1. Articles from laura j. balcer

    1-24 of 33 1 2 »
    1. Optimal intereye difference thresholds by optical coherence tomography in multiple sclerosis: An international study

      Optimal intereye difference thresholds by optical coherence tomography in multiple sclerosis: An international study

      Objective To determine the optimal thresholds for intereye differences in retinal nerve fiber and ganglion cell + inner plexiform layer thicknesses for identifying unilateral optic nerve lesions in multiple sclerosis. Current international diagnostic criteria for multiple sclerosis do not include the optic nerve as a lesion site despite frequent involvement. Optical coherence tomography detects retinal thinning associated with optic nerve lesions. Methods In this multicenter international study at 11 sites, optical coherence tomography was measured for patients and healthy controls as part of the International Multiple Sclerosis Visual System Consortium. High‐ and low‐contrast acuity were also collected in a subset ...

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    2. Optimal Inter‐Eye Difference Thresholds by OCT in MS: An International Study

      Optimal Inter‐Eye Difference Thresholds by OCT in MS: An International Study

      Objective To determine the optimal thresholds for inter‐eye differences in retinal nerve fiber and ganglion cell+inner plexiform layer thicknesses for identifying unilateral optic nerve lesions in multiple sclerosis. Background Current international diagnostic criteria for multiple sclerosis do not include the optic nerve as a lesion site despite frequent involvement. Optical coherence tomography detects retinal thinning associated with optic nerve lesions. Methods In this multi‐center international study at 11 sites, optical coherence tomography was measured for patients and healthy controls as part of the International Multiple Sclerosis Visual System Consortium. High‐ and low‐contrast acuity were also collected ...

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    3. The International Multiple Sclerosis Visual System Consortium: Advancing Visual System Research in Multiple Sclerosis

      The International Multiple Sclerosis Visual System Consortium: Advancing Visual System Research in Multiple Sclerosis

      Background: The International Multiple Sclerosis Visual System Consortium (IMSVISUAL) was formed in November 2014 with the primary goal of improving research, care, and education regarding the role of the visual system in multiple sclerosis (MS) and related disorders. Methods: In this review, we describe the formation, goals, activities, and structure of IMSVISUAL, as well as the relationship of IMSVISUAL with the Americas Committee for Treatment and Research in MS (ACTRIMS). Finally, we provide an overview of the work IMSVISUAL has completed to date, as well as an outline of research projects ongoing under the auspices of IMSVISUAL. Results: IMSVISUAL has ...

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    4. Evolution of Visual Outcomes in Clinical Trials for Multiple Sclerosis Disease-Modifying Therapies

      Evolution of Visual Outcomes in Clinical Trials for Multiple Sclerosis Disease-Modifying Therapies

      rom the Section Editor: In March 2018, the Journal of Neuro-Ophthalmology (JNO) launched its inaugural “Disease of the Year” section, featuring multiple sclerosis (MS). Beginning from a “Bench” perspective, Meltzner and colleagues presented an elegant overview of the pathogenic mechanisms believed to underpin central nervous system (CNS) injury in MS. To complement these efforts, Backner and Levin highlighted how the afferent visual pathway, as a putative model of CNS inflammation, can be interrogated with measures of structure and function to capture clinical and sub-clinical evidence disease activity in MS patients. Building on these concepts in this issue of the JNO ...

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    5. Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study

      Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study

      Background Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fibre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available. Methods In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis, and progressive multiple sclerosis. Patients were recruited from centres in Spain, Italy, France, Germany ...

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    6. Optical coherence tomography in an optic tract lesion, Retinal nerve fiber layer changes

      Optical coherence tomography in an optic tract lesion, Retinal nerve fiber layer changes

      A 49-year-old woman, status post temporal lobe resection, reported a hemianopia. Examination revealed a right afferent pupillary defect, horizontal bow-tie atrophy OD (temporal and nasal), and temporal atrophy OS. Optical coherence tomography showed a bow-tie pattern OD and predominant superior and inferior nerve fiber layer loss OS (figure 1; figure e-1 at Neurology.org ). The pattern OD is due to the combination of papillomacular bundle and nasal RNFL loss. The pattern OS is due to nerve fiber layer loss temporal to the fovea and, coupled with papillomacular bundle loss, produces temporal pallor. 1 MRI confirmed left optic tract atrophy (figure ...

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    7. Optical Coherence Tomography in Neurologic Disease (Textbook)

      Optical Coherence Tomography in Neurologic Disease (Textbook)

      Shortly after the invention of the first two-dimensional optical coherence tomography (OCT) scans by James Fujimoto and colleagues at the Massachusetts Institute of Technology in 1991, ophthalmologists recognized the extraordinary potential for OCT to facilitate quantitative assessment of the neuroretina. OCT rapidly became a commonplace tool in ophthalmologic practice to identify both inflammatory and degenerative conditions affecting the optic nerve and retina. The utility of OCT to detect and quantify sequelae of optic neuropathies, including glaucoma and those associated with primary neurological diseases , was soon brought to the forefront. Rapid advances in the technology have followed and have included faster ...

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    8. Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study

      Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study

      Background Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fibre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available. Methods In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis, and progressive multiple sclerosis. Patients were recruited from centres in Spain, Italy, France, Germany ...

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    9. Utility of optical coherence tomography in the evaluation of monocular visual loss related to retinal ischemia

      Utility of optical coherence tomography in the evaluation of monocular visual loss related to retinal ischemia

      We report four patients with monocular visual loss for whom optical coherence tomography (OCT) was helpful in distinguishing the sequelae of retinal artery occlusion from those of primary optic neuropathy. Determinations of the peripapillary retinal nerve fiber layer (RNFL) thickness as well as macular retinal layer thicknesses and architecture were used. The major findings in our patients show that changes in the inner retinal layers (including ganglion cell and inner plexiform layer) with disruption of normal macular architecture supports a diagnosis of retinal artery occlusion. Our results support the use of OCT imaging for patients with monocular visual loss of ...

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      Mentions: Laura J. Balcer
    10. Optical Coherence Tomography for the Neurologist

      Optical Coherence Tomography for the Neurologist

      Optical coherence tomography (OCT) is a relatively new technology that is now routinely and very widely used by ophthalmologists for structural documentation of the optic nerve and retina. In neuro-ophthalmology and neurology, the value of OCT is ever expanding; its role in an increasing number of conditions is being reported in parallel with the advances of the technology. Currently, as a clinical tool, OCT is particularly useful for the structural measurement of peripapillary retinal nerve fiber layer thickness, optic nerve head volumetric analysis, and macular anatomy. Optic neuropathies of varied etiology (particularly from multiple sclerosis) may be the most common ...

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      Mentions: Laura J. Balcer
    11. Optical coherence tomography reflects brain atrophy in multiple sclerosis: A four-year study

      Optical coherence tomography reflects brain atrophy in multiple sclerosis: A four-year study

      Objective The aim of this work was to determine whether atrophy of specific retinal layers and brain substructures are associated over time, in order to further validate the utility of optical coherence tomography (OCT) as an indicator of neuronal tissue damage in patients with multiple sclerosis (MS). Methods Cirrus high-definition OCT (including automated macular segmentation) was performed in 107 MS patients biannually (median follow-up: 46 months). Three-Tesla magnetic resonance imaging brain scans (including brain-substructure volumetrics) were performed annually. Individual-specific rates of change in retinal and brain measures (estimated with linear regression) were correlated, adjusting for age, sex, disease duration, and ...

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    12. Optical coherence tomography reflects brain atrophy in MS: A four year study

      Optical coherence tomography reflects brain atrophy in MS: A four year study

      Objective : To determine whether atrophy of specific retinal layers and brain substructures are associated over time, in order to further validate the utility of optical coherence tomography (OCT) as an indicator of neuronal tissue damage in patients with multiple sclerosis (MS). Methods : Cirrus high definition OCT (including automated macular segmentation) was performed in 107 MS patients biannually (median follow-up: 46-months). Three-tesla magnetic resonance imaging brain scans (including brain-substructure volumetrics) were performed annually. Individual-specific rates of change in retinal and brain measures (estimated with linear regression) were correlated, adjusting for age, sex, disease duration, and optic neuritis (ON) history. Results : Rates ...

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    13. Optical Coherence Tomography in Neurologic Diseases (Textbook)

      Optical Coherence Tomography in Neurologic Diseases (Textbook)

      Optical coherence tomography [OCT] provides tissue morphology imagery at much higher resolution than other imaging modalities such as MRI or ultrasound, and the machines are comparatively cheaper. It is an easy technique to perform; is non-ionizing, and therefore safe. These benefits are driving a rapid transformation of OCT, from its principal application as a research tool, into an extension of the 'neurological examination' in routine office practice. Originally used in assessing the severity of tissue damage and prognosis of multiple sclerosis and various neuro-ophthalmic conditions, OCT is increasingly used in other neurological disorders such as Parkinson's disease, ALS, and ...

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    14. Clinical trials to clinical use: using vision as a model for multiple sclerosis and beyond

      Clinical trials to clinical use: using vision as a model for multiple sclerosis and beyond

      Optical coherence tomography (OCT) has made possible the structure–function correlations that uniquely characterize the afferent visual pathway as a model for understanding multiple sclerosis (MS) and for developing new treatments. During the past decade, OCT measures of retinal nerve fiber layer (RNFL) and ganglion cell/inner plexiform layer (GCL + IPL) thickness have evolved from being a means to validate visual function tests, such as low-contrast letter acuity, to provide a window on the axonal and neuronal loss that are now widely recognized as contributors to permanent visual dysfunction in MS. Although acute optic neuritis (ON) leads to thinning of ...

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    15. Monocular and binocular low-contrast visual acuity and optical coherence tomography in pediatric multiple sclerosis

      Monocular and binocular low-contrast visual acuity and optical coherence tomography in pediatric multiple sclerosis

      Background Low-contrast letter acuity and optical coherence tomography (OCT) capture visual dysfunction and axonal loss in adult-onset multiple sclerosis (MS), and have been proposed as secondary outcome metrics for therapeutic trials. Clinical trials will soon be launched in pediatric MS, but such outcome metrics have not been well-validated in this population. Objectives To determine whether MS onset during childhood and adolescence is associated with measurable loss of visual acuity and thinning of the retinal nerve fiber layer (RNFL), whether such features are noted only in the context of clinical optic nerve inflammation (optic neuritis, ON) or are a feature of ...

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    16. Baseline Retinal Nerve Fiber Layer Thickness and Macular Volume Quantified by OCT in the North American Phase 3 Fingolimod Trial for Relapsing-Remitting Multiple Sclerosis

      Baseline Retinal Nerve Fiber Layer Thickness and Macular Volume Quantified by OCT in the North American Phase 3 Fingolimod Trial for Relapsing-Remitting Multiple Sclerosis

      Background: Patients with multiple sclerosis (MS) demonstrate thinning of peripapillary retinal nerve fiber layer (RNFL) and decreased macular volume as measured by optical coherence tomography (OCT). To our knowledge, there are no previous reports from a large MS OCT database with strict quality control measures that quantitate RNFL and macula in patients with relapsing-remitting multiple sclerosis. Methods: The University of California Davis OCT Reading Center gathered OCT data at baseline as part of the North American phase 3 trial of fingolimod (Gilenya). Average RNFL thickness (RNFLT) and macular volume (TMV) were measured using time domain OCT (TD-OCT). RNFL quadrants, clock ...

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    17. Active MS is associated with accelerated retinal ganglion cell/inner plexiform layer thinning

      Active MS is associated with accelerated retinal ganglion cell/inner plexiform layer thinning

      Objective: To determine the effect of clinical and radiologic disease activity on the rate of thinning of the ganglion cell/inner plexiform (GCIP) layer and the retinal nerve fiber layer in patients with multiple sclerosis (MS) using optical coherence tomography (OCT). Methods: One hundred sixty-four patients with MS and 59 healthy controls underwent spectral-domain OCT scans every 6 months for a mean follow-up period of 21.1 months. Baseline and annual contrast-enhanced brain MRIs were performed. Patients who developed optic neuritis during follow-up were excluded from analysis. Results: Patients with the following features of disease activity during follow-up had faster ...

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    18. The Impact of Utilizing Different Optical Coherence Tomography Devices for Clinical Purposes and in Multiple Sclerosis Trials

      The Impact of Utilizing Different Optical Coherence Tomography Devices for Clinical Purposes and in Multiple Sclerosis Trials
      Optical coherence tomography (OCT) derived retinal measures, particularly peri-papillary retinal nerve fiber layer (RNFL) thickness, have been proposed as outcome measures in remyelinating and neuroprotective trials in multiple sclerosis (MS). With increasing utilization of multiple centers to improve power, elucidation of the impact of different OCT technologies is crucial to the design and interpretation of such studies. In this study, we assessed relation and agreement between RNFL thickness and total macular volume (in MS and healthy controls) derived from three commonly used OCT devices: Stratus time-domain OCT, and Cirrus HD-OCT and Spectralis, two spectral-domain (SD) OCT devices. OCT was performed ...
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    19. Retinal Ganglion Cell Layer Volumetric Assessment by Spectral-Domain Optical Coherence Tomography in Multiple Sclerosis: Application of a High-Precision Manual Estimation Technique

      Retinal Ganglion Cell Layer Volumetric Assessment by Spectral-Domain Optical Coherence Tomography in Multiple Sclerosis: Application of a High-Precision Manual Estimation Technique
      Background: Neuronal loss in the retina has been demonstrated pathologically in eyes of patients with multiple sclerosis (MS). In vivo, MS eyes have reduced total macular volumes by optical coherence tomography (OCT). Using a high-resolution spectral-domain OCT, this pilot study used a manual method to measure ganglion cell layer (GCL) volumes and to determine the relation of these volumes to visual function in MS eyes. Methods: Sixteen eyes of 8 patients with MS and 8 eyes of 5 disease-free control participants were studied using fast macular OCT scans performed with Spectralis OCT (Heidelberg Engineering). Visual function tests of low-contrast letter ...
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    20. Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography

      Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography

      Optical coherence tomography studies in multiple sclerosis have primarily focused on evaluation of the retinal nerve fibre layer. The aetiology of retinal changes in multiple sclerosis is thought to be secondary to optic nerve demyelination. The objective of this study was to use optical coherence tomography to determine if a subset of patients with multiple sclerosis exhibit primary retinal neuronopathy, in the absence of retrograde degeneration of the retinal nerve fibre layer and to ascertain if such patients may have any distinguishing clinical characteristics. We identified 50 patients with multiple sclerosis with predominantly macular thinning (normal retinal nerve fibre-layer thickness ...

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    21. Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration

      Optical Coherence Tomography (OCT): Imaging the Visual Pathway as a Model for Neurodegeneration
      Axonal and neuronal degeneration are important features of multiple sclerosis (MS) and other neurologic disorders that affect the anterior visual pathway. Optical coherence tomography (OCT) is a non-invasive technique that allows imaging of the retinal nerve fiber layer (RNFL), a structure which is principally composed of ganglion cell axons that form the optic nerves, chiasm, and optic tracts. Since retinal axons are nonmyelinated until they penetrate the lamina cribrosa, the RNFL is an ideal structure (no other central nervous system tract has this unique arrangement) for visualizing the processes of neurodegeneration, neuroprotection and, potentially, even neuro-repair. OCT is capable of ...
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    22. Reproducibility of high-resolution optical coherence tomography in multiple sclerosis

      Reproducibility of high-resolution optical coherence tomography in multiple sclerosis

      Optical coherence tomography (OCT) is a non-invasive method to quantify neurodegeneration as an outcome in multiple sclerosis clinical trials; however, no data exist on Cirrus spectral domain optical coherence tomography (SD-OCT) reproducibility in patients with multiple sclerosis. The objective of this study was to determine the protocol for achieving optimal inter-visit, inter-rater, and intra-rater reproducibility for studies performed on healthy controls and multiple sclerosis patients utilizing novel high-definition SD-OCT. This is a prospective study of inter-visit, inter-rater, and intra-rater reproducibility in multiple sclerosis patients (n = 58) and healthy controls (n = 32) on Cirrus-HD SD-OCT. Excellent reproducibility of average and quadrantic ...

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    23. Evaluating loss of visual function in multiple sclerosis as measured by low-contrast letter acuity

      Evaluating loss of visual function in multiple sclerosis as measured by low-contrast letter acuity
      Background: Disturbances in visual function are common in patients with multiple sclerosis (MS) and are often accompanied by substantial impairments in daily functioning and quality of life. Lesions associated with these impairments frequently involve the afferent visual pathway. Expert Clinical Opinion: Because these impairments are often not readily apparent on commonly used high-contrast acuity tests, low-contrast charts (e.g., low-contrast Sloan letter charts) have gained validity in the assessment of visual dysfunction in patients with MS. Decrements in low-contrast letter acuity are associated with MS and correlate with increasing disability, MRI abnormalities, and reduced retinal nerve fiber layer (RNFL) thickness ...
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    1-24 of 33 1 2 »
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