Institute of Ophthalmology

Author Of 1 Presentation

Neuro-Ophthalmology Poster Presentation

P0772 - The optic nerve as a 5th location for dissemination in space for multiple sclerosis criteria: a role for optical coherence tomography (ID 410)

Speakers
Presentation Number
P0772
Presentation Topic
Neuro-Ophthalmology

Abstract

Background

The diagnosis of multiple sclerosis (MS) is based on a combination of clinical and para-clinical tests to demonstrate dissemination in time and space. The potential of optical coherence tomography (OCT) to demonstrate optic nerve involvement as a 5th location for dissemination in space has been recognised.

Objectives

To test the feasibility of OCT measures of retinal asymmetry as a diagnostic test for MS at the community level. To test for a broad range of comorbidities typically present in a general population. To carefully evaluate ophthalmological co-morbidities and test the relevance of intraocular pressures and refraction.

Methods

Community based study (72,120 subjects). Calculation of the inter-eye difference of inner retinal OCT data for MS using the UK Biobank data. The inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD) were calculated for the macular retinal nerve fibre layer (mRNFL), ganglion-cell inner plexiform layer complex (mGCIPL) and ganglion cell complex (mGCC). Area under the receiver operating characteristic curve (AUC) comparisons were followed by univariate and multivariable comparisons accounting for a large range of diseases and comorbidities. Cutoff levels were optimized by ROC and the Youden index.

Results

The prevalence of MS was 0.002 (95%CI 0.0013-0.0031). Overall the discriminatory power of diagnosing MS with the IEPD (AUC 0.71, 95%CI 0.67-0.76) and IEAD (0.71, 95%CI 0.67-0.75) for the mGCIPL were significantly higher if compared to the mGCC (IEPD AUC 0.64, 95%CI 0.59-0.69, p=0.0017; IEAD AUC 0.63, 95%CI 0.58-0.68, p<0.0001) and mRNFL (IEPD AUC 0.59, 95%CI 0.54-0.63, p<0.0001; IEAD AUC 0.55, 95%CI 0.50-0.59, p<0.0001). Screening sensitivity levels for the mGCIPL IEPD (4% cut-off) were 51.7% and for the IEAD (4 μm cut-off) 43.5%. Specificity levels were 82.8% and 86.8%. The number of co-morbidities was important. There was a stepwise decrease of the AUC from 0.72 in control subjects to 0.66 in more than nine co-morbidities or presence of neuromyelitis optica spectrum disease. In the multivariable analyses greater age, diabetes mellitus and a non-white ethnic background were relevant confounders. For most interactions the effect sizes were large (partial omega square > 0.14) with very narrow CIs.

Conclusions

The OCT GCIPL IEPD and IEAD may be considered as a supportive diagnostic test for MS diagnostic criteria in a young person without relevant co-morbidity. Importantly, previously discussed comorbidities such as need for refraction (> +/-5dpt) were not relevant.

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