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Evaluating Retinal Abnormalities in Patients With Multiple Sclerosis

Aziz A. Khanifar, MD; George J. Parlitsis, BS; Susan A. Gauthier, DO, MPH; Szilárd Kiss, MD
Arch Neurol. 2010;67(8):1035-1036. doi:10.1001/archneurol.2010.180.
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We read the article by Burkholder et al with interest.1 The study describes a potentially new biomarker, macular volume, in addition to retinal nerve fiber layer thickness to follow up patients with multiple sclerosis (MS) using optical coherence tomography (OCT).2 We offer a few comments regarding their conclusions.

The authors observe a decreased correlation between peripapillary retinal nerve fiber layer thinning and inner macular volume in eyes without optic neuritis (0.50 vs those with optic neuritis, 0.61) and hypothesize an “alternative mechanism for neuronal cell loss” in MS.1 However, their study used time-domain OCT (TD-OCT), specifically, Stratus OCT (Zeiss Meditec, Dublin, California), not spectral-domain OCT (SD-OCT). The difference is not trivial; 400 vs 20 000-40 000 A-scans per second, 10 μm vs 5 μm axial resolution, and 6 radial scans vs 145 horizontal scans are used to calculate macular volume for TD-OCT vs SD-OCT, respectively. It is possible that patients with MS with subclinical eye disease (nonoptic neuritis) display neuronal loss that is imperceptible to TD-OCT, accounting for the observed diminished correlation between retinal nerve fiber layer and inner macular volume in these patients.

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