Optimal Intereye Difference Thresholds in Retinal Nerve Fiber Layer Thickness for Predicting a Unilateral Optic Nerve Lesion in Multiple Sclerosis.
Optimal Intereye Difference Thresholds in Retinal Nerve Fiber Layer Thickness for Predicting a Unilateral Optic Nerve Lesion in Multiple Sclerosis.
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DOI：
10.1097/wno.0000000000000629
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发表时间：
2018-12
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影响因子：
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通讯作者：
Balcer LJ
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作者：
Nolan RC;Galetta SL;Frohman TC;Frohman EM;Calabresi PA;Castrillo-Viguera C;Cadavid D;Balcer LJ
视神经是多发性硬化症（MS）的常见受累部位。光学相干断层扫描（OCT）检测MS患者和符合临床或影像学分离脱髓鞘综合征标准的患者眼中视网膜神经纤维层（RNFL）变薄。尽管在早期多发性硬化症和临床孤立综合征（CIS）患者中，急性视神经炎（ON）或隐匿性视神经病变的发病率很高，但目前的国际多发性硬化症诊断标准并未将视神经作为影像学病变部位；大多数多发性硬化症患者在发病过程中也是如此。我们试图确定最能预测单侧视神经病变的乳头周围RNFL厚度的眼间差异的最佳阈值。作为一项正在进行的视觉结果合作研究的一部分，我们在一个中心分析了31名健康志愿者和124名MS患者的光谱域（SD-） OCT数据。计算乳头周围（360°）RNFL厚度的眼间差值作为差值的绝对值。首先，我们确定了健康志愿者眼间差的第95百分位值。该值应用于MS患者的方便样本组，作为验证队列，确定该阈值如何区分有单侧ON病史的患者和没有单侧ON病史的患者。我们还研究了乳头周围RNFL厚度的眼间差异与双眼低对比字母视力（LCLA）评分的关系。在健康的志愿者参与者（n=31）中，眼间差的第95百分位值（正常对照组的预期上限）为6.0微米。该值适用于方便样本组MS患者（n=124，验证队列）。采用2×2表分析，应用卡方检验计算6微米阈值对MS患者单侧ON病史的阳性预测值、阴性预测值、敏感性和特异性（P<0.0001）。6微米阈值预测双眼低对比视力评分较差，分别为2.5% （P=0.03）和1.25%（线性回归分析P=0.002）。受试者工作特征（ROC）曲线分析显示，识别多发性硬化症队列中单侧ON的最佳眼间差阈值为5微米。RNFL厚度的眼间差异5-6微米是识别MS中单侧视神经病变存在的强有力的结构阈值。
The optic nerve is a frequent site for involvement in multiple sclerosis (MS). Optical coherence tomography (OCT) detects thinning of the retinal nerve fiber layer (RNFL) in eyes of patients with MS and those meeting criteria for clinically- or radiologically-isolated demyelinating syndromes. Current international diagnostic criteria for MS do not include the optic nerve as an imaging lesion site despite the high prevalence of acute optic neuritis (ON), or occult optic neuropathy, among early MS and clinically isolated syndrome (CIS) patients;as well as most MS patients over the course of the disease. We sought to determine optimal thresholds for inter-eye difference in peripapillary RNFL thickness that are most predictive of a unilateral optic nerve lesion. We analyzed Spectral-domain (SD-) OCT data for 31 healthy volunteers and 124 patients with MS at a single center as part of an ongoing collaborative investigation of visual outcomes. Inter-eye differences in peripapillary (360°) RNFL thickness were calculated as the absolute value of the difference. First, we determined the 95th percentile value of inter-eye difference for the healthy volunteers. This value was applied to the convenience sample group of MS patients as a validation cohort determining how well this threshold could distinguish patients with vs. without a history of unilateral ON. The relation of inter-eye differences in peripapillary RNFL thickness to binocular low-contrast letter acuity (LCLA) scores was also examined. Among healthy volunteer participants (n=31), the 95th percentile value for inter-eye difference (upper boundary of expected for normal controls) was 6.0 microns. This value was applied to the convenience sample group of MS patients (n=124, validation cohort). Positive predictive value, negative predictive value, sensitivity and specificity for identifying MS patients with a history of unilateral ON were calculated for the 6-micron threshold value in a 2×2 table analysis with the application of chi-square tests (P<0.0001). The 6-micron threshold was predictive of worse binocular low-contrast acuity scores at 2.5% (P=0.03) and 1.25% (P=0.002 by linear regression analyses). A receiver operating characteristic (ROC) curve analysis demonstrated an optimal inter-eye difference threshold of 5 microns for identifying unilateral ON in the MS cohort. An inter-eye difference of 5–6 microns in RNFL thickness is a robust structural threshold for identifying the presence of a unilateral optic nerve lesion in MS.