Retinal Damage and Vision Loss in African American Multiple Sclerosis Patients

ObjectiveTo determine whether African American (AA) multiple sclerosis (MS) patients exhibit more retinal damage and visual impairment compared to Caucasian American (CA) MS patients. MethodsA total of 687 MS patients (81 AAs) and 110 healthy control (HC) subjects (14 AAs) were recruited at 3 academic hospitals between 2008 and 2012. Using mixed effects regression models, we compared high- and low-contrast visual acuity (HCVA and LCVA) and high-definition spectral domain optical coherence tomography measures of retinal architecture between MS patients of self-identified AA and CA ancestry. ResultsIn HCs, baseline peripapillary retinal nerve fiber layer (RNFL) thickness was 6.1 mu m greater in AAs (p=0.047), whereas ganglion cell/inner plexiform layer (GCIP) thickness did not differ by race. In MS patients, baseline RNFL did not differ by race, and GCIP was 3.98 mu m thinner in AAs (p=0.004). AAs had faster RNFL and GCIP thinning rates compared to CAs (p=0.004 and p=0.046, respectively). AA MS patients had lower baseline HCVA (p=0.02) and worse LCVA per year of disease duration (p=0.039). Among patients with an acute optic neuritis (AON) history, AAs had greater loss of HCVA than CA patients (p=0.012). InterpretationThis multicenter investigation provides objective evidence that AA MS patients exhibit accelerated retinal damage compared to CA MS patients. Self-identified AA ancestry is associated with worse MS-related visual disability, particularly in the context of an AON history, suggesting a more aggressive inflammatory disease course among AA MS patients or a subpopulation therein. Ann Neurol 2015;77:228-236