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Visual pathway axonal loss in benign multiple sclerosis: a longitudinal study
Kristin M Galetta1, Jennifer Graves, Lauren S Talman
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Background:
Benign multiple sclerosis (MS), traditionally defined as Expanded Disability Status Scale (EDSS) score ≤3 and ≥15-year disease duration, is thought to follow a milder clinical course. We determined the extent of visual pathway axonal loss by optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness in a benign MS cohort and examined the relation to vision and quality of life (QOL).
Methods:
In this longitudinal study of vision in MS at 3 academic centers, a subset of patients with EDSS, visual function, OCT, and QOL assessments was analyzed. Low- and high-contrast letter acuity was performed to assess visual function. RNFL thickness was determined using time-domain OCT. QOL scales included the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and Short Form-36 Health Survey.
Results:
Among 68 patients (135 eyes) studied longitudinally, 13 (26 eyes) had benign MS using criteria of EDSS score ≤3 and ≥15-year disease duration. Benign MS eyes had as much RNFL thinning (-3.6 μm, P = 0.0008 vs baseline, paired t test) as typical MS eyes (-3.3 μm, P < 0.0001). Both groups had significant low-contrast acuity loss. History of optic neuritis (ON) was more frequent in benign MS (69% vs 33% of eyes). History of ON distinguished benign vs typical MS (P = 0.002) and correlated with RNFL thickness at baseline (P = 0.002) and disease duration (P = 0.03) but not EDSS (P = 0.32, logistic regression). NEI-VFQ-25 scores were also worse for benign MS, accounting for age (75 ± 21 vs 88 ± 11, P = 0.005).
Conclusion:
Patients with benign MS have RNFL axonal loss that is as marked as that of typical MS and have reduced vision and QOL. While overall neurologic impairment is mild, visual dysfunction, not well captured by the EDSS, accounts for a substantial degree of disability in benign MS.
Insights
Even with mild neurological impairment, benign multiple sclerosis (MS) patients experience significant axonal loss in the visual pathway, leading to reduced vision and quality of life (QOL). This visual dysfunction is not adequately measured by the Expanded Disability Status Scale (EDSS).
Area of Science:
- Neuroscience
- Ophthalmology
- Clinical Neurology
Background:
- Benign multiple sclerosis (MS) is traditionally characterized by mild neurological impairment (Expanded Disability Status Scale [EDSS] ≤3) and long disease duration (≥15 years).
- The extent of visual pathway axonal loss and its impact on vision and quality of life (QOL) in benign MS remain incompletely understood.
Purpose of the Study:
- To quantify retinal nerve fiber layer (RNFL) thickness, a marker of axonal loss, in patients with benign MS using optical coherence tomography (OCT).
- To assess visual function and QOL in benign MS patients and correlate findings with disease characteristics.
Main Methods:
- A longitudinal study analyzed data from patients with MS, including those with benign MS (EDSS ≤3, ≥15-year duration).
- Visual function was assessed using low- and high-contrast letter acuity.
- Retinal nerve fiber layer (RNFL) thickness was measured by time-domain OCT.
- Quality of life (QOL) was evaluated using the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and the Short Form-36 Health Survey.
Main Results:
- Benign MS patients exhibited significant RNFL thinning comparable to typical MS patients.
- Both groups showed reduced low-contrast acuity, with benign MS patients reporting worse QOL scores (NEI-VFQ-25).
- A history of optic neuritis (ON) was more frequent in benign MS and correlated with RNFL thickness and disease duration, but not EDSS.
Conclusions:
- Patients with benign MS experience substantial axonal loss in the visual pathway, similar to typical MS.
- Despite mild overall disability, visual dysfunction significantly contributes to reduced vision and QOL in benign MS.
- The Expanded Disability Status Scale (EDSS) may not fully capture the extent of disability related to visual impairment in benign MS.
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