Clinical effects associated with five-year retinal nerve fiber layer thinning in multiple sclerosis

Dejan Jakimovski; Robert Zivadinov; Caila B Vaughn; Osman Ozel; Bianca Weinstock-Guttman

doi:10.1016/j.jns.2021.117552

Clinical effects associated with five-year retinal nerve fiber layer thinning in multiple sclerosis

J Neurol Sci. 2021 Aug 15:427:117552. doi: 10.1016/j.jns.2021.117552. Epub 2021 Jun 23.

Authors

Dejan Jakimovski¹, Robert Zivadinov², Caila B Vaughn³, Osman Ozel³, Bianca Weinstock-Guttman³

Affiliations

¹ Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. Electronic address: djakimovski@bnac.net.
² Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
³ Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.

PMID: 34175775
DOI: 10.1016/j.jns.2021.117552

Abstract

Background: Neurodegenerative changes in multiple sclerosis (MS) are associated with long-term disability progression (DP). Optical coherence tomography (OCT) measures may be used to monitor DP.

Objective: To determine significant effects driving the changes in OCT-based peripapillary retinal nerve fiber layer (pRNFL) in heterogeneous group of MS patients.

Methods: Total of 144 MS patients (109 relapsing-remitting MS and 35 progressive MS (PMS) with mean age at baseline of 47.6 and 56.5 years old, respectively) underwent clinical and OCT examination over 5-year follow-up. All OCT exams were reviewed using the OSCAR-IB criteria. The 5-year DP was determined based on Expanded Disability Status Scale (EDSS) changes and MS clinical trial criteria. Data regarding previous history of MS optic neuritis (MSON) and use of disease modifying treatment (DMT) was derived by in-person interview and review of electronic medical records. Mixed model-type of repeated measure analysis determined effects driving pRNFL change for analysis which utilized all eyes separately.

Results: Over an average of 5.3-years follow-up, the MS population demonstrated significant pRNFL thinning (F = 16.108, p < 0.001). The pRNFL thinning was greater due to progressive MS subtype (F = 5.102, p = 0.025), greater age at baseline (F = 4.554, p = 0.034), occurrence of DP (F = 6.583, p = 0.011), and previous history of MSON (F = 7.053, p = 0.008). Use of any or highly potent DMT (natalizumab versus first-line injectable treatments versus no DMT) significantly reduced the pRNFL thinning (F = 8.367, p = 0.004) over the follow-up. Lastly, occurrence of DP in PMS patients older than 50 years old was associated with greater pRNFL thinning (F = 6.667, p = 0.013).

Conclusion: Longitudinal pRNFL changes are modified by age, disease subtype, disabiltiy progression, history of MSON, DMT use and their interactions.

Keywords: Disability progression; Multiple sclerosis; OCT; Optic neuritis; RNFL.

MeSH terms

Humans
Middle Aged
Multiple Sclerosis* / complications
Multiple Sclerosis* / diagnostic imaging
Multiple Sclerosis* / drug therapy
Nerve Fibers
Optic Neuritis* / diagnostic imaging
Optic Neuritis* / etiology
Retina / diagnostic imaging
Tomography, Optical Coherence