Background/Purpose: Vascular dysfunction, characterized by vasospasm and endothelial activation, represents a central and early event in systemic sclerosis (SSc). Ocular vasospasm may induce optic nerve head (ONH) damage and have been involved in the pathogenesis of glaucoma, especially normal-tension glaucoma (NTG). Swept-source optical coherence tomography (OCT) is a high-resolution noninvasive imaging method for the quantitative assessment of the ONH and retinal nerve fiber layer (RNFL) structure changes, which are affected in glaucoma. The present study aimed to investigate the presence of structural abnormalities associated with NTG in SSc patients using OCT. In addition, we evaluated the correlations between OCT parameters and nailfold capillaroscopy and measures of digital blood flow using laser Doppler imaging in SSc patients.

Methods: In this cross-sectional study, patients with SSc (2013 ACR/EULAR classification criteria) and age- and sex-matched controls were included. All participants underwent complete ophthalmological examination, including visual acuity, intraocular pressure, slit-lamp biomicroscopy, gonioscopy and visual field examination. The following parameters were measured using high-speed swept-source OCT (SS-OCT, DRI OCT, Topcon, Tokyo, Japan); mean and sectoral RNFL thickness, sectoral and global macular RNFL thickness, macular ganglion cell layer (GCL), GCL + inner plexiform layer (IPL), RNFL+GCL+IPL thickness and ONH morphology. Furthermore, nailfold capillaroscopy (NFC) and the measurement of the digital blood flow of the second to fifth fingers of the non-dominant hand using Laser Doppler imaging before and after cold stimulus were performed in all patients.

Results: A total of 23 eyes of 23 controls (mean age 55.0 ± 9.2 years), and 40 eyes of 40 SSc patients (mean age 51.9 ± 11.2 years) were evaluated. The mean RNFL was of 104.28 ±11.99 µm in SSc patients and of 108.70 ± 12.14 µm in controls (p=0.19). SSc patients showed a thinner temporal RNFL compared with the controls (63.23 ± 11.74 µm versus 83.35 ± 20.19 µm, respectively; p=0.001). The other parameters were similar between the two groups. In SSc patients, the disease duration showed an inverse correlation with the superior  RNFL thickness (p=0.01), and the macular RNFL thickness in the outer nasal (p = 0.04), inner inferior (p=0.04) and inner nasal (p=0.04) areas. There was also a significant inverse correlation between the disease duration and the total and superior GCL+IPL thickness (p=0.04, p=0.04, respectively). Laser Doppler imaging measurements did not show significant correlation with OCT parameters. There was an inverse correlation between the avascular score in NFC and the vertical cup/disco ratio (p=0.012) and a positive correlation with the central macular and the fovea thickness segments (p=0.037, p=0.006, respectively).

Conclusion: The significantly thinner temporal RNFL, but not ONH abnormalities observed in patients with SSc, suggest the presence of early structural damage that may result in ganglion cell damage. Further prospective studies with higher number of patients are necessary to better understand the impact of structural RNFL damage in SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/structural-abnormalities-of-the-optic-nerve-head-and-retinal-nerve-fiber-layer-using-optical-coherence-tomography-in-patients-with-systemic-sclerosis/