Abstract
Purpose :
Our research analyzed the defect patterns of the retinal nerve fiber layer (NFL) in disc scans and ganglion cell complex (GCC) in macular scans to find the difference between multiple sclerosis (MS) and glaucoma.
Methods :
This was a case-control study. The MS patients were diagnosed with the 2017 McDonald criteria, while glaucoma patients were diagnosed through funduscopy, specifically by identifying disc rim thinning or peripapillary nerve fiber bundle defects.
The NFL was divided into eight sectors according to a modified Garway-Heath scheme, and the GCC was divided into nine sectors utilizing the ETDRS scheme. Then, they were all converted into percentage loss (% loss) by comparing them to a normative reference.
Eyes were classified into either the significant defect group or the no-defect group, determined by the 2.5th percentile of the normal reference. After grouping, the worse eye from each participant was selected for analysis.
We formulated indices based on the pattern of the % loss and used the area under the receiver operating characteristics curve (AROC) to evaluate the indices.
Results :
Our study recruited 56 MS subjects (111 eyes) and 91 glaucoma subjects (91 eyes). The significant defect group comprised 19 MS eyes and 70 glaucoma eyes, while the no-defect group consisted of 39 MS eyes and 21 glaucoma eyes.
Distinct patterns were identified. NFL defects in MS typically occur in the temporal quadrant, while glaucoma eyes often have NFL defects in the superior or inferior quadrants. GCC defects were evenly distributed across the nine ETDRS sectors in MS, but in glaucoma cases, defects were predominantly observed in the outer-temporal and outer-inferior sectors. The AROC values for both NFL and GCC indices were high in the significant defect group, with a significant difference between the two. (AROC of NFL: 0.97, CI 0.93-1.00 vs. AROC of GCC: 0.89, CI 0.82-0.96, p=0.006). In the no-defect group, both indices showed a fair AROC value, but there was no significant difference between NFL and GCC indices. (AROC of NFL: 0.71, 0.56-0.86 vs. AROC of GCC: 0.69, 0.54-0.84, p=0.861)
Conclusions :
Multiple sclerosis and glaucoma exhibit different NFL and GCC defect patterns in OCT scans. Analyzing the % loss patterns may enable accurate differentiation between the optic neuropathies associated with MS and glaucoma.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.