Functional-structural correlations in the afferent visual pathway in pediatric demyelination

E Ann Yeh; Ruth Ann Marrie; Y Arun Reginald; J Raymond Buncic; Austin E Noguera; Julia O'Mahony; Jean K Mah; Brenda Banwell; Fiona Costello; Canadian Pediatric Demyelinating Disease Network

doi:10.1212/WNL.0000000000001046

Functional-structural correlations in the afferent visual pathway in pediatric demyelination

Neurology. 2014 Dec 2;83(23):2147-52. doi: 10.1212/WNL.0000000000001046. Epub 2014 Oct 31.

Authors

E Ann Yeh¹, Ruth Ann Marrie², Y Arun Reginald², J Raymond Buncic², Austin E Noguera², Julia O'Mahony², Jean K Mah², Brenda Banwell², Fiona Costello²; Canadian Pediatric Demyelinating Disease Network

Affiliations

¹ From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada. ann.yeh@sickkids.ca.
² From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.

Abstract

Objective: We evaluated the relationship of optical coherence tomography (OCT)-measured ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness to other functional measures of afferent visual pathway competence including high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA), visual field sensitivity, and color vision perception in a pediatric population with demyelinating disorders.

Methods: This was a cross-sectional evaluation of 37 children, aged 8-18 years, with pediatric demyelinating disorders (n = 74 eyes), and 18 healthy controls (n = 36 eyes), who were recruited from the University of Toronto, Hospital for Sick Children and the University of Calgary, Alberta Children's Hospital, Canada. A standardized visual battery, including spectral-domain OCT, visual fields, LCVA, and HCVA, was performed in all subjects.

Results: Mean RNFL thickness was 26 µm (25.6%) lower in patients with demyelination (76.2 μm [3.7]) compared to controls (102.4 μm [2.1]) (p < 0.0001). Mean GCL thickness was 20% lower in patients as compared to controls (p < 0.0001). Mean GCL and RNFL thickness were strongly correlated (r = 0.89; p < 0.0001), yet in contrast to RNFL thickness, no differences in GCL thickness were noted between optic neuritis (ON) eyes and non-ON eyes of patients. HCVA and LCVA and visual field mean deviation scores decreased linearly with lower RNFL thickness.

Conclusion: GCL thickness was decreased in patients regardless of history of ON. The retina may be a site of primary neuronal injury in pediatric demyelination.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Cross-Sectional Studies
Demyelinating Diseases / diagnosis
Demyelinating Diseases / pathology*
Female
Humans
Male
Nerve Fibers / pathology*
Optic Neuritis / diagnosis
Optic Neuritis / pathology*
Retinal Ganglion Cells / pathology
Tomography, Optical Coherence / methods
Visual Fields / physiology
Visual Pathways / pathology*