The Change Of Retinal Nerve Fiber Layer And Its Clinical Significance In Alzheimer's Disease And Multiple Sclerosis

Part1 The changes of retinal nerve fiber layer and its clinical significance in Alzheimer's disease and mild cognitive impairmentPurposeTo measure the retinal nerve fiber layer thickness,Optic disc variables and macular variables with optical coherence tomography(Cirrus HD-OCT)in MCI and AD patients and to measure the visual field defect in MCI and mild AD patients with Humphrey 750 automated perimetry for assessing the change of retinal never fiber layer and its clinical significance.MethodsThirty six MCI(thirty six eyes)and eighty nine AD patients(eighty nine eyes)were chosen from Neurology of The First Affiliated Hospital of Zhengzhou University from November 2013 to December 2015 in this study.According to the condition of disease,AD was divided into mild AD(thirty nine eyes),moderate AD(thirty two eyes)and severe AD(eighteen eyes).Sixty healthy controls(sixty eyes)sex and age matched were recruited from Ophthalmology of The First Affiliated Hospital of Zhengzhou University.To measure the retinal nerve fiber thickness of mean,inferior,superior,nasal,temporal quadrants and optic disc variables(Rim area,Vertical Cup/disc ratio,Cup volume)and macular variables(macular volume,macular thickness)with optical coherence tomography(Cirrus HD-OCT)and assess the relationship among these variables and MMSE.Humphrey 750 perimetry was used to examine the visual field in patients with MCI,mild AD and normal subjects.The mean defect values of the three groups were compared,and the differences between the field of vision and the OCT examination were analyzed.Results1)The Comparison about Retinal nerve fiber layer thickness among MCI,mild-moderate-severe AD and normal control group:The mean retinal nerve fiber layer thickness:The mean retinal nerve fiber layer thickness was decreased in mild AD,moderate AD and severe AD groups.These groups also showed obvious difference comparison with normal control group(P<0.05,P<0.01).The mean retinal nerve fiber layer thickness was also decreased in MCI group,but MCI group showed no difference comparison with normal control group(P>0.05).MCI,mild AD,moderate AD and severe AD had no difference when compared with each other(P>0.05).The retinal nerve fiber layer thickness of each quadrant:The retinal nerve fiber layer thickness in superior,inferior and temporal quadrant was decreased in mild AD,moderate AD and severe AD groups.These groups also showed obvious difference comparison with normal control group(P<0.05,P<0.01).The retinal nerve fiber layer thickness in superior,inferior and temporal quadrant was also decreased in MCI group,but MCI group showed no difference comparison with normal control group(P>0.05).MCI,mild AD,moderate AD and severe AD had no difference when compared with each other(P>0.05).The nasal quadrant retinal nerve fiber layer thickness:MCI,mild AD,moderate AD,severe AD and normal control group had no significant difference when compared with each other(P>0.05).2)The Comparison about Optic disc variables among MCI,mild-moderate-severeAD and normal control group:Rim area:The rim area was decreased in mild AD,moderate AD and severe AD groups.These groups also showed obvious difference comparison with normal control group(P<0.01,P<0.05).The rim area was also decreased in MCI group,but MCI group showed no difference comparison with normal control group(P>0.05).MCI,mild AD,moderate AD and severe AD had no difference when compared with each other(P>0.05).Vertical Cup/disc ratio and Cup volume:The vertical Cup/disc ratio and cup volume were increased in mild AD,moderate AD and severe AD groups.These groups also showed obvious difference comparison with normal control group(P<0.01,P<0.05).The vertical Cup/disc ratio and cup volume were also increased in MCI group,but MCI group showed no difference comparison with normal control group(P>0.05).MCI,mild AD,moderate AD and severe AD had no difference when compared with each other(P>0.05).3)The Comparison about macular variables among MCI,mild-moderate-severeAD and normal control group:Macular volume:Comparison with normal control group,mild AD,moderate AD and severe AD also showed obvious difference(P<0.05,P<0.01),but MCI showed no difference(P>0.05).MCI,mild AD,moderate AD and severe AD had no difference when compared with each other(P>0.05).Macular thickness:Comparison with normal control group,mild AD,moderate AD and severe AD also showed obvious difference(P<0.05,P<0.01),but MCI showed no difference(P>0.05).MCI,mild AD,moderate AD and severe AD had no difference when compared with each other(P>0.05).4)The relationship among retinal nerve fiber thickness,optic disc variables,macularvariables and MMSE of AD and MCI:The retinal nerve fiber thickness(mean,inferior,superior,temporal),rim area,macular volume and macular thickness show a statistically positive correlation with MMSE scores,but Vertical Cup/disc ratio and cup volume show a negative correlation with MMSE scores.5)Visual field changes in mild cognitive impairment,mild Alzheimer's disease,and normal control groups:MCI,mild AD,and normal control group showed obvious difference in MD Value with F-Test(P<0.01).Compared with the normal group,the mild AD group was statistically significant(P<0.05),but there was no significant difference between MCI and normal group(P>0.05).There is 82.1%(32/39)visual field defect in mild AD group but only 6.7%(4/60)in normal control group,8.3%(3/36)in MCI group,respectively.The ratio of visual field loss is 62.5%(20/32)in the inferior arcuate regions,15.6%(5/32)in the superior arcuate regions,12.5%(4/32)blind spot extension,9.4%(3/32)Scattered in the dark,respectively.Conclusions1)There were different changes of retina and optic nerve in patients with Alzheimer's disease and may assist the neurological doctor in diagnosing the disease.2)There may be specific changes of retina and optic nerve in patients with Alzheimer's disease:the changes of macular volume and macular thickness are the early feature of Alzheimer's disease.The change may be earlier than the RNFL.The most common change of retinal nerve fiber layer thickness is the superior quadrant,followed by the inferior quadrant.3)The retina and optic nerve in patients with mild cognitive impairment had a thinning tendency,but compared with normal control group it was not statistically significant.The results showed that the damage of the retina and optic nerve was mild.4)There is the relationship between the retina and optic never degeneration and the aggravation of the disease in patients with Alzheimer's disease,therefore we can infer the severity of the disease by OCT.Part 2 The changes of retinal nerve fiber layer and its clinical significance in multiple sclerosisPurposeTo measure the retinal nerve fiber layer thickness,Optic disc variables and macular variables with optical coherence tomography(Cirrus HD-OCT)and to measure the visual field defect in multiple sclerosis(MS)patients with Humphrey 750 automated perimetry for assessing the change of retinal nerve fiber layer and its clinical significance.MethodsSixty nine MS patients(sixty nine eyes)were chosen from Neurology of The First Affiliated Hospital of Zhengzhou University from November 2013 to December 2015 in this study.Thirty six MS patients(thirty six eyes)with a history of acute optic neuritis were MS-ON group.Thirty three MS patients(thirty three eyes)without a history of acute optic neuritis were MS-NON group.Fifty five healthy controls(fifty five eyes)sex and age matched were recruited from Ophthalmology of The First Affiliated Hospital of Zhengzhou University.To measure the retinal nerve fiber thickness of mean,inferior,superior,nasal,temporal quadrants and optic disc variables(Rim area,Vertical Cup/disc ratio,Cup volume)and macular variables(macular volume and macular thickness)with optical coherence tomography(Cirrus HD-OCT)and assess the relationship among these variables and EDSS.To assess the visual field with use of Humphrey 750 automated perimetry and compare the MD Value among three groups.Results1)The Comparison about Retinal nerve fiber layer thickness among MS-ON group,MS-NON group and normal control group:The mean retinal nerve fiber layer thickness:The mean retinal nerve fiber layer thickness was decreased in MS-ON group and MS-NON group.These groups also showed obvious difference comparison with normal control group(P<0.05,P<0.01).MS-ON group and MS-NON group had obvious difference when compared with each other(P<0.05).The retinal nerve fiber layer thickness of each quadrant:The retinal nerve fiber layer thickness of each quadrant was decreased in MS-ON group and MS-NON group.MS-ON group and MS-NON group also showed obvious difference comparison with normal control group(P<0.05,P<0.01).MS-ON group and MS-NON group had obvious difference in superior,inferior and nasal quadrant except temporal quadrant when compared with each other(P<0.05).2)The Comparison about Optic disc variables among MS-ON group,MS-NON group and normal control group:Rim area:The rim area was decreased in MS-ON group and MS-NON group.MS-ON group and MS-NON group showed obvious difference comparison with normal control group(P<0.01,P<0.05).MS-ON group and MS-NON group also had obvious difference when compared with each other(P<0.05).Vertical Cup/disc ratio:The vertical Cup/disc ratio was increased in MS-ON group and MS-NON group.These groups showed obvious difference comparison with normal control group(P<0.01,P<0.05).MS-ON group and MS-NON group also had obvious difference when compared with each other(P<0.05).Cup volume:The cup volume was increased in MS-ON group and MS-NON group.MS-ON group and MS-NON group showed obvious difference comparison with normal control group(P<0.01,P<0.05).MS-ON group and MS-NON group also had obvious difference when compared with each other(P<0.05).3)The Comparison about macular variables among MS-ON group,MS-NON groupand normal control group:Macular volume and Macular thickness:The macular volume and macular thickness were decreased in MS-ON group and MS-NON group.Comparison with normal control group,MS-ON group and MS-NON group showed obvious difference(P<0.001).MS-ON group and MS-NON group also had obvious difference when compared with each other(P<0.05).4)The relationship among retinal nerve fiber thickness,optic disc variables,macularvariables and EDSS scores:The retinal nerve fiber thickness(mean,inferior,superior,temporal),rim area,macular volume and macular thickness show a statistically negative correlation with EDSS scores,but Vertical Cup/disc ratio and cup volume show a positive correlation with EDSS scores.5)The Comparison about Visual field among MS-ON group,MS-NON group andnormal corntrol group:MS-ON group,MS-NON group and normal control group showed obvious difference in MD Value with F-Test(P<0.001).Compared with the normal group,the MS-ON group was statistically significant(P<0.01).The absolute value of MD rises in patients with MS-ON.There were different visual field defects in MS-ON group but only 7.3%(4/55)in normal group,9.0%(3/33)in MS-NON group,respectively.The ratio of visual field loss is 33.3%(12/36)central scotoma,27.8%(10/36)blind spot extension,22.2%(8/36)connected with the blind spot,11.1%(4/36)paracentral scotoma,5.6%(2/36)concentric field narrowing,respectively.Conclusions1)There were different changes of retina and optic nerve in patients with multiple sclerosis(whether or not with optic neuritis).2)The loss of RNFL may occur in the early stages of non-eye clinical symptoms and is an early manifestation of MS patients.3)There is the relationship between the retina and optic never degeneration and the aggravation of the disease in patients with multiple sclerosis,therefore we can infer the severity of the disease by OCT.4)The visual field change was complex in patients with multiple sclerosis and the optic neuropathy involves not only the Papillomacular bundle,but also any part of the optic pathway,can help us locate the lesion site.