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Central and Peripheral Alterations of Retinal and Choroidal Vasculature in Multiple Sclerosis: Insights from
Jamie Mitchell1, Gemma McIlwaine1, Emma Pead2
1Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.
Purpose:
To evaluate retinal and choroidal vascular alterations in multiple sclerosis (MS) using multimodal imaging and determine their association with disability and disease progression.
Design:
Prospective, observational, single center, cross-sectional, case-control study.
Participants:
Sixteen MS and 25 control participants.
Methods:
Multimodal retinal imaging, including color fundus photography, ultra-widefield imaging, OCT, and OCT angiography, were performed. Retinal vascular parameters (RVPs) and choroidal vascular parameters (CVPs) were compared between control eyes and eyes with (eyes with a history of optic neuritis [MSON]) and without optic neuritis (ON) (eyes without a history of ON [MSnON]) using regression models. Associations of RVPs and CVPs with Expanded Disability Status Scale (EDSS) scores and annual EDSS progression rate were assessed. Subanalysis compared RVPs and CVPs between MSnON and MSON eyes using Wilcoxon rank-sum tests.
Main Outcome Measures:
Differences in RVPs and CVPs between groups and associations with EDSS and annual rate of EDSS progression.
Results:
Compared with controls, MSnON eyes showed narrower central retinal venules (P = 0.014), increased arteriole-to-venule ratio (AVR) (P = 0.031), and reduced venular fractal dimension (FD) (P = 0.013). Disability correlated with increased venular caliber (P < 0.001), vessel density (P = 0.026), superficial vascular complex (SVC) capillary density (P < 0.001), and choroidal thickness (P = 0.006), and decreased AVR (P = 0.006) and choroidal vascularity index (P = 0.030). Annual EDSS progression was associated with increased arteriolar caliber (P = 0.001), AVR (P= 0.025), SVC capillary density (P < 0.001), foveal avascular zone (FAZ) volume (P < 0.001), and deep FAZ area (P < 0.001) and a decreased venular width gradient (P = 0.011) and FD (P < 0.001). Eyes with a history of ON eyes showed narrower venular caliber (P = 0.008), density (P = 0.012), and FD (P = 0.006). When MSON and MSnON are compared, ON affected only central arteriolar caliber (P = 0.010) and global SVC density (P = 0.010).
Conclusions:
Structural retinal and choroidal vascular alterations in MS were associated with disability and disease progression. These findings highlight the importance of retinal vascular assessments in the diagnosis, monitoring, and prognostication of MS, warranting confirmation in longitudinal studies.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Insights
Retinal and choroidal vascular changes in multiple sclerosis (MS) are linked to disability and disease progression. These findings suggest retinal vascular imaging may aid in MS monitoring and prognosis.
Area of Science:
- Ophthalmology
- Neurology
- Medical Imaging
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease.
- Understanding vascular alterations in MS is crucial for disease management.
- Multimodal imaging offers insights into retinal and choroidal vasculature.
Purpose of the Study:
- To evaluate retinal and choroidal vascular alterations in MS using multimodal imaging.
- To determine the association of these vascular changes with disability and disease progression in MS patients.
Main Methods:
- A prospective, observational, cross-sectional study involving 16 MS patients and 25 controls.
- Multimodal retinal imaging (color fundus photography, ultra-widefield imaging, OCT, OCT angiography) was performed.
- Retinal vascular parameters (RVPs) and choroidal vascular parameters (CVPs) were analyzed and correlated with Expanded Disability Status Scale (EDSS) scores and progression rates.
Main Results:
- Eyes with MS (with and without history of optic neuritis) showed significant differences in RVPs compared to controls, including narrower venules and altered arteriole-to-venule ratio (AVR).
- Disability (EDSS) correlated with increased venular caliber, vessel density, superficial vascular complex (SVC) capillary density, and choroidal thickness, and decreased AVR and choroidal vascularity index.
- Disease progression was associated with increased arteriolar caliber, AVR, SVC capillary density, foveal avascular zone (FAZ) volume, and decreased venular width gradient and fractal dimension (FD).
Conclusions:
- Structural retinal and choroidal vascular alterations are significantly associated with disability and disease progression in MS.
- These findings underscore the potential of retinal vascular assessments for MS diagnosis, monitoring, and prognosis.
- Further longitudinal studies are warranted to confirm these associations and their clinical utility.
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
01:19Imaging Studies VII: Vascular Imaging