Author Topic: (Abst.) Retinal thickness and risk of disability worsening in MS  (Read 73 times)

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Offline agate

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From PubMed, March 25, 2016:

Quote
Lancet Neurol. 2016 Mar 18.

Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study

Martinez-Lapiscina EH1, Arnow S2, Wilson JA3, Saidha S4, Preiningerova JL5, Oberwahrenbrock T6, Brandt AU6, Pablo LE7, Guerrieri S8, Gonzalez I9, Outteryck O10, Mueller AK11, Albrecht P11, Chan W12, Lukas S13, Balk LJ14, Fraser C15, Frederiksen JL16, Resto J17, Frohman T18, Cordano C2, Zubizarreta I1, Andorra M1, Sanchez-Dalmau B1, Saiz A1, Bermel R17, Klistorner A15, Petzold A19, Schippling S13, Costello F12, Aktas O11, Vermersch P10, Oreja-Guevara C9, Comi G8, Leocani L8, Garcia-Martin E7, Paul F6, Havrdova E5, Frohman E18, Balcer LJ20, Green AJ2, Calabresi PA4, Villoslada P21; IMSVISUAL consortium.


BACKGROUND:

Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fibre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available.

METHODS:

In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis, and progressive multiple sclerosis.

Patients were recruited from centres in Spain, Italy, France, Germany, Czech Republic, Netherlands, Canada, and the USA, with the first cohort starting in 2008 and the latest cohort starting in 2013.

We assessed disability worsening using the Expanded Disability Status Scale (EDSS). The pRNFL thickness and macular volume were assessed once at study entry (baseline) by optical coherence tomography (OCT) and was calculated as the mean value of both eyes without optic neuritis for patients without a history of optic neuritis or the value of the non-optic neuritis eye for patients with previous unilateral optic neuritis.

Researchers who did the OCT at baseline were masked to EDSS results and the researchers assessing disability with EDSS were masked to OCT results. We estimated the association of pRNFL thickness or macular volume at baseline in eyes without optic neuritis with the risk of subsequent disability worsening by use of proportional hazards models that included OCT metrics and age, disease duration, disability, presence of previous unilateral optic neuritis, and use of disease-modifying therapies as covariates.

FINDINGS:

879 patients with clinically isolated syndrome (n=74), relapsing-remitting multiple sclerosis (n=664), or progressive multiple sclerosis (n=141) were included in the primary analyses.

Disability worsening occurred in 252 (29%) of 879 patients with multiple sclerosis after a median follow-up of 20 years (range 05-5 years). Patients with a pRNFL of less than or equal to 87 μm or less than or equal to 88 μm (measured with Spectralis or Cirrus OCT devices) had double the risk of disability worsening at any time after the first and up to the third years of follow-up (hazard ratio 206, 95% CI 136-311; p=0001), and the risk was increased by nearly four times after the third and up to the fifth years of follow-up (381, 163-891; p=0002).

We did not identify meaningful associations for macular volume.

INTERPRETATION:

Our results provide evidence of the usefulness of monitoring pRNFL thickness by OCT for prediction of the risk of disability worsening with time in patients with multiple sclerosis.

FUNDING:

Instituto de Salud Carlos III.

The abstract can be seen here.
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SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

 

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