Retinal asymmetry in multiple sclerosis.

Area of Science:

• Ophthalmology and Neuroscience
• Medical Imaging and Diagnostics

Background:

• Multiple sclerosis (MS) diagnosis relies on clinical and paraclinical tests.
• Retinal optical coherence tomography (OCT) shows promise in detecting MS-related changes.
• Assessing inter-eye retinal asymmetry via OCT could offer a novel diagnostic approach.

Purpose of the Study:

• To evaluate the feasibility of using OCT-derived retinal asymmetry measures for diagnosing MS at a community level.
• To compare the diagnostic performance of different retinal layers and asymmetry metrics (IEPD, IEAD) for MS detection.

Main Methods:

• Community-based study of 72,120 subjects using UK Biobank data (2007-2010).
• Calculated inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD) for macular RNFL, GCIPL, and ganglion cell complex.
• Utilized receiver operating characteristic curve (AUROC) analysis to assess discriminatory power, accounting for comorbidities.

Main Results:

• The macular GCIPL complex showed the highest diagnostic power (AUROC 0.71 for both IEPD and IEAD).
• Sensitivity for GCIPL complex IEPD (4% cut-off) was 51.7%, and for IEAD (4 µm cut-off) was 43.5%, with specificities of 82.8% and 86.8%.
• Diagnostic power decreased with increased comorbidities; the metric could not differentiate MS from neuromyelitis optica spectrum disease.

Conclusions:

• OCT macular GCIPL complex asymmetry (IEPD, IEAD) can serve as a supportive diagnostic measure for MS in young patients without significant comorbidities.
• Current sensitivity and specificity levels require improvement for widespread clinical adoption.
• Retinal OCT offers a rapid, non-invasive, and accessible imaging modality that could reduce the need for more invasive diagnostic procedures.