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S. C. Anderson, M. J. Kupersmith, G. Mandel, R. Kardon; One Month Findings Predict Retinal Nerve Fiber Layer (RNFL) Loss at 6 Months After Acute Optic Neuritis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):926.
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© ARVO (1962-2015); The Authors (2016-present)
We reported that in acute optic neuritis, RNFL shows acute swelling in greater than 80% sectors at baseline and thinning in greater than 50% of sectors at 1 month (ARVO 2008). We now report the 3 & 6 month RNFL outcomes of this first prospective study on patients followed from the onset of acute optic neuritis.
35 subjects had visual & RNFL assessments using OCT 3 and scanning laser polarimetry (SLP; enhanced corneal compensation) at entry, 1, 3 & 6 months. We judged acuity worse than 20/50 or mean deviation (MD) worse than -15 db as severe vision loss. RNFL thinning for OCT & SLP was significant if 2 clock-hour sectors were 10 microns less than in fellow normal eyes.
RNFL sectors were thinned by SLP in 53% & 76% and by OCT in 73% and 87% of eyes at 3 & 6 months, respectively. Severe vision loss & sector thinning at 1 month correlated with thinning of the OCT average RNFL at 6 months(r=.58, p=.006 & r=.54, p=0.02). The graphs show sector and mean RNFL loss (compared to fellow eyes) over time. Note swelling of RNFL, common at entry & 1 month, precludes demonstration of early loss at one month. At 6 months, OCT mean RNFL thinning correlated with visual acuity (r=.653, p=.001) and MD (r=.725, p=.0001) assessed at that time point.
Sector analysis with fellow eye comparison shows RNFL thinning is common in optic neuritis, particularly when visual deficits persist. Eyes with severe vision loss or RNFL thinning at 1 month have worse RNFL loss that continues passed 3 months. This corroborates the importance of the 1 month time point after an acute optic neuritis.
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