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Reduced Cone Density Is Associated with Multiple Sclerosis
Gemma McIlwaine1, Lajos Csincsik1,2, Rachel Coey1
1Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.
Purpose:
Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system. Recent evidence suggests that degeneration of the inner layers of the retina occurs in MS. This study aimed to examine whether there are outer retinal changes in patients living with MS.
Design:
This was a single center, cross-sectional study.
Participants:
Sixteen patients with MS and 25 controls (volunteers without diagnosed MS) were recruited for the study.
Methods:
We acquired volumetric spectral domain-OCT scans of the macula and a circular scan around the optic nerve head (ONH). We also captured adaptive optics (AO) images at 0° (centered on the foveola), 2°, 4°, and 6° temporal to the fovea.
Main Outcome Measures:
We calculated the thickness of the different retinal layers in the macula and around the ONH using the inbuilt software of the OCT. We evaluated changes in cone photoreceptors by calculating cone density and spacing by the inbuilt AO automatic segmentation algorithm with manual correction. We compared patients with and without optic neuritis and controls.
Results:
We found significant thinning of the inner retina and a thickening of the outer retina in the eye with a history of optic neuritis (eyes of patients with MS with a history of optic neuritis; mean difference [MD]: -11.13 ± 3.61 μm, P = 0.002 and MD: 2.86 ± 0.89 μm, P = 0.001; respectively). We did not observe changes in retinal layers without optic neuritis in eyes of patients with MS without a history of optic neuritis. However, regional differences were detected in the peripapillary retinal nerve fiber layer. Analyzing AO images revealed a significantly lower cone outer-segment density at all eccentricities in all patients compared with control eyes (P < 0.05), independent of optic neuritis history.
Conclusions:
Our results showed that all MS cases were associated with decreased cone densities. Future longitudinal studies will help to elucidate whether this is a specific and sensitive method to detect and monitor the development and progression of MS.
Financial Disclosures:
Proprietary or commercial disclosure may be found after the references.
Insights
Multiple sclerosis (MS) is linked to retinal changes. Patients with MS showed decreased cone density, and those with optic neuritis experienced inner retinal thinning and outer retinal thickening.
Area of Science:
- Ophthalmology
- Neuroscience
- Immunology
Background:
- Multiple sclerosis (MS) is an inflammatory neurodegenerative disease affecting the central nervous system.
- Retinal degeneration, particularly in inner retinal layers, is increasingly recognized in MS patients.
- Outer retinal changes in MS remain less understood.
Purpose of the Study:
- To investigate outer retinal structural changes in patients with multiple sclerosis (MS).
- To compare retinal layer thickness and cone photoreceptor density between MS patients and healthy controls.
Main Methods:
- A cross-sectional study involving 16 MS patients and 25 controls.
- Acquisition of spectral domain-OCT scans for macular and optic nerve head analysis.
- Adaptive optics (AO) imaging to assess cone photoreceptor density at various retinal eccentricities.
Main Results:
- Eyes with a history of optic neuritis in MS patients showed significant inner retinal thinning and outer retinal thickening.
- Cone outer-segment density was significantly reduced in all MS patients compared to controls, irrespective of optic neuritis history.
- Regional differences in the peripapillary retinal nerve fiber layer were observed in MS patients without optic neuritis.
Conclusions:
- All MS patients exhibited decreased cone densities, suggesting a potential biomarker.
- Outer retinal changes, particularly in cone photoreceptors, are present in MS.
- Further longitudinal studies are warranted to confirm the utility of these findings for MS detection and monitoring.
