Retinal layer thickness predicts disability accumulation in early RMS

In a new study, retinal layer thickness independently predicted disability accumulation in newly diagnosed relapsing multiple sclerosis (RMS), creating an added value to established markers. This is especially prominent for the macular ganglion cell-inner plexiform layer (GCIPL), compared to the peripapillary retinal nerve fibre layer (pRNFL). Limitations of these markers in patients with myopia, diabetes and glaucoma were however highlighted

“pRNFL and GCIPL have not been studied as predictors of disability accumulation in newly diagnosed RMS and within the framework of known baseline demographic, clinical, and radiological risk factors,” said Prof. Gabriel Bsteh (Medical University of Vienna, Austria). He presented the results of a study that included patients from whom a spectral-domain OCT scan was obtained within 90 days after RMS diagnosis [1,2]. Follow-up was at least 12 months and the primary endpoint was time to disability accumulation, defined as a confirmed Expanded Disability Status Scale (EDSS) score ≥3.0.

The analysed study cohort consisted of 231 MS patients. The mean age was 30.3 years, 74% were women, and the mean time to diagnosis was 45 days. The mean number of T2 lesions on baseline MRI was 11 (range 0–45). Baseline mean pRNFL and GCIPL thickness were 91.9 µm and 80.2 µm, respectively. The median follow-up was 61 months (range 12–93). EDSS ≥3.0 was reached by 28 patients (12.1%) after a median of 49 months (range 9–92).

Reaching EDSS ≥3.0 was predicted by pRNFL thickness ≤88 µm (HR 4.0; 95% CI 1.8–3.3; P<0.001) and by GCIPL thickness <77 µm (HR 5.1; 95% CI 1.6–4.2; P<0.001). Time to progression independent of relapse activity (PIRA) was also predicted by pRNFL thickness ≤88 µm (HR 3.1; 1.7–5.4; P<0.001) and by GCIPL thickness <77 µm (HR 4.1; 95% CI 2.3–7.3; P<0.001). Prof. Bsteh said it was “very encouraging” to see that this was independent of other important risk factors, such as age, MRI lesion load, and DMT use. PRFNL and GCIPL thickness did not predict inflammatory activity, measured by time to second clinical relapse.

Prof. Bsteh concluded that pRNFL/GCIPL thickness may be a cross-sectional marker of neuro-axonal damage and could potentially inform treatment strategy. However, availability of OCT is limited and it requires quality control. Prof. Bsteh also pointed out that changes in retinal layer thickness are not specific to MS, but can be influenced by other factors, including diabetes mellitus and glaucoma. Moreover, OCT is not applicable if there is myopia of >4–6 diopters or retinal comorbidities.

1. Bsteh G, et al. Retinal layer thickness predicts disability accumulation in early relapsing multiple sclerosis. EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.
2. Bsteh G, et al. Eur J Neurol. 2023;30(4):1025–1034.

Copyright ©2023 Medicom Medical Publishers



Posted on 7 September, 202318 March, 2024