Optical coherence tomography of the retina and optic nerve in the diagnosis of secondary progressive multiple sclerosis

Objective. To evaluate structural retinal changes in patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) over time and to analyze their association with the progression of neurological impairment.

Material and methods. Clinical data (EDSS, T25FW, 9-HPT, SDMT) and optical coherence tomography (OCT) results (average thickness of the ganglion cell and inner plexiform layer [avgGCL+IPL]; average thickness of the peripapillary retinal nerve fiber layer [avgRNFL]) were analyzed in patients with RRMS and SPMS (42 women, 19 men; age 46.20 ± 9.49 years) over a follow-up period of 12.87 ± 1.25 months. Comparisons were performed between groups stratified by disability level (Group 1: EDSS 0–2.0, Group 2: EDSS 2.5–3.5, Group 3: EDSS≥4.0), as well as by the presence of at least one sign of progression (increase in EDSS by 0.5–1.0, ≥20 % worsening in T25FW/9HPT, or ≥4-point/10 % decrease in SDMT).

Results and discussion. EDSS did not change significantly during follow-up (p = 0.451); however, 45.2 % of patients demonstrated signs of progression according to T25FW/9HPT/sDMT. T25FW performance worsened more markedly in Groups 2 and 3 (p < 0.001), while no significant differences were observed between groups in other measures. Statistically significant differences in avgGCL+IPL and avgRNFL were found between Groups 1 and 3 (p = 0.007 and p = 0.016, respectively). Annual avgGCL+IPL change was −0.58 [−1.00; −0.17] μm in Group 1 vs. −3.00 [−3.33; −1.25] μm in Group 3; annual avgRNFL change was −0.62 [−1.75; 0.75] μm in Group 1 vs. −2.38 [−3.25; −1.88] μm in Group 3. Moreover, annual reductions in avgGCL+IPL and avgRNFL were greater in patients with progression (−1.54 [−3.00; −0.46] and −2.31 [−4.69; −1.25] μm, respectively) compared with stable patients (−0.83 [−1.50; −0.25] and −0.75 [−1.88; 0.50] μm, respectively), with statistically significant differences (p = 0.018 and p = 0.003, respectively). Progression was predicted by avgGCL+IPL loss >1.17 μm/year (sensitivity 64.3%; specificity 66.7 %) and avgRNFL loss >1.125 μm/year (78.6 and 63.6 %, respectively).

Conclusions. Accumulation of neurological deficits occurs even in the absence of EDSS changes, while the neurodegenerative process is more active in patients with greater disability and longer disease duration. Annual thinning of avgGCL+IPL and avgRNFL on OCT may serve as a predictor of MS progression.

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