Abstract: Unexpected Retinal Abnormalities Detected Upon Evaluation for Neurological Disease (The 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS)

Saturday, June 1, 2013

Elias S Sotirchos, MD , Neurology, Johns Hopkins University, Baltimore, MD

Angela Vidal-Jordana, MD , Clinical Neuroimmunology Unit, Vall d’Hebron University Hospital, Baltimore, MD

Shiv Saidha, MD , Neurology, Johns Hopkins University, Baltimore, MD

Yasir Sepah, MBBS , Ophthalmology, Johns Hopkins University, Baltimore, MD

John N Ratchford, MD , Neurology, Johns Hopkins University, Baltimore, MD

Quan Dong Nguyen, MD , Ophthalmology, Johns Hopkins University, Baltimore, MD

Elliot Frohman, MD, PhD, FAAN , Neurology & Neurotherapeutics - MS Clinic, UT Southwestern Medical Center, Dallas, TX

Laura J Balcer, MD, MSCE , Neurology, New York University, New York, NY

Peter A Calabresi, MD, FAAN , Neurology, Johns Hopkins University, Baltimore, MD

Scott D Newsome, D.O. , Neurology, Johns Hopkins University, Abingdon, MD

Background: Optical coherence tomography (OCT) is an imaging technique that enables the acquisition of high-resolution images of the retina and is widely used in ophthalmology for the evaluation of retinal disease. In the field of neurology, OCT is primarily utilized to quantitatively assess the peripapillary retinal nerve fiber layer and macular volume in patients with optic neuropathies and demyelinating diseases and is being increasingly used in neurology clinical practices. Additionally, OCT has been used extensively in research on these conditions and has been proposed as an outcome measure for clinical trials in these patient populations.

Objectives: To determine the prevalence of unexpected retinal abnormalities detected with OCT in a large academic neurology practice.

Methods: Between June 2010 and June 2012, 1502 subjects underwent spectral-domain OCT imaging at the Johns Hopkins Multiple Sclerosis (MS) and Transverse Myelitis (TM) Center for either clinical or research purposes. Macular cube scans were examined qualitatively to evaluate for the presence of retinal abnormalities and patients’ records were reviewed to acquire clinical data.

Results: OCT scans of 683 individual subjects were assessed (mean age 43.5±12.9; 72% female; 365 MS, 18 clinically isolated syndrome, 50 idiopathic TM, 15 neuromyelitis optica spectrum disorder, 20 healthy controls, 20 sarcoidosis, and 195 other/unknown diagnoses). Retinal abnormalities were observed in 66 of 683 subjects (9.7%) and included: epiretinal membrane with or without vitreomacular traction (n=35), intraretinal cysts/microcysts (n=14), central serous chorioretinopathy and/or pigment epithelial detachment (n=13), macular/lamellar hole or pseudocyst (n=6). Microcystic macular edema (MME) of the inner nuclear layer was detected in 11 patients with MS (3.0% of all MS patients).

Conclusions: Our results demonstrate that unexpected qualitative retinal abnormalities are commonly found in subjects undergoing OCT for evaluation of suspected or established neurological disease. Neurologists employing OCT should be aware of the common retinal abnormalities that may be detected and know when to refer patients with incidental findings for detailed ophthalmologic evaluation. Furthermore, this study provides confirmation of the presence of MME in MS eyes in a cohort that has not previously been reported.

P47 Unexpected Retinal Abnormalities Detected Upon Evaluation for Neurological Disease