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NEUROLOGY 2010;74:252-258
© 2010 American Academy of Neurology

Retinal nerve fiber layer thickness is associated with lesion length in acute optic neuritis

K. Kallenbach, MD, H. Simonsen, B. Sander, PhD, MSc, B. Wanscher, PhD, MD, H. Larsson, MD, DMSc, M. Larsen, MD, DMSc and J. L. Frederiksen, MD, DMSc

From the Department of Neurology (K.K., J.L.F.), Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (H.S., H.L.), and Department of Ophthalmology (B.S.), Glostrup Hospital and University of Copenhagen; Department of Clinical Neurophysiology (B.W.), Glostrup Hospital; and Department of Ophthalmology (M.L.), Glostrup Hospital, the National Eye Clinic, Kennedy Center, and University of Copenhagen, Denmark.

Address correspondence and reprint requests to Dr. K. Kallenbach, Department of Neurology, Glostrup Research Institute, Glostrup Hospital, Nordre Ringvej 69, 2600 Glostrup, Denmark klakal01{at}glo.regionh.dk.

Background: Acute optic neuritis occurs with and without papillitis. The presence of papillitis has previously been thought to imply an anterior location of the neuritis, but imaging studies seeking to test this hypothesis have been inconclusive.

Methods: This prospective observational cohort study included 41 patients with unilateral optic neuritis and 19 healthy volunteers. All patients were evaluated and examined within 28 days of onset of symptoms. The peripapillary retinal nerve fiber layer thickness (RNFLT), an objective quantitative measure of optic nerve head edema, was measured by optical coherence tomography and the length and location of the inflammatory optic nerve lesion were evaluated using MRI.

Results: Ophthalmoscopically, 34% of the patients had papillitis. The retinal nerve fiber layer in affected eyes (mean 123.1 µm) was higher during the acute phase than that of fellow eyes (mean 98.1 µm, p < 0.0001) and higher than that in healthy control eyes (mean 97.1 µm, p < 0.0001). The RNFLT was related to the length of the optic nerve lesion (p = 0.0002), but not to the location of the optic nerve lesions (p = 0.72).

Conclusions: In this study of the acute phase of optic neuritis, the degree of optic nerve head edema depended upon the extent of the optic nerve lesion, but not on its location. This suggests that factors other than inflammation, such as compromised venous drainage, vascular leakage, impaired axonal transport, and other mechanisms, are involved in the development of optic nerve head edema in optic neuritis.

Abbreviations: CI = confidence interval; MS = multiple sclerosis; OCT = optical coherence tomography; ON = optic neuritis; RNFLT = retinal nerve fiber layer thickness.

Supplemental data at www.neurology.org

Study funding: Supported by unrestricted grants for the department: The Synoptic Foundation, the Civilingeniør Bent Bøgh and Hustru Inge Bøghs Foundation, the Aase and Ejnar Danielsens Foundation, the Karen A. Tolstrups Foundation, the Grosserer Chr. Andersen and Ingeborg Andresen f. Schmidts Foundation, the Ole Jacobsen Mindelegat, the Sygeforsikring "Danmark" sundheds-foundation, the Velux Foundation, and the John and Birthe Meyer Foundation.

Disclosure: Author disclosures are provided at the end of the article.

Received July 10, 2009. Accepted in final form October 29, 2009.