No evidence of disease activity is associated with reduced rate of axonal retinal atrophy in MS

Pisa, Marco; Guerrieri, Simone; Maggio, G. Di; Medaglini, S.; Moiola, Lucia; Martinelli, Vittorio; Comı, Gıancarlo; Leocani, Letizia

doi:10.1212/wnl.0000000000004736

Cited by 37 publications

(30 citation statements)

References 35 publications

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“…We detected RNFL thinning on OCT in 56% of MS‐ON eyes and 75% of Ab‐ON eyes, similar to a recent study identifying RNFL thinning in 50% of children with multiple sclerosis and a history of optic neuritis . OCT offers an opportunity to monitor disease activity and progression non‐invasively; in adults with multiple sclerosis, RNFL thinning is a sensitive and specific predictor of clinical disease activity, independent of lesion accumulation on brain MRI . However, it is not yet part of routine clinical practice across all paediatric centres, and robust control data in typically developing children remain limited, as is standardization of RNFL measurements, particularly in the acute phase of optic neuritis when swelling may complicate some automated RNFL measures.…”

Section: Discussionsupporting

confidence: 81%

Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome

Eyre

Hameed

Wright

et al. 2018

Develop Med Child Neuro

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Long-term visual impairment is reported in 40% of children with a relapsing demyelinating syndrome following optic neuritis. Relapse of optic neuritis, occurring more frequently in the non-multiple-sclerosis group. Retinal nerve fibre layer thinning is associated with worse visual outcome. Optical coherence tomography can be used alongside clinical parameters as an objective measure of neuroretinal loss.

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Section: Discussionsupporting

confidence: 81%

Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome

Eyre

Hameed

Wright

et al. 2018

Develop Med Child Neuro

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“…It should be considered for inclusion in composite measures assessing disease activity in clinical trials and routine practice. This is underlined by a recent study showing that loss of pRNFL is reduced in patients showing no evidence of disease activity and is able to correctly classify no evidence of disease activity status in a significant proportion of patients .…”

Section: Discussionmentioning

confidence: 91%

Peripapillary retinal nerve fibre layer thinning rate as a biomarker discriminating stable and progressing relapsing–remitting multiple sclerosis

Bsteh

Hegen

Teuchner

et al. 2019

Euro J of Neurology

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Background and purpose Peripapillary retinal nerve fibre layer (pRNFL) thickness is a strong candidate as a biomarker of axonal degeneration in multiple sclerosis (MS). The aim was to determine a cut‐off value of pRNFL thinning rates in relapsing–remitting MS (RRMS) to discriminate between stable and progressing patients. Methods In this 3‐year prospective longitudinal study on 141 RRMS patients, annual pRNFL thinning rates (aLpRNFL) were determined by individual linear regression models. The best possible cut‐off value discriminating clinically progressing (physical progression or cognitive decline) and stable patients was defined by receiver operating characteristic analysis. Cut‐off values were validated using a multivariate logistic regression model. Results Average aLpRNFL in progressing patients (2.4 μm, SD 2.1) was significantly higher compared to stable patients (0.5 μm, SD 1.2, P < 0.001). At a predefined specificity of 90%, aLpRNFL >1.5 μm was able to distinguish between stable and progressing RRMS with a sensitivity of 76.1%. aLpRNFL >1.5 μm was associated with a 15‐fold increased risk of clinically progressing MS (P < 0.001). Conclusions A cut‐off of aLpRNFL discriminating clinically progressing and stable RRMS was identified. After validation in independent cohorts, this cut‐off could be used as a biomarker of axonal degeneration supporting disease monitoring in daily clinical routine.

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“…Therefore, we cannot conclude that increased axonal damage corresponds to a higher disability. Similarly, other authors were also unable to demonstrate this association (Henderson et al, ; Oreja‐Guevara, Noval, Manzano, & Diez‐Tejedor, ), although recent studies established a relationship between RNFL thickness and risk of disability progression (Martínez‐Lapiscina et al, ), and rate of RNFL thinning and NEDA‐3 at 2 years (AUC = 0.8) (Pisa et al, ) There may be multiple reasons for this, including the short follow‐up period, patient heterogeneity, the small sample sizes used in most studies, or perhaps because EDSS is not sensitive enough to detect changes in disability when there is no motor impairment. Therefore, future studies should aim to use larger sample sizes, longer follow‐up times, and more sensitive scales capable of detecting subtler changes in disability.…”

Section: Discussionmentioning

confidence: 99%

Functional and structural changes in the visual pathway in multiple sclerosis

et al. 2019

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IntroductionMultiple sclerosis (MS) is a heterogeneous disease with an unpredictable course. Visual pathway is a target of the disease and may reflect mechanisms that lead to disability. Structural and functional changes in the visual pathway may be studied by noninvasive techniques such as optical coherence tomography (OCT), visual evoked potentials (VEP), or B‐mode transorbital sonography (TOS).ObjectivesThe aim is to assess changes in the visual pathway in eyes of MS patients with and without a history of optic neuritis over a 3‐year period and to explore their relationship with disability.Materials and MethodsIn total, 112 eyes from 56 patients with relapsing MS were recruited: 29 with, and 83 without a history of ON (hON and nhON, respectively). Several parameters were measured by OCT, VEP, and TOS. Baseline measurements were also compared to 29 healthy controls. At 36 months, measurements were repeated in all eyes.ResultsAt baseline, all tests showed significant differences in optic nerve structure and function in both patient cohorts in all the parameters studied, suggestive of more impairment of the visual pathway among the hON cohort. OCT showed significant differences between healthy controls and the nhON cohort. At 36 months, the nhON cohort showed significant changes by OCT, VEP, and TOS suggestive of further visual pathway impairment. OCT measurements also correlated with baseline EDSS among the nhON cohort.ConclusionsOCT is the most suitable technique and outperforms VEP and TOS to detect subclinical damage in the visual pathway. It discriminated MS patients from healthy controls and showed a progressive decline in optic nerve thickness over time among these patients.

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No evidence of disease activity is associated with reduced rate of axonal retinal atrophy in MS

Cited by 37 publications

References 35 publications

Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome

Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome

Peripapillary retinal nerve fibre layer thinning rate as a biomarker discriminating stable and progressing relapsing–remitting multiple sclerosis

Functional and structural changes in the visual pathway in multiple sclerosis

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