Lower baseline retinal thickness in patients with MS correlates with long-term disability
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Decreased ganglion cell-inner plexiform layer thickness at baseline as assessed by optical coherence tomography correlated with a four-fold greater risk for long-term disability worsening in MS, according to findings published in Neurology.
“Our interest in using retinal optical coherence tomography [OCT] started in 2006 through a collaboration with Laura Balcer, MD, a neuro-ophthalmologist at NYU Langone, and Ellliot M. Frohman, MD, PhD, FAAN, neurologist at UT Southwestern Medical Center, in which we wished to have a better indicator for whether inflammation was causing brain tissue damage,” Peter A. Calabresi, MD, director in the division of neuroimmunology and professor of neurology at Johns Hopkins University School of Medicine, told Healio Neurology. “OCT showed that patients had different degrees of retinal injury following optic neuritis. Even more interestingly, we found that subclinical retinal degeneration was occurring even in the absence of clinical attacks. Retina atrophy mirrored brain atrophy rates and we hypothesized that it may be useful for a quick office-based estimate of how much tissue damage was happening to people with MS early on in the disease process.”
Calabresi and colleagues sought to assess whether retinal OCT evaluation at baseline correlated with long-term disability worsening among 132 individuals (mean age, 43 years) with MS at a 10-year follow-up point. The majority (n = 106) had relapsing-remitting MS.
In the prospective, longitudinal study, the researchers evaluated spectral-domain OCT, EDSS and visual acuity at baseline and at the 10-year follow-up point. They used generalized linear regression models adjusted for age, gender, race, MS subtype and baseline disability and defined clinically meaningful Expanded Disability Status Scale worsening as an increase of 2 if the baseline score was < 6 or an increase of 1 if the baseline score was 6. Median follow-up was 10.4 years.
According to results of multivariable models that omitted eyes with prior optic neuritis, an average baseline ganglion cell-inner plexiform layer thickness of less than 70 μm correlated with a four-fold increased odds for meaningful long-term disability worsening as measured by EDSS (adjusted OR = 3.97; 95% CI, 1.24-12.7). Moreover, the researchers observed a nearly three-fold increased odds for low-contrast visual acuity worsening (adjusted OR = 2.93; 95% CI, 1.4-6.13).
“Thus, OCT can be used to estimate disease severity early on and inform treatment decisions,” Calabresi said. “This is important because we have 23 agents to choose from and having a prognostic tool is very useful. OCT is a safe and inexpensive imaging tool and can be obtained in 15 minutes in the office.”
This type of information may help guide decision-making when it comes to choosing highly effective treatments that carry a greater risk of side effects, Calabresi added.
“We have an ongoing study at Johns Hopkins University funded by the NIH and are collaborating with other groups around the world as part of a consortium, dubbed IMSVISUAL, in which we hope to further validate the utility of OCT in the MS clinic,” he said.