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Optical coherence tomography angiography enhances the detection of optic nerve damage in multiple sclerosis
  1. Rebecca I Spain1,2,
  2. Liang Liu3,
  3. Xinbo Zhang3,
  4. Yali Jia3,
  5. Ou Tan3,
  6. Dennis Bourdette1,2,
  7. David Huang3
  1. 1 VA Portland Health Care System, Portland, Oregon, USA
  2. 2 Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
  3. 3 Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr David Huang, Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland 97239-4146, Oregon, USA; huangd{at}


Background Quantitative assessment of optic nerve damage is important in the evaluation of optic neuritis (ON) and multiple sclerosis (MS).

Objective To detect optic nerve damage using optical coherence tomography (OCT) and OCT angiography in MS.

Methods Peripapillary retinal nerve fibre layer (NFL) thickness, macular ganglion cell complex (GCC) thickness and Optic Nerve Head Flow Index (ONH-FI) were measured. The ONH-FI was defined as flow signal averaged over the optic disc. Diagnostic accuracy was evaluated by the area under the receiver-operating characteristics curve (AROC).

Results Sixty-eight eyes of 45 MS participants and 55 eyes of 32 healthy controls (HCs) were analysed. Of MS eyes, 25 had a history of ON (MS+ON) and 43 didn’t (MS−ON). MS−ON and MS+ON eyes had reductions in ONH-FI (p=0.031 and p=0.001, respectively), GCC thickness (p=0.245 and p<0.001, respectively), and NFL thickness (p=0.003 and p=0.024, respectively), compared with HCs. The highest AROC (0.940) was achieved by the logistic regression combination of all three variables, which was significantly higher than other variables (p=0.018).

Conclusion MS produces both retinal structural loss and decreased ONH perfusion in MS eyes with and without history of ON. The combination of perfusion and structural measurements enhances detection of optic nerve damage in MS. OCT angiography may be a useful additional retinal marker in evaluation of ON in MS.

  • multiple sclerosis
  • optic neuritis
  • retina
  • optical coherence tomography
  • OCT angiography

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  • Contributors RIS, LL, DB and DH: conception, design, analysis and interpretation of data. RIS, LL, DH: drafting the article. XZ, YJ and OT; revising it critically for important intellectual content. DB, RIS and DH: final approval of the version to be published. All authors read and approved the final manuscript

  • Funding This study was supported by the following NIH grants: UL1TR000128, UL1 RR024140, R01-EY013516, R01-EY023285, DP3 DK104397 and P30 EY010572 (Bethesda, MD). Additional support includes a grant from the Medical Research Foundation of Oregon (GNEUR0728A) and a Career Development Award from the Department of Veterans Affairs (B7493-W, Rebecca Spain). Supported by unrestricted departmental funding from Research to Prevent Blindness (New York, USA). Oregon Health & Science University (OHSU) foundation, NSFC (Grant No. 61471226) and the Champalimaud Foundation (Lisbon, Portugal).

  • Competing interests RIS, LL, XZ and DB have nothing to disclose. Oregon Health & Science University (OHSU) and DH, YJ and OT have a significant financial interest in Optovue, a company that may have a commercial interest in the results of this research and technology. These potential conflicts of interest have been reviewed and managed by OHSU.

  • Ethics approval OHSU IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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