Retinal ganglion cell loss is associated with future disability worsening in early relapsing–remitting multiple sclerosis

Abstract

Background and purpose: Thinning of the retinal combined ganglion cell and inner plexiform layer (GCIP) as measured by optical coherence tomography (OCT) is a common finding in patients with multiple sclerosis. This study aimed to investigate whether a single retinal OCT analysis allows prediction of future disease activity after a first demyelinating event.Methods: This observational cohort study included 201 patients with recently diagnosed clinically isolated syndrome or relapsing-remitting multiple sclerosis from two German tertiary referral centers. Individuals underwent neurological examination, magnetic resonance imaging, and OCT at baseline and at yearly follow-up visits. Results:Patients were included at a median disease duration of 2.0 months. During a median follow-up of 59 (interquartile range = 43-71) months, 82% of patients had ongoing disease activity as demonstrated by failing the no evidence of disease activity 3 (NEDA-3) criteria, and 19% presented with confirmed disability worsening. A GCIP threshold of ≤77 μm at baseline identified patients with a high risk for NEDA-3 failure (hazard ratio

Association of retinal vessel pathology and brain atrophy in relapsing-remitting multiple sclerosis

“…All MRI examinations were performed during daytime (7 AM to 6 PM). We acquired three-dimensional T1- and T2‐weighted fluid‐attenuated inversion recovery (FLAIR) images as described elsewhere ( 2 ). All MRI examinations were further processed with the software packages SPM12, CAT12 ( https://www.neuro.uni-jena.de/cat12/ ) and LST ( https://www.applied-statistics.de/ ).…”

“…To account for inter-eye correlations of OCT and OCTA measures, we used mean values of both eyes as one single data point when both eyes were available for calculation. If one eye was excluded due to our exclusion criteria (see above), we used the values of the remaining eye as described elsewhere ( 2 ). For evaluation of longitudinal alterations of OCT and OCTA measures, eyes with a history of clinical ON, suspected subclinical ON, or poor image quality at baseline or during the study follow-up were removed from this analysis for every timepoint completely.…”

“…Though the retina reflects an unmyelinated part of the central nervous system (CNS), it is frequently affected by different autoimmune diseases. Atrophy of the retinal nerve fiber layer (RNFL) and ganglion cells is frequently found in most patients with multiple sclerosis (MS) and has been linked to a worse disease prognosis (1)(2)(3)(4). Moreover, ganglion loss over time might reflect CNS atrophy and is discussed as a new biomarker for neurodegenerative processes in the course of MS (5,6).…”

Retinal small vessel pathology is associated with disease burden in multiple sclerosis

“…In patients with MS, inner retinal layer thinning is frequently found and has been linked to neurodegenerative processes in the CNS and might be indicative of a worse disease prognosis. [2][3][4][5][6][7] Beyond retinal layer alterations, growing evidence suggests changes in the retinal vasculature in patients with MS. OCT angiography (OCTA), an extension of OCT imaging, allows for detailed visualization of the retinal vasculature. Here, successive scans are acquired at a single location of the retina.…”

“…In patients with MS, inner retinal layer thinning is frequently found and has been linked to neurodegenerative processes in the CNS and might be indicative of a worse disease prognosis. 2 – 7 …”