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Daniel S. Reich, MD, PhD; Seth A. Smith, PhD; Eliza M. Gordon-Lipkin, BS; Arzu Ozturk, MD; Brian S. Caffo, PhD; Laura J. Balcer, MD; Peter A. Calabresi, MD

Arch Neurol. 2009;66(8):998-1006.

Objective  To determine whether damage to the optic radiation (OR) in multiple sclerosis (MS) is associated with optic nerve injury and visual dysfunction.

Design  Case-control study.

Setting  Referral center.

Participants  Ninety referred patients with MS and 29 healthy volunteers.

Main Outcome Measures  Magnetic resonance imaging indices along the OR were reconstructed with diffusion tensor tractography. Retinal nerve fiber layer thickness and visual acuity at high and low contrast were measured in a subset of the MS group (n = 36).

Results  All tested magnetic resonance imaging indices (fractional anisotropy [FA]; mean, parallel, and perpendicular [] diffusivity; T2 relaxation time; and magnetization transfer ratio) were significantly abnormal in patients with MS. Mean retinal nerve fiber layer thickness was significantly correlated with FA (r = 0.55; P < .001) and (r = –0.37; P = .001). The retinal nerve fiber layer thickness in the nasal retinal quadrant was also specifically correlated with FA and in the synaptically connected contralateral OR. In individuals with less severely damaged optic nerves (mean retinal nerve fiber layer thickness >80 µm), letter acuity scores at 2.5% contrast were correlated with OR-specific FA (r = 0.55; P = .004), (r = –0.40; P = .04), and magnetization transfer ratio (r = 0.54; P = .01), as well as the fraction of OR volume made up of lesions (r = –0.69; P < .001).

Conclusions  Fractional anisotropy and are potentially useful quantitative magnetic resonance imaging biomarkers of OR-specific damage in MS. Such damage is associated with retinal injury and visual disability.

Author Affiliations: Departments of Radiology (Drs Reich, Smith, and Ozturk) and Neurology (Drs Reich and Calabresi and Ms Gordon-Lipkin), The Johns Hopkins University School of Medicine; Department of Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University (Dr Caffo); and F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute (Dr Smith), Baltimore, Maryland; and Departments of Neurology and Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia (Dr Balcer).

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