Abstract Details

Title Investigating the Structure and Function of the Retinohypothalamic Tract in Neuromyelitis Optica by Optical Coherence Tomography (OCT) and Pupillometry

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-005

Objective To characterize structural abnormalities of retinal architecture in patients with neuromyelitis optica spectrum disorder (NMOSD) and a history of optic neuritis with corresponding alterations in the melanopsin-mediated sustained pupillary constriction response.

Background

The melanopsin-mediated persistent constriction phase of the pupillary light reflex is a potential surrogate for the retinohypothalamic tract and mechanism for studying input into homeostatic dysregulation in brain disorders. Previous work has shown damage in patients with multiple sclerosis and evidence of structural damage to retinal architecture. However, these findings have not yet been shown in other immune mediated disorders affecting the optic nerve, such as NMOSD.

Design/Methods This case-control study compares the melanospin-mediated, sustained pupillary constriction phase response following cessation of a blue light stimulus when compared with photoreceptor-mediated pupillary constriction phase response in NMOSD patient eyes with a history of optic neuritis to healthy control eyes. This functional assessment was compared to objective measurement of retinal structure, the thickness of the retinal ganglion cell layer and inner plexiform layer (GCL+IPL), as measured by optical coherence tomography (OCT).

Results Eyes from individuals with NMOSD and a history of optic neuritis and reduced thickness of the GCL+IPL showed significant attenuation of the melanopsin-mediated sustained pupillary response when compared to eyes from individuals with NMOSD without a history of optic neuritis or normal controls (both with normal GCL+IPL thickness).

Conclusions Attenuation of the melanopsin-mediated sustained pupillary constriction response was associated with thinning of the GCL+IPL layer in eyes of patients with a history of NMOSD. This attenuated response in NMOSD patients is a potential surrogate marker of dysfunction of the retinohypothalamic tract and provides further evidence that this pathway can be used to study other disorders of the brain and retina that might impact retinohypothalamic input.

Authors/Disclosures
Ethan I. Meltzer, MD (Dell Medical School, The University of Texas at Austin) PRESENTER	Dr. Meltzer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon therapeutics. Dr. Meltzer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. Dr. Meltzer has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis. Dr. Meltzer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Meltzer has received research support from Genentech. Dr. Meltzer has received publishing royalties from a publication relating to health care.
Peter Sguigna, MD (UT Southwestern Medical Center)	Dr. Sguigna has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Sguigna has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Sguigna has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Sguigna has received research support from Genentech. The institution of Dr. Sguigna has received research support from Clene Nanomedicine. The institution of Dr. Sguigna has received research support from The International Progressive Multiple Sclerosis Alliance through the National Multiple Sclerosis Society. The institution of Dr. Sguigna has received research support from PCORI. The institution of Dr. Sguigna has received research support from DOD/CDMRP. The institution of Dr. Sguigna has received research support from Alexion. Dr. Sguigna has received intellectual property interests from a discovery or technology relating to health care.
Teresa Frohman, PA (Frohman & Frohman, PLLC)	No disclosure on file
	No disclosure on file
Elliot M. Frohman, MD, FAAN	Dr. Frohman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Janssen. Dr. Frohman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Janssen. Dr. Frohman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date. Dr. Frohman has received publishing royalties from a publication relating to health care.

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