Evaluation of Retinal Layer Thickness Parameters as Biomarkers in a Real-World Multiple Sclerosis Cohort

Abstract

Retinal layer thickness parameters measured by optical coherence tomography (OCT) are emerging biomarkers of neuroaxonal degeneration and inflammation in multiple sclerosis (MS). We aimed to evaluate the value of retinal layer thickness for prediction of disability worsening and relapse in a real-world MS cohort. Patients and Methods: For this longitudinal observational study, we included MS patients with spectral-domain OCT scans available and ≥1 year of clinical follow-up. The value of peripapillary retinal nerve fiber layer (pRNFL), macular ganglion-cell-and-inner-plexiformlayer (GCIPL) and inner nuclear layer (INL) thickness for prediction of disability worsening and relapse during the observation period was tested by multivariate models. Results: We analyzed 60 MS patients during a mean observation period of 2.9 years (SD 1.8). Lower baseline thickness of GCIPL (cut-off <77µm; HR 4.1, p=0.001) and pRNFL (cut-off ≤88µm; HR 3.1, p=0.019) were associated with an increased risk of disability worsening. Longitudinally, mean thinning rates were −0.8µm/year (SD 1.6) for GCIPL, −0.6µm/year (SD 3.5) for pRNFL. GCIPL thinning ≥1.0µm/year and pRNFL >1.5µm/year is associated with higher likelihood of disability worsening (HR 5.7, p=0.009 and HR 6.8, p=0.003, respectively). INL thickened in patients with relapse by a mean 0.9µm while thinning by 0.3µm in patients without relapse (p=0.04). In multivariate analyses, INL thickening was associated with an increased probability of relapse (OR 17.8, p=0.023). Conclusion: Cross-sectional and longitudinal measurement of GCIPL and pRNFL thinning is reliable as a biomarker of disability worsening in a real-world setting. Change of INL thickness is a promising marker of relapse, i.e. inflammatory activity.

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

“…Other authors reached the same conclusion, showing that GCIPL thinning >1 lm/year represented an increased risk of disability worsening. 51 As shown above, several longitudinal studies demonstrated the relationship between RNFL thickness and disability progression. After proving the good performance of AI with OCT data for the diagnosis of this disease, the next step could be to apply AI using OCT data for MS prognosis.…”

“…Rothman et al 47 showed that lower baseline macular volume was associated with higher 10-year EDSS scores. Paying attention to RNFL thickness, the study conducted by Schurz et al 51 demonstrated how a pRNFL thinning > 1.5 lm/year was related to a higher likelihood of disability worsening. The same annual pRNFL thinning rate was used to discriminate between stable and progressing MS patients, and was associated with a 15fold increased risk of disability progression.…”

Association of Cerebrospinal Fluid Parameters and Neurofilament Light Chain With Retinal Nerve Fiber Layer Thickness in Multiple Sclerosis

“…Data on aLpRNFL was only available for 25 patients with only 6 of them showing signs of progression. We did not include GCIPL thickness which is reported to be even a more sensitive biomarker of disease progression in MS ( 5 , 32 , 33 ). Also, paired serum and CSF samples for NfL analysis were not available for all subjects.…”

Citicoline: A Candidate for Adjunct Treatment of Multiple Sclerosis

“…Moreover, in POAG patients, oral citicoline treatment halted the decrease in retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), their thickness monitored by optical coherence tomography (OCT) [55]. Interestingly, many MS patients have thinner retinal layers than healthy controls, and retinal thickness measured with OCT correlates with their disability and risk of disability worsening [56,57].…”