Department of Neurology Johns Hopkins University Baltimore Maryland.
Department of Neurology New York University Langone Medical Center New York New York.
Ann Clin Transl Neurol. 2019 Jan 19;6(2):222-232. doi: 10.1002/acn3.674. eCollection 2019 Feb.
Optical coherence tomography (OCT)-derived measures of the retina correlate with disability and cortical gray matter atrophy in multiple sclerosis (MS); however, whether such measures predict long-term disability is unknown. We evaluated whether a single OCT and visual function assessment predict the disability status 10 years later.
Between 2006 and 2008, 172 people with MS underwent Stratus time domain-OCT imaging [160 with measurement of total macular volume (TMV)] and high and low-contrast letter acuity (LCLA) testing ( = 150; 87%). All participants had Expanded Disability Status Scale (EDSS) assessments at baseline and at 10-year follow-up. We applied generalized linear regression models to assess associations between baseline TMV, peripapillary retinal nerve fiber layer (pRNFL) thickness, and LCLA with 10-year EDSS scores (linear) and with clinically significant EDSS worsening (binary), adjusting for age, sex, optic neuritis history, and baseline disability status.
In multivariable models, lower baseline TMV was associated with higher 10-year EDSS scores (mean increase in EDSS of 0.75 per 1 mm loss in TMV (mean difference = 0.75; 95% CI: 0.11-1.39; = 0.02). In analyses using tertiles, individuals in the lowest tertile of baseline TMV had an average 0.86 higher EDSS scores at 10 years (mean difference = 0.86; 95% CI: 0.23-1.48) and had over 3.5-fold increased odds of clinically significant EDSS worsening relative to those in the highest tertile of baseline TMV (OR: 3.58; 95% CI: 1.30-9.82; = 0.008). pRNFL and LCLA predicted the 10-year EDSS scores only in univariate models.
Lower baseline TMV measured by OCT significantly predicts higher disability at 10 years, even after accounting for baseline disability status.
光学相干断层扫描（OCT）测量视网膜的结果与多发性硬化症（MS）中的残疾和皮质灰质萎缩相关；然而，这些测量方法是否能预测长期残疾尚不清楚。我们评估了单次 OCT 和视力功能评估是否能预测 10 年后的残疾状况。
在 2006 年至 2008 年间，172 名 MS 患者接受 Stratus 时域-OCT 成像[160 名患者进行了总黄斑体积（TMV）测量]和高、低对比度字母视力（LCLA）测试（=150；87%）。所有参与者在基线和 10 年随访时均接受扩展残疾状况量表（EDSS）评估。我们应用广义线性回归模型评估基线 TMV、视盘周围视网膜神经纤维层（pRNFL）厚度和 LCLA 与 10 年 EDSS 评分（线性）和临床显著 EDSS 恶化（二进制）之间的关联，调整了年龄、性别、视神经炎病史和基线残疾状况。
在多变量模型中，较低的基线 TMV 与较高的 10 年 EDSS 评分相关（TMV 每损失 1mm，EDSS 评分增加 0.75 分（平均差异=0.75；95%CI：0.11-1.39；=0.02）。在使用三分位数的分析中，基线 TMV 最低三分位数的个体在 10 年内的 EDSS 评分平均高出 0.86 分（平均差异=0.86；95%CI：0.23-1.48），与基线 TMV 最高三分位数的个体相比，临床显著 EDSS 恶化的可能性高出 3.5 倍以上（OR：3.58；95%CI：1.30-9.82；=0.008）。pRNFL 和 LCLA 仅在单变量模型中预测 10 年 EDSS 评分。
OCT 测量的基线 TMV 明显预测 10 年后更高的残疾水平，即使考虑到基线残疾状况也是如此。
