Highlights
- •Multiple Sclerosis is associated with thinning of the inner retina.
- •Female gender and MRI activity was associated with thinning of the MRNFL.
- •Most of the neuroaxonal thinning occurs early in the disease, with another phase of neurodegeneration - Most possibly in later stages.
- •Optical coherence tomography can be a potential outcome measure in therapeutic multiple sclerosis trials.
Abstract
Background
Multiple sclerosis is an inflammatory demyelinating disease characterized by progressive
axonal loss affecting mainly the inner retinal layers. Optical coherence tomography
(OCT) provides in-vivo quantification of the retinal layers and allows measuring progressive
retinal changes. Our objective was to assess the longitudinal changes in the retina
using spectral domain OCT (SDOCT) and to identify independent predictors affecting
retinal thinning in MS patients.
Methods
A prospective study in a tertiary care MS center was conducted to study the longitudinal
retinal changes in MS patients. All subjects underwent baseline and follow up OCT
assessment with segmentation analysis. Regression analysis was performed to assess
clinical factors (age, sex, disease duration, history of optic neuritis before baseline,
non-ocular clinical relapses) and MRI disease activity during the follow-up period.
Results
The study included 102 MS patients with a mean follow-up duration of 3.9 ± SD years.
At the last follow-up assessments, there were significant thinning of the average
macular thickness (AMT) (p < .001), macular nerve fiber layer (MRNFL) (p < .001),
ganglion cell-inner plexiform layer (GCIPL) (p < .001), and the peripapillary nerve
fiber layer (PRNFL) (p < .001), compared to baseline. Early disease duration up to
10 years was associated with thinning of AMT, PRNFL, and GCIPL, while longer disease
duration (> 15 years) was associated with only GCIPL thinning. Prior optic neuritis
was predictive of more thinning of PRNFL (p = < .01), while MRI activity and female
gender were significantly associated with more MRNFL thinning (p = < .01).
Conclusion
MS is associated with longitudinal thinning affecting AMT inner retinal layers (MRNFL,
GCIPL, PRNFL). Early disease duration, female gender, MRI activity, and prior optic
neuritis were predictive of faster rate of neuro-axonal loss. This may have implications
in the design of future therapeutic trials.
Keywords
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Article info
Publication history
Published online: February 11, 2018
Accepted:
February 9,
2018
Received in revised form:
January 16,
2018
Received:
December 3,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
