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Retinal layer segmentation in multiple sclerosis: a systematic review and meta-analysis.

Axel Petzold1, Laura J Balcer2, Peter A Calabresi3

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Spectral domain optical coherence tomography (SD-OCT) reveals retinal layer atrophy in multiple sclerosis (MS). The peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer (GCIPL) show significant thinning, aiding MS diagnosis and monitoring.

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Medical Imaging

Background:

  • Structural retinal imaging is crucial for detecting inflammation and neurodegeneration in multiple sclerosis (MS).
  • Spectral domain optical coherence tomography (SD-OCT) enables supervised automated segmentation of retinal layers.
  • Investigating retinal layer atrophy via SD-OCT can identify neurodegeneration markers in MS.

Purpose of the Study:

  • To systematically review and meta-analyze studies using SD-OCT to assess retinal layer thickness in individuals with MS.
  • To identify specific retinal layers exhibiting atrophy associated with neurodegeneration in MS.
  • To compare retinal layer thickness between healthy controls, MS with optic neuritis (MSON), and MS without optic neuritis (MSNON).

Main Methods:

  • Systematic literature search of PubMed, Web of Science, and Google Scholar for SD-OCT studies in MS patients (1991-2016).
  • Inclusion of cross-sectional and longitudinal studies, classifying eyes into healthy controls, MSON, and MSNON groups.
  • Random effects meta-analysis to assess retinal layer thickness differences and bias using funnel plots.

Main Results:

  • Significant thinning of the peripapillary retinal nerve fiber layer (RNFL) was observed in both MSON and MSNON eyes compared to controls.
  • Macular RNFL and ganglion cell-inner plexiform layer (GCIPL) also showed significant thinning in MSON and MSNON eyes versus controls.
  • Inner nuclear layer (INL) showed slight thickening in MSON eyes; outer retinal layers showed no significant differences between MS and control eyes.

Conclusions:

  • The peripapillary RNFL and macular GCIPL exhibit the most substantial and consistent thinning in MS patients.
  • These specific retinal layers (RNFL and GCIPL) are recommended for inclusion in MS diagnosis, monitoring, and research due to their robustness.
  • The INL may potentially reflect inflammatory disease activity in MS.