Comparative diagnostic accuracy of ganglion cell-inner plexiform and retinal nerve fiber layer thickness measures by Cirrus and Spectralis optical coherence tomography in relapsing-remitting multiple sclerosis

Abstract

Objective: To estimate sensitivity and specificity of several optical coherence tomography (OCT) measurements for detecting retinal thickness changes in patients with relapsing-remitting multiple sclerosis (RRMS), such as macular ganglion cell-inner plexiform layer (GCIPL) thickness measured with Cirrus (OCT) and peripapillary retinal nerve fiber layer (pRNFL) thickness measured with Cirrus and Spectralis OCT.

Methods: Seventy patients (140 eyes) with RRMS and seventy matched healthy subjects underwent pRNFL and GCIPL thickness analysis using Cirrus OCT and pRNFL using Spectralis OCT. A prospective, cross-sectional evaluation of sensitivities and specificities was performed using latent class analysis due to the absence of a gold standard.

Results: GCIPL measures had higher sensitivity and specificity than temporal pRNFL measures obtained with both OCT devices. Average GCIPL thickness was significantly more sensitive than temporal pRNFL by Cirrus (96.34% versus 58.41%) and minimum GCIPL thickness was significantly more sensitive than temporal pRNFL by Spectralis (96.41% versus 69.69%). Generalised estimating equation analysis revealed that age (P = 0.030), optic neuritis antecedent (P = 0.001), and disease duration (P = 0.002) were significantly associated with abnormal results in average GCIPL thickness.

Conclusion: Average and minimum GCIPL measurements had significantly better sensitivity to detect retinal thickness changes in RRMS than temporal pRNFL thickness measured by Cirrus and Spectralis OCT, respectively.

Figure 1

Ganglion cell-inner plexiform layer (GCIPL) analysis of the left eye of a patient with relapsing-remitting multiple sclerosis without optic neuritis antecedent in a 6 × 6 × 2 mm macular cube using a Cirrus optical coherence tomography. (a) Deviation map of the GCIPL thickness (red: below percentile 1; yellow: below percentile 5). (b) Sector distribution. (c) GCIPL thickness map, with overlying ellipses showing the dimensions of the analyzed annulus. The outer ellipse has a vertical diameter of 4 mm and the inner ellipse of 1 mm. (d) Horizontal B-scan centered in the fovea, showing the automated segmentation of the GCIPL.

Figure 2

Comparison of the color scale frequency for each sector using ganglion cell-inner plexiform layer analysis with Cirrus optical coherence tomography among eyes with and without optic neuritis in relapsing-remitting multiple sclerosis patients and from healthy control subjects. Black represents eyes classified as red (below percentile 1); dark gray represents eyes labeled as yellow (below percentile 5); light gray represents green (between percentiles 5 and 95), and white represents white (above percentile 95).