Association of Spectral-Domain OCT With Long-term Disability Worsening in Multiple Sclerosis

Abstract

Objective:To evaluate whether a retinal spectral-domain optical coherence tomography (SD-OCT) assessment at baseline is associated with long-term disability worsening in people with multiple sclerosis (PwMS), we performed SD-OCT and Expanded Disability Status Scale (EDSS) assessments among 132 PwMS at baseline and at a median of 10 years later.Methods:In this prospective, longitudinal study, participants underwent SD-OCT, EDSS, and visual acuity (VA) assessments at baseline and at follow-up. Statistical analyses were performed using generalized linear regression models, adjusted for age, sex, race, MS subtype, and baseline disability. We defined clinically meaningful EDSS worsening as an increase of ≥2.0 if baseline EDSS score was <6.0, or an increase of ≥1.0 if baseline EDSS score was ≥6.0.Results:132 PwMS (mean age: 43 years; n=106 patients with relapsing remitting MS) were included in analyses. Median duration of follow-up was 10.4 years. In multivariable models excluding eyes with prior optic neuritis, relative to patients with an average baseline ganglion cell+inner plexiform layer (GCIPL) thickness ≥70µm (the mean GCIPL thickness of all eyes at baseline), an average baseline GCIPL thickness <70µm was associated with a 4-fold increased odds of meaningful EDSS worsening (adjusted odds ratio: 3.97; 95% CI: 1.24-12.70; p=0.02), and an almost 3-fold increased odds of low-contrast VA worsening (adjusted odds ratio: 2.93; 95% CI: 1.40-6.13; p=0.04).Conclusions:Lower baseline GCIPL thickness on SD-OCT is independently associated with long-term disability worsening in MS. Accordingly, SD-OCT at a single time-point may help to guide therapeutic decision making among individual PwMS.Classification of Evidence:This study provides Class I evidence that lower baseline GCIPL thickness on SD-OCT is independently associated with long-term disability worsening in MS.

Comparison of Machine Learning Methods Using Spectralis OCT for Diagnosis and Disability Progression Prognosis in Multiple Sclerosis

“… 8 Moreover, a baseline pRNFL thickness <88 µm was reflected in a 3-fold increased risk of EDSS progression. 7 Also ganglion cell-inner plexiform layer (GCIPL) showed promise for this purpose, where a baseline GCIPL thickness < 70 µm was independently associated with long-term disability worsening in MS. 26 Similar result was obtained by Bsteh et al . 6 who set the baseline macular GCIPL (mGCIPL) barrier at 77 µm and the annual mGCIPL loss rate barrier at 1 µm.…”

Optical Coherence Tomography and Visual Evoked Potentials as Prognostic and Monitoring Tools in Progressive Multiple Sclerosis

“…Most of the evidence available in the field is actually related to the RRMS course, with neuroretinal atrophy being associated with disease activity ( Pisa et al, 2017 ), but with the possibility to detect RNFL and GCIPL thinning over time in MS patients with progression independent of relapse activity (PIRA; Bsteh et al, 2020 ; Pisa et al, 2020 ). Cross-sectional RNFL, total macular volume (TMV), and GCIPL thickness measures independently predicted long-term disability in large cohorts of predominately RRMS patients ( Martinez-Lapiscina et al, 2016 ; Rothman et al, 2019 ; Lambe et al, 2021 ), while the application of mathematical models has suggested RNFL evolution, resulting from a mix of inflammatory and degenerative processes, to accurately reflect disability progression over time ( Montolío et al, 2019 ).…”

Brain Volume Loss Can Occur at the Rate of Normal Aging in Patients with Multiple Sclerosis Who Are Free from Disease Activity

“…Second, damage to the optic nerve, which may lead to retrograde axonal decay, is virtually ubiquitous in patients with MS and may lead to extensive tissue pathology in the retina, characterized by the loss of ganglion cells and their axons, respectively organized as the ganglion cells and inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) [32]. Studies using optical coherence tomography, which is a non-invasive technique allowing detailed in vivo imaging of the different retinal layers, have provided consistent evidence of reduced GCIPL and RNFL thickness in patients with MS [33], irrespective of having a previous clinical history of optic neuritis or not [34,35]; and correlating with poor vision, global disability, compromised quality of life and, interestingly, also with BVL on MRI [36][37][38][39][40]. Pisa and colleagues noted a relatively preserved RNFL in 20 subjects with MS who were categorized as NEDA-3 after a 2-year evaluation period, compared with those not meeting the respective criteria (n = 43) [41].…”