research paper presentation

1. OCT in Multiple Sclerosis:
a Structural & Functional
Analysis.
Manal Al-Romeih, MSc

2. Aim:
To test the possibility of using OCT as a
biological marker for central nervous system
degenerative process in multiple sclerosis.

3. Multiple sclerosis:
A neuro-degenrative disease
Mylin sheath defect
Affects stability and speed of nerve
impulse conductivity
Ophthalmological
manifestation
Systemic
manifestation

4. Link between Oct & MS:
Unmylinated retinal fibers
Neural generation and
protection
Axonal
damage

5. MS/ ON
22 patients
41 eyes
MS/ NO-ON
19 patients
38 eyes
36 subjects
72 eyes
Normal Control
151 eyes
77 subjects
Subjects:
Ophthalmologic disorders.
Neurologic disorders.
Systemic diseases.
Refractive error ≥±6 DS.

6. Materials & Methods:
EDSS: a method of
quantifying disability
in MS based on eight
Functional Systems (FS)

7. OCT scans
RNFL GCC

8. Results:
MS/ NO-ON MS/ ON P value
Visual acuity, mean ± SD 0.92±0.17 0.9± 0.2 0.83
Contrast Sensitivity, mean ±
SD (48) 32.7±4.9 30.6±6.6 0.11
Low contrast, mean ± SD (25) 15.2±6.5 14.2±5.4 0.45
Color vision (affected) 6 (1:3) 7 (1:3) 1.0
Color confusion index (CCI) 1.1±0.31 1.1± 0.2 0.55
Disease duration (months),
mean 60.2 76.6 0.36
EDSS, mean ± SD 1±1.7 1±1.9 0.81

9. 102.5±6.7 92.4±12.8
Results, cont., :
R N F L /N C R N F L /M S
0
5 0
1 0 0
1 5 0
G C C /N C G C C /M S
0
5 0
1 0 0
1 5 0
ANOVA p= 0.001
ANOVA p<0.0001
Comparison between the groups in OCT
parameters
102.5±6.7 92.4±12.8
90.5±6.8 85.5±9.5
Unpaired t,
p<0.001
Unpaired t,
p= 0.0004

10. Correlations
OCT & VA
OCT & CS
OCT & CCI
Results, cont., :
r= 0.46
p= 0.002r= 0.14
p= 0.38
r= 0.62
p< 0.0001
r= 0.61
p< 0.0001

11. * MS induced other ocular affections 47.6%
* Visual field:
50% of the MS/ON
50% had VF defects
33.3% of the MS/ NO-ON
MS/ONMS/NO-ON
3.32.7Mean PSD
r= 0.4, p= 0.16r= -0.57, p= 0.004Correlation of RNFL
to PSD
r= 0.17, p= 0.55r= -0.68, p= 0.0004Correlation of GCC
to PSD
Results, cont., :

12. VEP
VEP:
* No significant relation to visual functions, EDSS.
*
*Sensitivity of VEP 92%
Sensitivity of OCT 81%
Results, cont., :
GCC vs Lat. r=-0.213, p=0.381

13. Results, cont., :
EDSS
EDSS
(MS/NO-ON)
EDSS
(MS/ON)
RNFL r= -0.28, p= 0.09 r=-0.44, p=0.004
GCC r= -0.313, p= 0.06 r= -0.06, p= 0.7
FLV r= 0.52, p=0.001 r= 0.38, p=0.014
GLV r=0.44, p=0.006 r= 0.23, p=0.14

14. Discussion
OCT
VEP
White &
grey matter
atrophy
Subclinical
atrophy
Visual
functions
EDSS

15. Discussion, cont.,
Henderson, 2008
Saidha, 2011
Villoslada,2011
Laron,2010
Montero, 2004
Parisie, 1999
Gundogan, 2007
Naismith, 2009
Fatehi, 2012
VA
CV
VEPVF

16. Conclusion:
 Due to its high sensitivity and correlation to visual
functions; OCT- and RNFL in particular- is a very valuable
diagnostic tool in multiple sclerosis.
 It can be used to:
quantify the degree of neuro-degeneration:
- In clinical trials
- In the follow up of the MS patients.
- To assess the success of the treatment.
 The eye can serve as a window to what is happening in
the central nervous system.

17. Reference:
• Fatehi, Farzad, Shaygannejad, Vahid, Mehr, Lida Kiani, Dehghani, Alireza. Optical coherence tomography
versus visual evoked potential in multiple sclerosis patients. Ir J neurol 2012; 11(1): 12- 15.
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New Biomarker Candidate in Multiple Sclerosis?—A Structural and Functional Evaluation. Invest
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18. Acknowledgment:
 Dr. Samah Fawzi, MD
Assistant professor, KSU, CAMS, Optometry.
 Prof. Abdulkader Daif, MD
Head of neurology department, KKUH.
 Prof. Hani Al-Mezaine, MD
Head of ophthalmology department, KKUH.
 Prof. Ahmad Bahammam, MD
Head of institutional Review Board (IRB), KKUH.
 All the staff of Multiple sclerosis clinic & ophthalmology
department in KKUH.

19. Thank You!