Assessment of structural and functıonal vısual outcomes ın relapsıng remıttıng multıple sclerosıswıth vısual evoked potentıals and optıcal coherence tomography Betul Tugcu a,1 , Aysun Soysal b, ⁎ ,1 , Murat Kılıc a , Burcu Yuksel b ,Nılufer Kale b , Ulvıye Yıgıt a , Baki Arpaci b a Bakirkoy Education and Research Hospital, Ophthalmology Department, Istanbul, Turkey b Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Neurology Department, Istanbul, Turkey abstract article info Article history: Received 17 June 2013 Received in revised form 26 August 2013 Accepted 19 September 2013 Available online 1 October 2013 Keywords: Multiple sclerosis Optic coherence tomography OCT Visual evoked potentials VEP RNFL The purpose of this study is to consider the clinical utility of optical coherence tomography (OCT) and find a correlation with VEP. Effects of different disease modifying treatments (DMT) were further evaluated by measur- ing OCT parameters and whether a correlation exists between the RNFL thickness, disease duration and expand- ed disability status scale (EDSS) were also assessed. 13 patients were on interferon beta-1a (IFN), 14 patients were receiving glatiramer acetate (GA), 19 patients were not being treated with any DMT and 21 healthy controls were included the study. During OCT examination, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness was found to be lower in all MS groups but macular volume (MV) was lower only in GA group than controls. Although, P100 latencies were longer than controls in all MS groups, there was no statisti- cally significant difference between IFN and w/o DMT groups. Patients with ON history, P100 latencies were found significantly longer than those without ON. VEP amplitudes were found lower with ON history patients than those without ON, however this was not statistically significant. EDSS strongly correlated with P100 latency, RNLF, GCC but no correlation was observed with VEP amplitude and MV. Our results show that RNFL, GCC and MV were all decreased in MS patients with or without DMT comparing to controls and it is more prominent in eyes with ON. Further follow-up studies are warranted to understand the pathophysiology of CNS axonal degeneration and involvement of optic nerves. © 2013 Elsevier B.V. All rights reserved. 1. Introduction Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating disorder of the central nervous system (CNS) characterized by demye- lination and axonal degeneration [1]. Acute optic neuritis (ON) due to an inflammatory demyelinating lesion of the optic nerve is often seen in association with MS [2]. Although functional recovery usually follows the acute episode of visual loss, persistent visual deficits are common. In vivo measurements of thinning of the retinal nerve fiber layer (RNFL) suggest that the extent of axonal loss is associated with the degree of persistent visual dysfunction following optic neuritis [3–5]. Retinal axonal loss begins early in the course of MS in the absence of clinically evident ON and retinal thinning is nearly identical between MS sub- types [6–8]. The mechanisms responsible for the formation of lesions in different patients and in different stages of the disease as well as those involved in the induction of diffuse brain damage are complex and heterogeneous. This heterogeneity is reflected by different clinical manifestations of the disease, such as relapsing or progressive MS [9,10]. Because of the complex immunopathological mechanisms involved, the evidence for the effectiveness of different therapeutic strategies varies widely be- tween the different agents. Up to date, several therapies for MS exist, however many possible therapies are still under investigation. Monitor- ing the progression of disease activity, effectiveness of therapies carry great importance in the management of patients with MS. MS diagnosis and prognosis require integrating clinical findings with the assessment of magnetic resonance imaging (MRI) and other paraclinical methods including visual evoked potentials (VEP), and elimination of alternative disorders that might mimic MS [10,11]. To date, biomarkers or imaging techniques remain insufficient to estimate prognosis and provide evidence for development of neuronal loss and atrophy [12]. Optical coherence tomography (OCT) is a new method assessing the impact of MS on the thickness of the RNFL by measuring the echo time delay and intensity of back-reflection of light from different structures in the eye. OCT is a noninvasive and reproducible tool and might present valuable data for axonal degeneration [13–18]. The purpose of this study is to consider the clinical utility of OCT and find a correlation with VEP, and in assessment of relative effect of differ- ent disease modifying treatments (DMT) on MS patients by measuring Journal of the Neurological Sciences 335 (2013) 182–185 ⁎ Corresponding author at: Atakoy 5. Kisim E1/1A Blok Daire: 8 Bakirkoy, Istanbul 34158, Turkey. Tel.: +90 212 4091515. E-mail address: ayssoysal@gmail.com (A. Soysal). 1 First (BT) and second authors (AS) have contributed equally in this study. 0022-510X/$ – see front matter © 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jns.2013.09.027 Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns