 photoreceptors • 550 imaging/image analysis: clinical • 613 neuro-ophthalmology: optic nerve  
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