Retinal microvascular differences between multiple sclerosis and neuromyelitis optica spectrum disorder: a cross-sectional study with diagnostic modeling.

PurposeTo evaluate the spatial relationship between macular superficial vessel density (SVD) and macular ganglion cell-inner plexiform layer (GCIPL) thickness in primary angle closure glaucoma (PACG), and to investigate diagnostic abilities of macular SVD and foveal avascular zone (FAZ) parameters.MethodsThis was a cross-sectional study on 38 PACG patients (38 eyes) and 25 healthy subjects (25 eyes). Macular region was imaged using a 1050-nm-wavelength swept-source optical coherence tomography (OCT) angiography (OCTA) system (DRI OCT Triton, TOPCON). Vessel density of the macular region was quantified by ImageJ software. The peripapillary retinal nerve fiber layer (pRNFL) thicknesses and macular GCIPL thickness were obtained by swept-source OCT. Pearson correlation analysis was used to evaluate the spatial positional relationship between macular SVD and macular GCIPL thickness. At the same time, the correlation between macular SVD and pRNFL thickness was evaluated. Areas under the receiver operating characteristics curves (AUCs) of OCT, OCTA and FAZ measurement metrics were calculated to assess the diagnostic ability for glaucoma.ResultsMacular GCIPL thickness had a moderate correlation with the macular SVD in the inferonasal sector (r = 0.426, P = 0.008). In addition, there was a strong correlation between inferonasal sector of macular vessel density and 5,6,7,8 clock-hour regions of the pRNFL thicknesses (all r > 0.5). Inferoinferior sector of macular SVD and 6,7 clock-hour regions of pRNFL thicknesses also had strong correlation (all r > 0.5). The AUCs of macular SVD ranged between 0.61 (superonasal sector) and 0.76 (inferoinferior sector). The FAZ circularity index showed the highest diagnostic power (AUC = 0.94;95% CI, 0.85–0.99), followed by superotemporal sector of macular GCIPL thicknesses (0.93;95% CI,0.83–0.98).ConclusionsSector of macular SVD not only had a spatial positional correlation with corresponding macular GCIPL thickness, but also with clock-hour regional pRNFL thicknesses in PACG eyes. FAZ circulation index might be a useful diagnostic parameter.

ABSTRACTIntroduction:The involvement of ocular system especially optic neuritis (ON) is an important clinical aspect of inflammatory demyelinating disease (IDD) of the central nervous system. The primary IDD spectrum includes neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein-associated diseases (MOGAD), multiple sclerosis (MS), and clinically isolated syndrome (CIS). The clinical presentation of ON varies according to disease pathophysiology.Aim:We aimed to determine the clinical characteristics of treatment-naïve ON at baseline and on the 6-month follow-up and assessed the predictors of visual outcome.Methods:A prospective study of patients with treatment-naïve ON was performed with structural and functional ophthalmological evaluation. Univariate and multivariate logistic regression analyses were used to determine the predictive factors of visual outcome.Results:Out of 46 patients of IDD, ON occurred in 30 patients. The etiological subtyping included NMOSD (10), CIS (8), MOGAD (7), and MS (5) patients in our study. The ON group showed female preponderance, greater delay in diagnosis, and significant relapsing course. Bilaterality occurred predominantly in NMOSD followed by MOGAD. Optical coherence tomography analysis showed predominant thinning of superior and inferior quadrants in retinal nerve fiber layer (RNFL) and global thinning of Ganglion cell inner plexiform layer (GC-IPL) in NMOSD, but the values were not statistically significant. Univariate analysis for predictors of visual outcome showed age at onset, delay in diagnosis, NMOSD, longitudinally extensive ON (LEON) and chiasmal lesions were associated with poor outcome, while multivariate analysis showed statistical association of NMOSD and LEON with poor outcome.Conclusion:NMOSD and longitudinally extensive optic neuritis showed poor ophthalmological outcome and optical coherence tomography was unyielding.

There are no reports in the literature studying the possible relationship between Epstein-Barr virus (EBV) and optic nerve involvement in multiple sclerosis (MS). The aim of our study was to analyze the association between EBV antibodies titres and optical coherence tomography (OCT) and OCT angiography (OCTA) quantitative parameters. We conducted a retrospective study. The study included 98 eyes of 49 patients with MS. Years of MS duration, relapse count, history of optic neuritis (ON), and immunoglobulin (Ig) G antibodies to the EBV viral capsid antigen (VCA) were recorded from each patient. Also, OCT analysis (including retinal nerve fibre layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness) and OCTA analysis (including perfusion density (PD) and flux index (FI) of the radial peripapillary capillary plexus) were performed in each participant. No significant associations were observed between anti-EBV antibody levels and OCT or OCTA parameters (p > 0,05). Correlation analysis between OCT and OCTA measurements showed a significant positive correlation between RNFL thickness and GCIPL thickness with peripapillary PD and FI (p < 0,035). Subgroup analysis revealed a significant diminution of RNFL thickness, GCIPL thickness and peripapillary PD and FI (p < 0,05) in the ON group. We were unable to demonstrate a significant association between anti-EBV VCA IgG antibody titres and OCT or OCTA parameters. Nonetheless, further longitudinal studies are needed to explore the possible association of EBV with optic nerve involvement in MS.

Combination of serum markers with optical coherence tomography angiography for evaluating neuromyelitis optica spectrum disorders and multiple sclerosis

Although cupping of the optic nerve is classically a sign of glaucomatous optic neuropathy, it has been shown that cupping can sometimes occur after an episode of optic neuritis (ON). The purpose of this study was to compare cupping in patients after ON from multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and to investigate the relationship between cupping and retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thinning. This was a retrospective cohort involving patients (≥18 years) with ON from 3 institutions. Patients were eligible if they had optical coherence tomography (Cirrus, OCT) performed ≥6 months after a single unilateral ON. The amount of thinning and cupping was estimated from the difference in the OCT parameters between affected and unaffected eyes. Univariable and multivariable regressions were used to investigate the relationship between cupping and ON etiology. Pearson correlation was used to investigate the relationship between cupping and RNFL and GCC. Eighty-six subjects (MS: 35, NMOSD: 26, and MOGAD: 25) were included. There was no significant difference in gender and race between the groups, and most patients (86.1%) were female. Patients with NMOSD were significantly older than patients with MS or MOGAD ( P = 0.002). In the univariate model, cupping was significantly higher in the NMOSD group ( P = 0.017); however, after adjusting for age, GCC, and RNFL of the affected eye, the difference was no longer statistically significant ( P = 0.949). The correlation between cupping asymmetry and RNFL and GCC of the affected eye was inversely strong in patients with MS (R = -0.60 and R = -0.64, respectively), inversely moderate in patients with MOGAD (R = -0.34 and R = -0.40, respectively), and weak in patients with NMOSD (R = -0.03 and R = -0.17, respectively). Our results demonstrated that cupping after ON is correlated with RNFL and GCC thinning; although cupping was overall greater in the NMOSD group, once adjusted for age, RNFL, and GCC, it did not differ among patients with MS, NMOSD, and MOGAD.

Neuromyelitis optica spectrum disorders (NMOSD) are most often characterized by severe involvement of the optic nerves and/or spinal cord in a mono- or multiphasic manner and associated with anti-aquaporin 4 (AQP4) antibody (Ab) positivity. Optical coherence tomography (OCT) showed moderate to severe retinal axonal loss in neuromyelitis optica spectrum disorders (NMOSD) after optic neuritis (ON) episode. Peripapillary retinal nerve fiber layer (RNFL) and macular thinning seem more marked in NMOSD than in multiple sclerosis (MS) and sometimes (8.7–25.6 %) accompanied by a nonspecific macular change: microcystic macular edema (MME). NMOSD patients without ON might present subclinical retinal axonal loss, but it remains a matter of debate and seems clearly to occur in a lower intensity than in MS. The mechanism of this subclinical involvement remains unclear but could be due to anti-AQP4 antibodies and AQP4 expression on astrocytes inside the optic nerve and RNFL and on retinal Muller cells. OCT may help to differentiate NMOSD from MS by rigorous analysis of eyes with multiple sclerosis associated ON (MSON) and without MSON. In NMOSD, correlations between visual disability and OCT parameters are strong, whereas correlations between clinical disability and OCT parameters remain to be discussed. A few brain magnetic resonance imaging (MRI) studies coupled to OCT investigated optic ways imaging and found interesting correlation between retinal axonal loss and brain white and gray matter parameters. OCT is a wonderful tool enabling us to quantify retinal axonal loss in NMOSD. The main limitations of OCT studies in NMOSD are the small size of NMOSD cohort and sometimes a severe residual visual acuity enabling not to perform OCT.

BackgroundQuantitative assessment of optic nerve damage is important in the evaluation of optic neuritis (ON) and multiple sclerosis (MS).ObjectiveTo detect optic nerve damage using optical coherence tomography (OCT) and OCT...

Aims/Background Pediatric acquired demyelinating disorders (ADS) include various monophasic and recurrent inflammatory conditions of the central nervous system (CNS). Optic neuritis (ON) is a demyelinating disease primarily affecting the optic nerve axons due to autoimmune inflammation. To investigate the clinical characteristics, ophthalmic manifestations, laboratory test results, and prognostic indicators of Chinese children and adolescents with ADS. Methods The clinical data of 57 patients with ADS treated in the Beijing Children's Hospital from March 2021 to December 2023, were retrospectively collected and analyzed. The primary outcomes include best-corrected visual acuity (BCVA) at onset, peripapillary retinal nerve fiber layers (RNFL) thickness, serum myelin oligodendrocyte glycoprotein (MOG) antibody level, aquaporin-4 (AQP4) antibody level, and final BCVA after hormone therapy. Results The analyses included 57 children and adolescents in the study, including 38 optic neuritis (ON), 12 neuromyelitis optica spectrum disorder (NMOSD), 5 acute disseminated encephalomyelitis (ADEM), and 2 multiple sclerosis (MS) patients. The median age of patients facing the initial attack of ON was 9 years (3-15 years), with 23 children and adolescents (40.4%) aged eight years or younger, and 37 patients (64.9%) were bilaterally affected. Half of the children and adolescents (15/30) were MOG-Ab seropositive, and 19.4% (6/31) were AQP4-Ab seropositive. Children and adolescents with NMOSD were more likely to have severe visual impairment at acute onset (p < 0.05), with 84.2% of them having low vision acuity (BCVA worse than 0.1), as compared with 64.9% in the ON group. The RNFL thickness of affected eye was thinner than unaffected eyes (median 72.0 μm vs. median 102.0 μm, p < 0.05). Patients with NMOSD exhibited lower RNFL thickness across all measured sectors compared to those with ON. Significant differences were noted in the average RNFL and in each specific region of the retina, including the temporal RNFL, nasal RNFL, nasal superior RNFL, nasal inferior RNFL, temporal superior RNFL, and temporal inferior RNFL (all p < 0.05). After the treatment with intravenous methylprednisolone, both patients with ON (52 eyes; 86.7%) or NMOSD (20 eyes; 90.9%) group had functional visual recovery (BCVA better or equal 0.4). Conclusion This study shows that Chinese children and adolescents with ADS present distinctive clinical features, including earlier onset and more bilateral involvement. Furthermore, NMOSD patients experience more severe visual acuity impairment and thinner peripapillary RNFL. All children and adolescents of ON or NMOSD respond well to methylprednisolone treatment.

To identify the retina-structural and visual-functional alterations in the patients with aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein-associated disease (MOGAD), and multiple sclerosis (MS) patients, all of whom had demyelinating transverse myelitis (TM) without optic neuritis (ON). In this retrospective cross-sectional study, we reviewed the medical records of 97 patients, including 23 with AQP4-ON, 13 with AQP4-TM, 32 with MOG-ON, 3 with MOG-TM, 13 with MS-ON, and 13 with MS-TM. We measured the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell layer-inner plexiform layer (GCIPL) using optical coherence tomography to evaluate structural changes and compared these parameters with those of an age-matched healthy control. Functional outcomes were measured as visual acuity and mean deviation in visual field test. Mean RNFL and GCIPL thicknesses in all of the patients with TM were lower relative to the healthy control, while visual function was well preserved. Among the TM patients, RNFL thickness did not vary significantly among the groups, whereas GCIPL thickness in AQP4-TM and MS-TM was significantly lower than that in MOG-TM. All three TM groups showed significant mean RNFL reduction compared with the healthy control, whereas mean GCIPL thinning was evident only in AQP4-TM and MS-TM, not in MOG-TM. Patients with demyelinating TM incur retina-microstructural damage that varies by specific disease entity. Damage is distinct in AQP4-IgG-positive NMOSD and MS, but it is not so severe as to cause functional damage.

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

Migraine is a common headache disorder with neurovascular involvement. Because eyecare practitioners are likely to encounter people with migraine in their everyday practice, it is important to understand how migraine might impact on ocular health. In this narrative review, we provide an update on the latest ophthalmic imaging evidence for retinal involvement in migraine, derived from studies of retinal structure and retinal vascular perfusion using spectral domain and swept source optical coherence tomography (OCT) and OCT angiography. Combined structural OCT evidence from a recent meta-analysis indicates subtle and non-specific thinning of the peripapillary retinal nerve fibre layer (RNFL) in people with migraine, whereas there is little consistent evidence for structural abnormalities of the macular region. Recent advances in OCT angiography technology have also provided an opportunity to visualise microstructural damage and vascular dysregulation in the eyes of people with migraine. However, given that OCT and OCT angiography studies have been exclusively cross-sectional, it is not possible to demonstrate the causal effect of migraine events. Furthermore, the lack of common methodology (different ophthalmic imaging devices and analysis algorithms), and very limited datasets (small samples, heterogenous migraine groups), lead to an inability to make strong conclusions regarding the nature of altered retinal structure and vascular perfusion in migraine. Nevertheless, we discuss the clinical implications of such observations for eyecare practitioners and provide practical advice for the monitoring and management of patients with a history of migraine.

BackgroundVascular alterations are now recognized as important contributors to the pathophysiology of neuromyelitis optica spectrum disorder (NMOSD). This study aimed to use optical coherence tomography (OCT) and OCT-angiography (OCTA) to assess alterations in the retinal structure and microvasculature in patients with NMOSD, so we can understand pathophysiology of NMOSD, implicating this on disease activity, visual outcome and management on the future.MethodsA case–control study was conducted on 40 NMOSD patients with (NMOSD + ON) and without (NMOSD – ON) history of optic neuritis and 36 healthy subjects. The following data were assessed in NMOSD patients: clinical history, EDSS, and visual function testing. Both groups underwent spectral domain (SD)-OCT and OCTA.ResultsIn this study, NMOSD + ON patients had a statistically significant reduction in all SD-OCT parameters compared to healthy control. Regarding OCTA, there was a significant reduction in radial peripapillary capillary density (RPCD) in NMOSD + ON (P-value < 0.001) and some sectors of NMOSD–ON compared to healthy control. NMOSD + ON patients had significant differences in RPCD compared to those without (P-value < 0.001).ConclusionsHere we show that the advance of this study is that retinal microvascular alterations have been noticed in NMOSD–ON eyes, indicating that subclinical primary retinal vasculopathy and disease activity may occur in NMOSD before onset of ON and retinal atrophy. This may have implications on early detection of disease activity, early interference in management and prognostic tool to visual outcome in following the patients.

Retina and choroid, given their high metabolic demands, are vulnerable to ischemic injury during the hemodynamic instability associated with heart failure (HF). Despite this, posterior segment ocular changes in HF remain understudied. This systematic review and meta-analysis consolidates optical coherence tomography (OCT) and OCT angiography (OCT-A) findings in HF. We conducted a comprehensive search of Web of Science, PubMed/MEDLINE, and EMBASE on March 15, 2025. A random-effects meta-analysis of six studies was performed using Hedges' g to estimate effect sizes, with six additional studies included for qualitative synthesis (total n = 1139 eyes). The meta-analysis was limited to studies on heart failure with reduced ejection fraction (HFrEF), as this was the only heart failure subtype with sufficient data for quantitative analysis. Key findings revealed significant reductions in parafoveal superficial capillary plexus vessel density (SCP VD) (Hedges' g = -0.42, 95%CI -0.78 to -0.05, p = 0.03) and subfoveal choroidal thickness (Hedges' g = -0.75, 95%CI -1.31 to -0.18, p = 0.01) in patients with HFrEF. Furthermore, severity-dependent thinning of retinal nerve fiber layer and significant correlations between whole macular vessel density and both left ventricular EF and New York Heart Association functional class emphasize the potential of these parameters in stratifying disease severity. Additionally, one study revealed thinning of ganglion cell-inner plexiform layer in patients with HF with preserved ejection fraction (HFpEF). Those with acute decompensated HF showed macular VD attenuation in superficial layers and decreased subfoveal choroidal thickness. Pediatric cases demonstrated central macular thinning, selective decreases in SCP VD, and choroidal thinning. Collectively, OCT and OCT-A metrics provide useful information regarding systemic microvascular dysfunction, suggesting potential for disease detection and improved risk stratification. However, it is important to note that these findings are based on observational studies, which limits the ability to draw definitive causal conclusions. This highlights the need for prospective, longitudinal research to establish temporal relationships and validate these observations.

This study aimed to compare findings of optical coherence tomography (OCT) angiography (OCTA) between eyes with nearly recovered and partially recovered outer retina after full-thickness macular hole (FTMH) surgery and to identify OCTA findings associated with visual acuity. We retrospectively reviewed 30 patients who underwent surgery for idiopathic FTMH. Swept-source OCT (SS-OCT) and OCTA were performed preoperatively and at three and six months postoperatively. Subgroups were divided according to the integrity of the external limiting membranes and ellipsoid zones postoperatively. Correlations of best-corrected visual acuity six months postoperatively with SS-OCT and OCTA measurements were analyzed. There was no difference in preoperative retinal or choroidal vascular index on OCTA between the nearly and partially recovered groups. Six months postoperatively, the choriocapillaris flow-void area was significantly higher in the partially recovered group than in the fellow eye. The nearly recovered group showed better choroidal vascular flow, and vision at six months postoperatively correlated with the ratio of the operated eye’s choriocapillaris flow-void area to the fellow eye. Sufficient choriocapillaris flow on OCTA is associated with better outer retinal recovery and visual outcomes after macular hole surgery.

Glaucoma Progression Detection Time Using OCT and OCTA in African and European Descendants.