Two presentations at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2016 Congress, now underway in London, underscored the value of measures of neurodegeneration in the eye in predicting a patient’s future disability.
Peter Calabresi with the Johns Hopkins School of Medicine opened the session with the presentation, “Tools for measuring neuroaxonal loss in the visual pathway.”
Recent studies have shown that measuring the loss of neurons in the eye can be used to predict disease trajectories of MS patients. Calabresi argued that such measurements can become an important part of assessments of new immunomodulatory drugs in clinical trials, and could aid clinicians in evaluating treatments and guide therapy decisions for patients.
One method, called optical coherence tomography (OCT), has been proposed as such a tool. The technique is simple, produces reproducible results, and was recently evaluated in an analysis that showed OCT measures of the retina ably predict how patients will fare over five years.
In addition, Calabresi mentioned that magnetic resonance imaging (MRI), spectroscopy, and electrophysiology can be used to complement OCT measurements, giving a fuller picture of MS aspects that impact disease progression.
These tools, he noted, should optimally be combined with biomarkers to better understand the molecular events contributing to neurodegeneration in MS.
In an example of how OCT can be used, Alissa Rothman, a fellow Johns Hopkins researcher, presented data from a study showing that OCT measures of the retina could predict disability 10 years later using the Expanded Disability Status Scale (EDSS).
The study, “Retinal measurements predict 10-year disability in multiple sclerosis,” recruited 89 MS patients, who were first examined by OCT, and then had their disability assessed on average 9.3 years later.
When adjusting analyses for age, sex, and a history of optic neuritis (inflammation of an optic nerve), the study showed that a loss of one cubic millimeter of total macular volume (the macula is a part of the retina) predicted a decrease of 2 in the EDSS score. In contrast, thickness of the retinal nerve fiber layer did not predict disability.
“As has been previously shown with brain atrophy and lesion volume, retinal measures can have predictive value for medium-term disability in MS. Our preliminary findings support the utility of OCT as a tool to predict neurodegeneration and disease progression over time in MS patients,” Rothman concluded.
Both presentations marked the highlights of the Parallel Session 2 on the second day of the ECTRIMS meeting, which runs through Sept. 17.