RNFL -New Imaging

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RNFL -New Imaging

Postby Sharon » Thu Apr 19, 2007 7:59 pm

My neurologist has suggested that I get a Retinal Nerve Fiber Layer (RNFL) imaging of my eyes. The equipment used is an Optical Coherence Tomography machine. The test is non-invasive, and quick. I do not know if insurance will make payment for MS, but my understanding is the cost is minimal. The neuro believes the test will be used in standard treatment of MS within the next couple of years. My non-scientific understanding of the test is: measurement of a bundle of nerves in the eye (the nerves do not normally have myelin). The size of the bundle is compared to a standard based on age at the first test. The second test is compared to the patients first test. There is a correlation to decrease in size of the bundle to disability and also to the size of the brain. Here is a medical explanation:


Optical coherence tomography in multiple sclerosis.Frohman E, Costello F, Zivadinov R, Stuve O, Conger A, Winslow H, Trip A, Frohman T, Balcer L.
Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 75235, USA. elliot.frohman@utsouthwestern.edu

We do not have currently satisfactory clinical and anatomical correlates to gauge disability in multiple sclerosis. Structural biomarkers (such as MRI) are hindered because they cannot precisely segregate demyelination from axonal elements of tissue injury within the CNS. Axonal degeneration in multiple sclerosis is related to irreversible disability, which suggests that the confirmation of neuroprotective strategies needs highly quantifiable measures of axon loss that can be correlated with reliable measures of physiological function. The coupling of quantifiable measures of visual function with ocular imaging techniques, such as optical coherence tomography, enables us to begin to understand how structural changes in the visual system influence function in patients with multiple sclerosis. In this review, we consider the usefulness of optical imaging of the retina as a biomarker for neurodegeneration in multiple-sclerosis.

PMID: 16987732 [PubMed - indexed for MEDLINE]


I plan on getting the test soon. Optomologists are currently being trained. FYI for anyone living in the Denver, CO area - Dr. Karen Repine
was recommended by the neuro.

Take care everyone,
Sharon[/quote]
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Postby Loriyas » Fri Apr 20, 2007 7:23 am

Sharon
Do you currently have difficulty with your vision and that is why this test is recommended? Is this test/macine new or one that a typical opthamologist would be familiar with? Do you know of a site that may give more info on this type of machine and testing that I could research?
Thanks
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Postby Sharon » Tue Apr 24, 2007 3:40 pm

Lori -

In answer to your questions:

First, a bit of history - I am 63-1/2 yrs old - I was diagnosed in 2003. Looking back, I probably could have been diagnosed 30 years ago.

The MS has not affected my eyesight - I have not experienced Optic Neuritis. My doctor suggested that I have the test completed because it is a new tool for measurement of possible longterm disability. My personal MS has been relatively mild. My yearly MRI's have not changed - they have never showed inflammation or active lesions. But, I do have two spots on the brain and two spots in my spine. Since my MS was not active, I chose not to go on the medications. I do notice that muscle weakness has become gradually worse. Question is "is it MS or is it age?" The neuro said that my weakness could be "micro" changes - stuff that would not show on an MRI, but possibly would show on the RNFL test. There is also a correlation between the changes in size of the nerve bundle to the changes in size of the brain.

The test is a new tool for the doctors - there are not alot of baselines yet, but, the neuro seems to think that it will be used as a standard measurement in MS patients in 3-4 years.

I found quite a bit of information on the internet just by Googling the name of the test and/or the name of the machine and adding the words "multiple sclerosis."

Hope this helps. I have my appointment set for end of June - my insurance will cover the cost since it is medical related.
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Postby carolsue » Wed Apr 25, 2007 2:25 pm

I had this test done last fall for the first time and plan to use this technique to monitor over time.

My neuro offered the idea when I expressed concern about how to monitor progression, how hard to hit this disease, and whether I'm being paranoid about cognitive decline. The test came back very normal.

My understanding was that this machine is fairly expensive and so may not be in every opthamologist's office, but it should be in any advance eye care center.

FYI, my MS is also very mild, and I do not have ON either. But I'm a bit younger, and I'm being more aggressive (on interferon)
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Postby Loriyas » Wed Apr 25, 2007 6:38 pm

Thank you for the information. I happen to have an appt with my neurologist this coming week and will discuss it with her. In fact, we are going to discuss how to track progression, among other things so the timing is great.

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