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Inner Retinal Layer Changes Reflect Changes in Ambulation Score in Patients with Primary Progressive Multiple

Jonathan A Gernert1, Luise Böhm1, Michaela Starck2

  • 1Institute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, 81377 Munich, Germany.

International Journal of Molecular Sciences
|August 26, 2023
PubMed
Summary

Optical coherence tomography (OCT) can track retinal thinning in multiple sclerosis (MS) patients, correlating with worsening walking ability. This imaging tool aids in monitoring disease progression, especially in primary-progressive MS (PPMS).

Keywords:
ambulatory functional scoremultiple sclerosis (MS)optical coherence tomography (OCT)primary progressive multiple sclerosis (PPMS)relapsing–remitting multiple sclerosis (RRMS)

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Area of Science:

  • Ophthalmology and Neuroscience
  • Neurodegenerative Diseases
  • Medical Imaging

Background:

  • Establishing surrogate markers for multiple sclerosis (MS) disability progression is crucial for effective patient monitoring.
  • Optical coherence tomography (OCT) shows potential for tracking neuroaxonal degeneration but lacks extensive longitudinal data in primary-progressive MS (PPMS).
  • The association between OCT parameters and ambulatory function in MS patients requires further investigation.

Purpose of the Study:

  • To compare annual retinal layer changes in persons with MS (PwMS), including relapsing-remitting MS (RRMS) and PPMS, against healthy controls (HC) using OCT.
  • To assess the relationship between OCT-derived retinal parameters and worsening ambulatory function in PPMS patients.

Main Methods:

  • Retrospective analysis of longitudinal OCT data from two German MS centers, including PwMS (PPMS and RRMS) and HC.
  • Measurement of walking ability using a 500m standardized distance, categorized by the Ambulatory Scale (AS) and Expanded Disability Status Scale (EDSS).
  • Inclusion of 119 PwMS and 61 HC, with a median follow-up of 3 years for PwMS.

Main Results:

  • Significant differences in annual relative changes of peripapillary retinal nerve fiber layer (pRNFL) and inner nuclear layer (INL) were observed in PwMS compared to HC.
  • Annual atrophy rates did not differ between RRMS and PPMS subgroups.
  • In PPMS, worsening AS was significantly linked to thinning in total macular volume (TMV), ganglion cell and inner plexiform layer (GCIP), and outer nuclear/plexiform layers (ONPL). Each -0.1% decrease in TMV, GCIP, and ONPL increased AS deterioration risk by 31%, 11%, and 16%, respectively.
  • Worsening EDSS in PPMS correlated significantly with atrophy rates in pRNFL, TMV, and GCIP.

Conclusions:

  • OCT can effectively measure disability progression in PPMS, with increasing inner retinal layer atrophy rates associated with declining ambulation.
  • OCT is a reliable, side-effect-free imaging modality suitable for routine monitoring of PwMS.
  • Retinal neuroaxonal degeneration detected by OCT serves as a valuable biomarker for MS progression.