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Abstract
Objective To evaluate the frequency of asymptomatic optic nerve lesions and their role in the asymptomatic retinal neuroaxonal loss observed in multiple sclerosis (MS).
Methods We included patients with remitting-relapsing MS in the VWIMS study (Analysis of Neurodegenerative Process Within Visual Ways In Multiple Sclerosis) (ClinicalTrials.gov Identifier: 03656055). Included patients underwent optical coherence tomography (OCT), optic nerve and brain MRI, and low-contrast visual acuity measurement. In eyes of patients with MS without optic neuritis (MS-NON), an optic nerve lesion on MRI (3D double inversion recovery [DIR] sequence) was considered as an asymptomatic lesion. We considered the following OCT/MRI measures: peripapillary retinal nerve fiber layer thickness, macular ganglion cell + inner plexiform layer (mGCIPL) volumes, optic nerve lesion length, T2 lesion burden, and fractional anisotropy within optic radiations.
Results An optic nerve lesion was detected in half of MS-NON eyes. Compared to optic nerves without any lesion and independently of the optic radiation lesions, the asymptomatic lesions were associated with thinner inner retinal layers (p < 0.0001) and a lower contrast visual acuity (p ≤ 0.003). Within eyes with asymptomatic optic nerve lesions, optic nerve lesion length was the only MRI measure significantly associated with retinal neuroaxonal loss (p < 0.03). Intereye mGCIPL thickness difference (IETD) was lower in patients with bilateral optic nerve DIR hypersignal compared to patients with unilateral hypersignal (p = 0.0317). For the diagnosis of history of optic neuritis, sensitivity of 3D DIR and of mGCIPL IETD were 84.9% and 63.5%, respectively.
Conclusions Asymptomatic optic nerve lesions are an underestimated and preponderant cause of retinal neuroaxonal loss in MS. 3D DIR sequence may be more sensitive than IETD measured by OCT for the detection of optic nerve lesions.
Glossary
- CIS=
- clinically isolated syndrome;
- CIS-NON=
- clinically isolated syndrome without history of optic neuritis;
- DIR=
- double inversion recovery;
- DTI=
- diffusion tensor imaging;
- EPI=
- echoplanar imaging;
- FA=
- fractional anisotropy;
- FLAIR=
- fluid-attenuated inversion recovery;
- FOV=
- field of view;
- IETD=
- intereye retinal thickness differences;
- INL=
- inner nuclear layer;
- IQR=
- interquartile range;
- mGCIPL=
- macular ganglion cell + inner plexiform layer;
- mINL=
- macular inner nuclear layer;
- MME=
- microcystic macular edema;
- MS=
- multiple sclerosis;
- MS-NON=
- multiple sclerosis without history of optic neuritis;
- MS-ON=
- multiple sclerosis with history of optic neuritis;
- OCT=
- optical coherence tomography;
- ON=
- optic neuritis;
- ORs=
- optic radiations;
- pRNFL=
- peripapillary retinal nerve fiber layer;
- RNFL=
- retinal nerve fiber layer;
- RRMS=
- relapsing-remitting multiple sclerosis;
- TE=
- echo time;
- TI=
- inversion time;
- TR=
- repetition time;
- VA=
- visual acuity;
- VEP=
- visual evoked potential
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received June 6, 2019.
- Accepted in final form January 14, 2020.
- © 2020 American Academy of Neurology
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- Author response: Asymptomatic optic nerve lesions: An underestimated cause of silent retinal atrophy in MS
- Editor Response: Asymptomatic optic nerve lesions: An underestimated cause of silent retinal atrophy in MS
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