Retinal OCT markers hold promise for early MS diagnosis

Retinal optical coherence tomography (OCT) parameters could act as surrogates of MRI-based dissemination in time. The results of a German study add to the growing body of evidence to support the inclusion of these parameters in the McDonald criteria, allowing for an earlier diagnosis of MS without increasing the risk of misdiagnosis.

OCT is associated with future relapse risk in early MS. Therefore, it has emerged as a possible alternative for oligoclonal bands, which in turn were included in the 2017 revision of the McDonald diagnostic criteria for MS as a possible substitute for dissemination in time. Contrary to oligoclonal bands, OCT is not invasive and is therefore a more convenient option. A German research group further explored the use of OCT markers for early MS diagnosis [1]. They retrospectively analysed OCT data of 178 patients (120 women) who had a first demyelinating event suggestive of MS between 2011 and 2020.

At baseline, 134 (75%) patients fulfilled the 2017 McDonald criteria for relapsing-remitting MS. Over a mean follow-up of 4 years, 54 (30%) patients developed clinically definite MS. For conversion to clinically definite MS, the optimal cut-off value of peripapillary retinal nerve fibre layer (pRNFL) thickness in patients without optic neuritis was <98 µm, with a sensitivity of 0.72 and a specificity of 0.51. The optimal cut-off value for ganglion cell and inner plexiform layer (GCIPL) thickness was <68 µm, with a sensitivity of 0.68 and a specificity of 0.46.

Lower pRNFL (HR 2.30; 95% CI 1.30–4.00; P=0.003) as well as lower GCIPL (HR 2.1; 95% CI 1.20–3.60; P=0.008) thickness were associated with an increased clinically definite MS rate. This association was lacking with McDonald 2017 dissemination in time criteria including oligoclonal bands (HR 1.8; 95% CI 0.57–5.90; P=0.310), or criteria based on baseline MRI only (HR 1.3; 95% CI 0.73–2.30; P=0.387).

The authors concluded that retinal OCT markers, and GCIPL thickness in particular, hold promise for early MS diagnosis. OCT may improve MS diagnostic accuracy by identifying dissemination in time in patients who present without optic neuritis.

1. Buenrostro GS, et al. Retinal optical coherence tomography markers for dissemination in time. P402, MSMilan 2023, 11–13 October, Milan, Italy.

 

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Posted on 4 December 20234 December 2023