Diagnostic accuracy of retinal abnormalities in predicting disease activity in MS

Objectives: To assess the association between the thickness of the retinal nerve fiber layer ( RNFL), assessed by optical coherence tomography ( OCT), retinal periphlebitis ( RP), and multiple sclerosis ( MS) disease activity. Methods: We studied a prospective cohort of 61 patients and 29 matched controls for 2 years, performing a neurologic assessment every 3 months and an ophthalmologic evaluation, including OCT scans, every 6 months. Baseline MRI studies were also carried out from which brain volume and lesion load were assessed. Results: We found that the RNFL thickness in patients with MS was thinner than in controls, particularly in the temporal quadrant ( p = 0.004). Although RNFL atrophy was greater in patients who also had optic neuritis ( p = 0.002), it also augmented in MS patients who did not have optic neuritis compared with controls ( p = 0.014). RNFL atrophy was correlated with greater disability ( r = -0.348, p = 0.001) and longer disease duration ( r = -0.301, p = 0.003). Furthermore, baseline temporal quadrant RNFL atrophy was associated with the presence of new relapses and changes in the Expanded Disability Status Scale by the end of the study ( p < 0.05 in all cases). Indeed, RNFL thickness was correlated with white matter volume ( r = 0.291, p = 0.005) and gray matter volume ( r = 0.239, p = 0.021). The presence of RP was a risk factor for having new relapses in the next 2 years ( odds ratio = 1.52, p = 0.02), and patients with RP had larger gadolinium-enhancing lesions volume ( p = 0.003). Conclusion: Retinal nerve fiber layer atrophy and the presence of retinal periphlebitis are associated with disease activity, suggesting that retinal evaluation can be used as biomarkers of multiple sclerosis activity.