Correlation between Visual Acuity and Retinal Nerve Fiber Layer Thickness in Optic Neuropathies

Ji Woong Park; Sung Eun Kyung

doi:10.3341/jkos.2016.57.4.628

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Park and Kyung: Correlation between Visual Acuity and Retinal Nerve Fiber Layer Thickness in Optic Neuropathies

Original Article

J Korean Ophthalmol Soc 2016;57(4):628-633.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.628

Correlation between Visual Acuity and Retinal Nerve Fiber Layer Thickness in Optic Neuropathies

Ji Woong Park, MD, Sung Eun Kyung, MD, PhD

Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea

Address reprint requests to Sung Eun Kyung, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: 82-41-550-6497, Fax: 82-41-561-0137 E-mail: kseeye@hanmail.net

Received 26 November 2015 Revised 12 February 2015 Accepted 12 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the correlation between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT, Cirrus HD-OCT^®) and visual acuity in optic neuritis, ischemic optic neuropathy and traumatic optic neuropathy.

Methods

Thirty-eight patients were recruited. RNFL thickness and visual acuity in optic neuritis, ischemic optic neuropathy and traumatic optic neuropathy were measured at least 6 months after the event. The correlation between log MAR best-corrected visual acuity (BCVA) and retinal nerve fiber thickness in each quadrant was analyzed.

Results

log MAR BCVA and RNFL thickness of each quadrant in optic neuropathy exhibited a statistically significant correlation. In optic neuritis, RNFL thickness of the superior quadrant was significantly thicker than in ischemic optic neuropathy and traumatic optic neuropathy (p = 0.009, 0.003). In addition, RNFL thickness of the inferior quadrant in optic neuritis was significantly thicker than in traumatic optic neuropathy (p = 0.012).

Conclusions

There was a statistically significant correlation between log MAR BCVA and RNFL thickness by OCT in patients with optic neuropathies. The RNFL thickness may predict visual acuity after an optic neuropathy attack and help to differentiate malingering patients with impaired vision loss.

Keywords: Optic neuropathy, Optical coherence tomography, Retinal nerve fiber layer

References

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Figure 1.

Scatter plot of mean RNFL thickness vs. log MAR BCVA in affected eyes (n = 41, number of eyes with optic neuropathies). The mean RNFL thickness is plotted as a function of visual acuity. The solid line represents the linear regression best fit line for the data (Y = −0.018X + 1.573)^*, which was statistically significant (p-value^† = 0.001). BCVA = best corrected visual acuity; RNFL = retinal nerve fiber layer. ^*X = RNFL thickness (μm), Y = log MAR BCVA;^†Simple linear regression.

Table 1.

Epidemiological features and retinal nerve fiber layer thickness in each group

	ON (n = 25)	TON (n = 10)	ISON (n = 6)	p-value^*	Control Eyes (n = 31)	Total (n = 72)
Age (years)	30.36 ± 13.50	38.10 ± 11.61	68.00 ± 9.68		39.00 ± 15.91	38.29 ± 17.01
Gender (M:F)	13:12	9:1	3:3		20:11	45:27
Period (months)	25.52 ± 27.49	31.70 ± 30.41	17.03 ± 17.25	0.394		25.78 ± 26.81
log MAR BCVA^‡	0.14 ± 0.29	0.58 ± 0.73	1.15 ± 0.89	0.003^†	0.00 ± 0.02	0.23 ± 0.51
Superior sector (μm)	94.48 ± 24.29	65.6 ± 20.11	56.33 ± 10.58	<0.001^†	116.94 ± 14.93	96.96 ± 28.41
Temporal sector (μm)	50.32 ± 12.80	37.72 ± 11.58	48.83 ± 13.98	0.061	62.16 ± 8.03	53.54 ± 13.66
Inferior sector (μm)	97.64 ± 29.88	63.10 ± 24.81	70.67 ± 30.58	0.007^†	121.32 ± 17.91	100.79 ± 32.34
Nasal sector (μm)	58.64 ± 5.47	50.43 ± 12.51	57.17 ± 2.78	0.063	62.71 ± 7.99	59.13 ± 8.61
Average (μm)	75.27 ± 14.47	54.20 ± 14.58	58.25 ± 13.10	0.001^†	90.78 ± 8.81	77.60 ± 18.14

Values are presented as mean ± SD unless otherwise indicated.

ON = optic neuritis; TON = traumatic optic neuropathy; ISON = ischemic optic neuropathy; M = male; F = female; BCVA = best corrected visual acuity.

^* Kruskal-wallis test compared in each group;

^† p-value < 0.05;

^‡ log MAR best corrected visual acuity.

Table 2.

Comparison of mean retinal nerve fiber layer sector thickness between groups A and B

	Mean of A (n = 41)	Mean of B (n = 31)	Mean of A-B	p-value^*
Superior (μm)	81.85 ± 4.20	116.91 ± 2.68	35.08 ± 5.37	<0.001
Temporal (μm)	47.02 ± 2.11	62.16 ± 1.44	15.14 ± 2.73	<0.001
Inferior (μm)	85.27 ± 5.04	121.33 ± 3.22	36.05 ± 6.44	<0.001
Nasal (μm)	56.41 ± 1.27	62.71 ± 1.44	6.30 ± 1.92	0.002
Age (years)	37.76 ± 2.81	39.00 ± 2.86		0.761

Values are presented as mean ± SD unless otherwise indicated. Group A is ‘eyes having ON or TON or ISON’ and group B is ‘control eyes’.

ON = optic neuritis; TON = traumatic optic neuropathy; ISON = ischemic optic neuropathy.

^* Unpaired t-test.

Table 3.

Correlation between log MAR BCVA and retinal nerve fiber layer sector thickness in affected eyes^*

	Superior	Temporal	Inferior	Nasal	Mean (n=41)
Y^† = aX^‡ + b	−0.009X + 1.153	−0.006X + 0.692	−0.01X + 1.249	−0.028X + 1.977	−0.018X + 1.573
p-value^§	0.008	0.381	<0.001	0.017	0.001

BCVA = best corrected visual acuity.

^* n = 41, number of eyes with optic neuropathies;

^† Retinal nerve fiber layer thickness (μm);

^‡ log MAR BCVA;

^§ Simple linear regression.

Table 4.

Differences between initial and final mean retinal nerve fiber layer thickness of affected eyes (n = 17)

	Superior (μm)	Temporal (μm)	Inferior (μm)	Nasal (μm)
Initial (mean)	191.35	101.47	187.76	109.59
Final (mean)	84.82	51.35	90.76	59.47
p-value^*	<0.001	<0.001	<0.001	0.002
Mean (initial-final)^†	106.53 ± 118.49	50.12 ± 67.54	97.01 ± 88.20	50.12 ± 63.70

Values are presented as mean ± SD unless otherwise indicated.

^* Wilcoxon signed rank test;

^† Comparison of differences between initial and final retinal nerve fiber layer thickness of affected eyes in each sectors, p-value 0.145 by Kruskal-Wallis test.

Table 5.

Comparisons of The mean retinal nerve fiber layer thickness between groups A and B^* (p-value^† is presented)

p-value^†	ON vs. TON (n = 25, 10)	TON vs. ISON (n = 10, 6)	ON vs. ISON (n = 25, 6)
Superior	0.009^‡	0.978	0.003^‡
Temporal	0.061	0.429	2.067
Inferior	0.012^‡	2.871	0.171
Nasal	0.078	0.423	1.308
Average (total)	0.003^‡	0.902	0.072

ON = optic neuritis; TON = traumatic optic neuropathy; ISON = ischemic optic neuropathy.

^* Group A is ‘eyes having ON or TON or ISON’ and group B is ‘control eyes’;

^† Bonferroni correction, 3×p-value of Mann-Whitney analysis;

^‡ p-value < 0.05.

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