Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics - PubMed (original) (raw)

Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics

Jenny Nij Bijvank et al. J Neurol Neurosurg Psychiatry. 2022 Feb.

Abstract

Background: The visual system could be included in the diagnostic criteria for multiple sclerosis (MS) to demonstrate dissemination in space (DIS) and dissemination in time (DIT).

Objective: To investigate the diagnostic value of retinal asymmetry in MS.

Methods: A prospective, longitudinal study in individuals with MS (n=151) and healthy controls (n=27). Optical coherence tomography (OCT) was performed at 0, 2 and 4 years. Macular ganglion cell and inner plexiform layer (mGCIPL) thickness was determined as well as measures for retinal asymmetry: the inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD). Receiver operator characteristics curves were plotted and the area under the curve (AUC) was calculated for group comparisons of the mGCIPL, IEPD, IEAD and atrophy rates.

Results: The diagnostic accuracy of both the IEPD and IEAD for differentiating bilateral and unilateral MS optic neuritis was high and stable over time (AUCs 0.88-0.93). The IEPD slightly outperformed the IEAD. Atrophy rates showed low discriminatory abilities for differentiating MS from controls (AUC 0.49-0.58).

Conclusion: The inter-eye differences of the mGCIPL have value for demonstration of DIS but in individuals with longstanding MS not for DIT. This may be considered as a test to detect DIS in future diagnostic criteria. Validation in a large prospective study in people presenting with symptoms suggestive of MS is required.

Keywords: multiple sclerosis; neuroophthalmology.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Conflict of interest statement

Competing interests: JNB is supported by the Dutch MS Research Foundation, grant nr. 18-1027. BMJU has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and Teva. AP reports personal fees from Novartis, Heidelberg Engineering, Zeiss, grants from Novartis, outside the submitted work; and AP is part of the steering committee of the OCTiMS study which is sponsored by Novartis. AP is part of the steering committee of Angio-OCT which is sponsored by Zeiss. He does not receive honorary as part of these activities. The NIHR BRC at Moorfields Eye Hospital supported AP.

Figures

Figure 1

Figure 1

Box-and-Whisker plots of (A) the inter-eye percentage differences (IEPD) and (B) the inter-eye absolute difference (IEAD) at baseline, year 2 and year 4. The red line indicates the 5% cut-off for the IEPD and the 4 µm cut-off of the IEAD. BON, bilateral MS associated optic neuritis; HC, healthy controls; MS, multiple sclerosis; NON, no MS associated optic neuritis; ON, unilateral MS associated optic neuritis. The median (bold horizontal line), 25–75 percentiles (box), 5–95 percentiles (whiskers), mean (symbol in the box) and outliers (symbols outside the box) are shown.

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