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Cup-to-Disc Ratio Is Associated with Disability in Multiple Sclerosis: A Combined OCT and Subjective Visual Vertical
Ieva Vienažindytė1, Tautvydas Klėgėris2, Ingrida Ulozienė2
1Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Medicina (Kaunas, Lithuania)
|June 26, 2026
Summary
Higher cup-to-disc ratio (CDR) in optical coherence tomography (OCT) scans, but not peripapillary retinal nerve fiber layer (pRNFL) thickness, correlated with disability in multiple sclerosis (MS) patients. Further research is needed to confirm these findings due to potential confounding factors.
Area of Science:
- Ophthalmology
- Neurology
- Biomarker Discovery
Background:
- Non-invasive biomarkers are crucial for monitoring neurodegeneration in multiple sclerosis (MS).
- Optical coherence tomography (OCT) measures retinal structure, including peripapillary retinal nerve fiber layer (pRNFL) thickness.
- Optic nerve head morphology, like cup-to-disc ratio (CDR), is an under-explored OCT parameter in MS.
Purpose of the Study:
- To investigate the association between OCT-derived parameters (pRNFL thickness and CDR) and clinical disability in MS patients.
- To explore the relationship between OCT parameters, subjective visual vertical (SVV), and disability.
- To assess the predictive value of baseline OCT parameters for future disability progression.
Main Methods:
- Retrospective analysis of 100 MS patients, including OCT scans (pRNFL and CDR) and Expanded Disability Status Scale (EDSS) scores.
- SVV was measured in 37 patients using a virtual reality protocol.
- Statistical analyses included Spearman correlation and multivariable linear regression, adjusted for age, sex, and follow-up duration.
Main Results:
- pRNFL thickness showed no association with baseline or changes in EDSS.
- Baseline CDR significantly correlated with both baseline and follow-up EDSS (p < 0.0001).
- Adjusted regression models confirmed CDR as a significant predictor of follow-up EDSS (p = 0.0002).
Conclusions:
- Higher CDR, an indicator of optic nerve head morphology, is associated with greater disability in MS.
- pRNFL thickness was not found to be associated with disability in this cohort.
- Findings require cautious interpretation due to limitations in accounting for optic neuritis history and physiological CDR variability.
