Association of Retinal Nerve Fiber Layer Thickness With Disease ...

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Journal of Neurological Sciences [Turkish] 30:(4)# 38; 702-710, 2013 http://www.jns.dergisi.org/text.php3?id=718. Research Article. Association of Retinal Nerve ...
J.Neurol.Sci.[Turk]

Journal of Neurological Sciences [Turkish] 30:(4)# 38; 702-710, 2013 http://www.jns.dergisi.org/text.php3?id=718 Research Article Association of Retinal Nerve Fiber Layer Thickness With Disease Disability, Disease Duration, SF-36, and PASAT Scores in Multiple Sclerosis Mehmet GENCER1, İsmail DELİPOYRAZ1, Bülent BUTTANRI2, Recai TÜRKOĞLU1, Yılmaz ÇETİNKAYA1, Hülya TİRELİ1 1

Haydarpasa Numune Training and Research Hospital, Department of Neurology, İstanbul, Türkiye 2Haydarpasa Numune Training and Research Hospital, Department of Ophtalmology, İstanbul, Türkiye

Summary Objective: We aimed to establish the thickness of retinal nerve fiber layer (RNFL) in multiple sclerosis (MS) patients and correlate it with disease disability, disease duration, physical and cognitive impairment. Methods: We studied 71 consecutive patients (142 eyes) with MS and proportionally matched 30 healthy controls (60 eyes). The thickness of RNFL was measured in both eyes by optical coherence tomography (OCT). Disease duration, Expanded Disability Status Scale (EDSS), Short Form-36 (SF-36), and Paced Auditory Serial Addition Test (PASAT) tests were examined in all patients. We investigated the correlations between RNFL and these parameters. Results: The average RNFL in MS patients was significantly lower compared with healthy controls (p:0.0001). We found no differences in the RNFL thickness between eyes with and without optic neuritis (p:0.448). The RNFL were significantly thinner in patients with EDSS ≥5.5 compared with group EDSS 0-2.5 (p:0.006). The RNFL thickness was significantly reduced with increasing of the disease duration (p:0.0001). The RNFL atrophy was significantly correlated with PASAT scores (p:0.0001). There was a low positive correlation between RNFL thickness and physical functioning as a parameter of SF-36 (p:0.031). Conclusion: We concluded that RNFL thinning is associated with disease duration and severity, and physical and cognitive impairment. Key words: Multiple sclerosis; retinal nerve fiber layer, optical coherence tomography, Expanded Disability Status Scale (EDSS), Short Form-36 (SF-36), Paced Auditory Serial Addition Test (PASAT) Multipl Skleroz'da Retinal Sinir Lif Kalınlığının Hastalık Dizabilitesi, Hastalık Süresi, SF-36 ve PASAT Skorları İle İlişkisi Özet Amaç: Multipl skleroz (MS) olgularında retinal sinir lif kalınlığının (RSLK) hastalık dizabilitesi, süresi, fiziksel ve kognitif kayıp ile ilişkisinin araştırılması hedeflenmiştir. Metod: Çalışmada 71 ardışık MS hastası (142 göz) ve hasta grubu ile uyumlu 30 sağlıklı kontrol grubu (60 göz) incelenmiştir. Her iki gözün RSLK, optik koherens tomografi (OKT) cihazı ile ölçülmüştür. Tüm olgularda hastalık süresi, genişletilmiş özürlülük puan durumu (EDSS) kaydedilmiş, Short Form-36 (SF-36) ve Paced Auditory Serial Addition Test (PASAT) testleri yapılmıştır. Bu parametreler ile RSLK arasında bir ilişki bulunup bulunmadığı araştırılmıştır.

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Bulgular: Hasta grubunun ortalama RSLK değerleri sağlıklı kontrol grubuna kıyasla anlamlı düşük bulunmuştur (p:0.0001). Optik nöritli gözlerin RSLK ile optik nörit geçirmemiş gözlerin RSLK karşılaştırıldığında anlamlı bir fark bulunmamıştır (p:0.448). EDSS ≥5.5 olan grubun RSLK, EDSS 0-2.5 grubuna göre ince bulunmuştur (p:0.006). Hastalık süresi uzadıkça RSLK'da incelme olduğu gözlenmiştir. (p:0.0001). RSLK'daki atrofi ile PASAT skorları arasında anlamlı bir pozitif korelasyon saptanmıştır (p:0.0001). Yine RSLK ile SF-36 alt ölçeklerinden fiziksel işlevsellik arasında düşük de olsa bir pozitif korelasyon saptanmıştır (p:0.031). Sonuç: RSLK'daki incelme, hastalık süresi uzun ve dizabilitesi fazla, fiziksel ve kognitif kaybı daha fazla olan hastalarda daha belirgindir. Anahtar Kelimeler: Multipl skleroz, retinal sinir lif kalınlığı, optik koherens tomografi, genişletilmiş özürlülük puan durumu (EDSS), Short Form-36 (SF-36), Paced Auditory Serial Addition Test (PASAT) by Expanded Disability Status Scale (EDSS)(16). Patients were classified to three groups for EDSS: 0-2.5 (mild disability), 3.0-5.0 (moderate disability), and ≥5.5 (severe disability). Disease duration in this study was defined as time from establishment of MS diagnosis to enrolment in the trial. Patients were classified to three groups for disease duration: 0-3 years (short disease duration), 4-9 years (medium disease duration), and ≥10 years (long disease duration). The quality of life and health status were evaluated according to ShortForm Health Survey (SF-36) scale, supplemented by eight subgroups ( physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health)(8). The PASAT, as a part of the Multiple Sclerosis Functional Composite,was used as a sole measure of cognition in MS patients. This consists of difficult serial addition of numbers, and it ultimately assesses information-processing speed and/or working memory(10). The thickness of RNFL was measured in both eyes by optical coherence tomography (OCT) in MS patients, and healthy controls. Disease duration, EDSS, SF-36, and PASAT tests were examined in all patients. We investigated the correlations between RNFL and these parameters.

INTRODUCTION Axonal loss is the most important pathological factor that contributes to permanent disability in multiple sclerosis (MS)(6). For assessment of axonal loss in MS patients several MRI techniques, such as T1 lesion load(31), atrophy measures, and brain parenchymal fraction(17), have been applied. These techniques require advanced technology, time consumption and cost. The measurement of retinal nerve fiber layer (RNFL) by optical coherence tomography (OCT) has been proposed as a way to verify axonal loss(26). OCT is a noninvasive technique that allows the quantitative cross-sectional imaging of the RNFL(13). In this study, we aimed to establish the thickness of RNFL in MS patients and correlate it with disease disability, disease duration, physical and cognitive impairment. MATERIAL AND METHODS We studied 71 patients (142 eyes) with MS (49 patients with relapsing-remitting MS, 6 patients with relapsing progressive MS, 16 patients with secondary progressive MS) and proportionally matched 30 controls (60 eyes). All patients fulfilled the revised McDonald criteria(21). Age and sexmatched healthy control subjects (HC), with no history of neurological and ocular disease were included in the study as a control group. The degree of neurologic impairment in MS patients were evaluated

The study protocol was approved by the local research ethics committee, and

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written informed consent was obtained in all cases, according to the Declaration of Helsinki.

p:0.0001 for vitality; p:0.0001 for social functioning; p:0.0001 for role-emotional; p:0.003 for mental health).

Statistical analyses were performed with Number Cruncher Statistical System 2007 Statistical Software (Utah, USA) package. Single-track variance analysis for comparison between the groups, Tukey multiple comparison test for comparison of subgroups, t-test for comparison of two groups, chi square test for comparison of non-parametric data, Pearson correlation test to determine the relation between the variable data were used for the comparisons. The statistical significance limit was accepted as p