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Association of epiretinal membranes with disability in people with multiple sclerosis
Ting-Yi Lin1, Anna Bacchetti1, Brenna McCormack1
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background:
Epiretinal membranes (ERMs) consist of glial and fibrocellular tissue, potentially arising from pathologic microgliosis, macrogliosis, and/or retinal pigment epithelium (RPE) cell migration. The clinical relevance of ERMs in people with multiple sclerosis (PwMS) remains largely unstudied.
Objectives:
To investigate ERM prevalence and their associations with retinal layer thicknesses and disability measures in PwMS.
Methods:
PwMS exhibiting ERMs (ERM+) were matched 1:1 with PwMS without ERMs (ERM-) by optic neuritis (ON) history, multiple sclerosis (MS) subtype, age, sex, and race. Disability assessments included high-contrast/low-contrast letter acuity (HC-/LCLA), Expanded Disability Status Scale (EDSS), walking speed test (WST), manual dexterity test (MDT), and processing speed test (PST) scores.
Results:
Among 1264 participants screened (1120 PwMS and 144 healthy controls [HCs]), ERMs were observed in 206 PwMS (18.4%) and 17 HCs (11.8%). ERM+ PwMS exhibited higher EDSS (1.0 ± 0.3, p = 0.002), longer WST (0.8 ± 0.2 seconds, p < 0.001), longer MDT (2.2 ± 0.5 seconds, p < 0.001), lower PST (-3.0 ± 1.4, p = 0.08), lower LCLA (-4.2 ± 1.1 letters, p < 0.001), and lower ganglion cell-inner plexiform layer (-1.8 ± 0.8 µm, p = 0.03), inner nuclear layer (-0.8 ± 0.3 µm, p = 0.01), outer nuclear layer (-1.6 ± 0.6 µm, p = 0.01), and RPE (-0.5 ± 0.1 µm, p < 0.001) thicknesses. Higher ERM stage correlated with greater disability.
Conclusion:
ERMs may identify a distinct MS phenotype, potentially characterized by pathological microglial and/or macroglial activity. ERMs may be a marker of similar global processes throughout the central nervous system that potentially contribute to greater overall disability.
Insights
Epiretinal membranes (ERMs) were found in 18.4% of people with multiple sclerosis (PwMS), correlating with increased disability and retinal thinning. ERMs may indicate a distinct MS phenotype linked to central nervous system processes.
Area of Science:
- Ophthalmology
- Neuroscience
- Immunology
Background:
- Epiretinal membranes (ERMs) are fibrocellular growths potentially linked to glial activation and retinal pigment epithelium (RPE) migration.
- The clinical significance of ERMs in people with multiple sclerosis (PwMS) is not well understood.
Purpose of the Study:
- To determine the prevalence of ERMs in PwMS.
- To examine the association between ERMs, retinal layer thickness, and disability in PwMS.
Main Methods:
- A cohort of PwMS with ERMs (ERM+) was compared to a matched cohort of PwMS without ERMs (ERM-).
- Matching criteria included optic neuritis history, MS subtype, age, sex, and race.
- Disability was assessed using measures like the Expanded Disability Status Scale (EDSS), walking speed, manual dexterity, and processing speed tests.
Main Results:
- ERMs were detected in 18.4% of PwMS, compared to 11.8% of healthy controls.
- ERM+ PwMS showed significantly higher EDSS scores, slower walking and manual dexterity tests, and reduced processing speed and low-contrast letter acuity.
- ERM+ PwMS also exhibited thinner retinal layers, including the ganglion cell-inner plexiform, inner nuclear, outer nuclear, and RPE layers.
- Higher ERM stage correlated with increased disability.
Conclusions:
- ERMs may signify a unique multiple sclerosis (MS) phenotype associated with microglial/macroglial activity.
- The presence of ERMs could serve as a biomarker for widespread central nervous system pathology contributing to greater disability in PwMS.
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