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The Retina in Multiple System Atrophy: Systematic Review and Meta-Analysis
Carlos E Mendoza-Santiesteban1, Iñigo Gabilondo2, Jose Alberto Palma1
1Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States.
Frontiers in Neurology
|June 10, 2017
Summary
Multiple system atrophy (MSA) causes retinal nerve fiber layer thinning, particularly sparing the temporal region. This suggests damage to specific nerve cell pathways, differing from Parkinson disease.
Area of Science:
- Neuroscience
- Ophthalmology
- Neuropathology
Background:
- Multiple system atrophy (MSA) is a rare, fatal neurodegenerative disease primarily affecting oligodendroglial cells.
- Patients with MSA rarely report visual issues, yet retinal imaging reveals potential damage.
Purpose of the Study:
- To investigate retinal structural changes in Multiple System Atrophy (MSA) patients using optical coherence tomography (OCT).
- To compare retinal findings in MSA with those in Parkinson disease (PD).
Main Methods:
- A systematic literature review and meta-analysis of studies published before January 2017.
- Included studies reported OCT outcomes in MSA patients and controls, analyzed using a random-effects model.
Main Results:
- Meta-analysis of 7 studies revealed significant thinning of the peripapillary retinal nerve fiber layer (RNFL) in MSA patients (pooled difference: -5.48 μm).
- Thinning occurred in all RNFL quadrants except the temporal sector, where thickness was similar between MSA and controls.
- This pattern suggests preferential loss of retinal ganglion cells projecting to the magnocellular pathway, sparing those crucial for visual acuity.
Conclusions:
- Retinal damage in MSA differs from Parkinson disease, with relative preservation of the temporal RNFL and macular ganglion cell layer in MSA.
- Hypothesized predominant damage to large myelinated optic nerve axons (M-cells) in MSA, requiring greater oligodendrocyte support.
- Parvocellular pathway (P-cells) may be more affected in Parkinson disease.
