Differentiating Multiple Sclerosis and Glaucoma With Sectoral Pattern Analysis of Peripapillary Nerve Fiber Layer

Purpose: To distinguish between multiple sclerosis (MS) and glaucoma by nerve fiber layer (NFL) thinning patterns. Methods: MS patients were diagnosed by the 2017 McDonald Criteria; glaucoma patients had disc rim thinning or an NFL defect, with or without perimetric defect. The peripapillary NFL thickness was divided into eight sectors, and percentage reduction (% reduction) was calculated relative to normative reference values. The MS and glaucoma eyes were grouped based on the severity of NFL thinning in the worst sector: significant reduction (<1 percentile of normal reference), borderline reduction (1%∼5%), and no reduction (>5%). We devised four diagnostic indexes, and the area under the curve of receiver operating characteristics (AROC) and accuracy were used to evaluate the indexes. Results: We enrolled 58 control subjects (58 eyes), 56 MS subjects (112 eyes), and 92 glaucoma subjects (92 eyes) at two centers. The most pronounced percent reduction in MS eyes occurred in the temporal-upper and temporal-lower sectors. In glaucoma eyes, this occurred in the inferior-temporal, inferior-nasal, and superior-temporal sectors. The temporal pattern index had the best AROC (0.96, 0.91–1.00) and accuracy (92.6%) in the significant reduction group. It had good AROC (0.88, 0.78–0.99) and accuracy (76.7%) in the borderline reduction group. Conclusions: Normalizing NFL reduction as a percentage of normal reference accentuated patterns characteristic of MS and glaucoma. Quantitative pattern indexes were effective in differentiating the two diseases. Translational Relevance: The utility of optical coherence tomography in the differential diagnosis of optic neuropathies is enhanced by analyzing the retinal nerve fiber layer percentage reduction pattern.