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Retinal layer thickness predicts disability accumulation in early relapsing multiple sclerosis.

Gabriel Bsteh1, Harald Hegen2, Patrick Altmann1

  • 1Department of Neurology, Medical University of Vienna, Vienna, Austria.

European Journal of Neurology
|January 31, 2023
PubMed
Summary

Retinal nerve fiber layer (pRNFL) and ganglion cell inner plexiform layer (GCIPL) thickness predict disability accumulation in early relapsing multiple sclerosis (RMS). Thinner GCIPL and pRNFL indicate higher risk.

Keywords:
biomarkerdisabilitymultiple sclerosisoptical coherence tomographypredictorretina

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Immunology

Background:

  • Relapsing multiple sclerosis (RMS) is characterized by unpredictable disability accumulation.
  • Early prediction of disability progression is crucial for effective management of RMS.
  • Retinal neurodegeneration, measurable via optical coherence tomography (OCT), may reflect central nervous system changes in MS.

Purpose of the Study:

  • To investigate the predictive value of baseline peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell and inner plexiform layer (GCIPL) thickness for disability accumulation in early RMS.
  • To determine if these retinal measurements add to established predictors of MS progression.

Main Methods:

  • Prospective observational study including 231 newly diagnosed RMS patients.
  • Spectral-domain OCT scans obtained within 90 days of diagnosis.
  • Multivariate Cox regression models used to assess the impact of pRNFL and GCIPL thickness on disability accumulation (Expanded Disability Status Scale [EDSS] score ≥ 3.0) over a median follow-up of 61 months.

Main Results:

  • Lower GCIPL thickness (< 77 μm) and pRNFL thickness (≤ 88 μm) significantly predicted disability accumulation (EDSS ≥ 3).
  • Higher age, incomplete remission, ≥10 MRI lesions, and infratentorial lesions were associated with increased risk.
  • Highly effective disease-modifying treatment showed a protective effect.

Conclusions:

  • Baseline GCIPL and pRNFL thickness are valuable predictors of future disability accumulation in early RMS.
  • Retinal layer thickness measurements provide independent prognostic information beyond established clinical and MRI markers.
  • OCT-derived retinal parameters can enhance risk stratification and personalized treatment strategies in RMS.