Retina Thickness Can Be Used to Identify MS Patients with Progressive Disease, Study Suggests

Retina Thickness Can Be Used to Identify MS Patients with Progressive Disease, Study Suggests
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The thickness of two layers of nerve cells forming the back of the eye, or retina, can be used to distinguish patients with progressing forms of multiple sclerosis (MS) from those with stable disease, a study suggests.

The study, “Macular ganglion cell–inner plexiform layer thinning as a biomarker of disability progression in relapsing multiple sclerosis,” was published in the Multiple Sclerosis Journal.

In MS, previous studies have shown that shrinkage of the peripapillary retinal nerve fiber layer (pRNFL) — one of the layers of the retina that contains the nerve endings (axons) of neurons found in the retina — is an indicator of axonal degeneration that is linked to physical and cognitive disability progression.

But some studies are now suggesting that assessing changes in the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL) — a combination of two retina layers that contain the cell bodies of neurons found in the retina — may be better to monitor MS progression.

“However, cut-off values regarding mGCIPL atrophy [shrinkage] for both cross-sectional and longitudinal use in individual patients are lacking,” researchers wrote.

To define the optimal cutoff values of mGCIPL thinning that could be used to distinguish patients with progressive MS from those with stable disease, investigators in Austria measured the thickness of the mGCIPL in 183 patients with relapsing MS over the course of three years.

Thickness measurements were performed using optical coherence tomography (OCT), a non-invasive imaging test that uses light to take pictures of the retina.

The team also compared the accuracy of the new cutoff values for mGCIPL to identify patients with progressive MS to those previously established for pRNFL.

From the 183 patients who were recruited to participate in the study, 168 completed it and were included in the final analyses. Of these, 64 patients (35%) were defined as clinically progressing during the observation period.

At the start of the study, the average thickness of the mGCIPL was lower in patients with disability progression, compared to those without disability progression — 77.3 versus 84.3 micrometers (mcm) in those without disability progression.

Statistical analyses indicated that patients whose mGCIPL measured less than 77 mcm in thickness had a 2.7 times higher risk of experiencing disability progression.

Using a cutoff value of 77 mcm for mGCIPL, and a previously established cutoff value of 88 mcm for pRNFL, researchers were able to correctly distinguish patients with progressive disease from those with stable MS in 66.7% (based on mGCIPL) and 63.1% (based on pRNFL) of the cases.

In the overall population of patients participating in the study, the mean annual loss of mGCIPL was 1 mcm. This value was higher among patients with progressive MS (2.1 mcm) and much lower among those with stable disease (0.3 mcm).

Statistical analyses also found that patients whose mean annual loss of mGCIPL was equal or greater than 1 mcm had an 18 times higher risk of having a clinical progressive form of MS.

At a cutoff value of 1 mcm for annual loss of mGCIPL, and a cutoff value of 1.5 mcm for pRNFL, mGCIPL showed superior sensitivity (87% versus 75% with pRNFL) at identifying patients with progressive disease.

Additional analyses also showed that values of annual loss of GCIPL were associated more strongly with clinical progression, disability progression, and cognitive decline than pRNFL loss values.

“We present evidence that cross-sectionally measured mGCIPL thickness and annualized thinning rates of mGCIPL are able to identify clinically progressing [relapsing] MS with high accuracy. This reemphasizes the power of retinal thinning as a biomarker for monitoring neurodegeneration in MS,” the researchers wrote.

“In clinical practice, we advocate that regular — ideally annual — OCT measuring both mGCIPL and pRNFL should be included in routine disease monitoring, where sufficient quality of imaging and layer segmentation is available,” the team added.

Joana holds a BSc in Biology, a MSc in Evolutionary and Developmental Biology and a PhD in Biomedical Sciences from Universidade de Lisboa, Portugal. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that made up the lining of blood vessels — found in the umbilical cord of newborns.
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Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.
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Joana holds a BSc in Biology, a MSc in Evolutionary and Developmental Biology and a PhD in Biomedical Sciences from Universidade de Lisboa, Portugal. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that made up the lining of blood vessels — found in the umbilical cord of newborns.
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