Yam Charmaine, Brownlee Wallace J, Prados Carrasco Ferran, Toosy Ahmed, Ciccarelli Olga
Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, London, UK
Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, London, UK.
J Neurol Neurosurg Psychiatry. 2025 Apr 10;96(5):435-442. doi: 10.1136/jnnp-2024-334551.
We investigated the long-term colour and contrast vision outcomes, 15 years after a first demyelinating event, with their structural correlates using optical coherence tomography (OCT) and brain MRI.
Patients recruited with their first demyelinating event, were invited~15 years later to undergo clinical assessments, OCT and brain MRI and were clinically classified according to multiple sclerosis (MS) phenotypes. Linear mixed models evaluated associations between visual outcomes, MS phenotypes and OCT measures.
94 patients were evaluated after a median of 14.3 years. 111 eyes affected by optic neuritis and 77 unaffected eyes were studied. Optic neuritis eyes displayed worse colour vision than unaffected eyes. Unaffected eyes showed worse colour vision in relapsing-remitting MS and secondary progressive MS (SPMS) than clinically isolated syndrome, while no similar discriminatory ability was seen for OCT measures. However, ganglion cell inner plexiform layer (GCIPL) was superior to peripapillary retinal nerve fibre layer (pRNFL) in predicting all visual outcomes. Worse colour vision was associated with lower retinal thicknesses and higher brain T2 lesion load; adding MRI volumetrics to macular GCIPL predictors did not improve model prediction of visual outcomes.
Colour vision was impaired in unaffected eyes, especially in SPMS. GCIPL thinning underpinned this impairment more than pRNFL, suggesting neuroaxonal loss as the pathobiological substrate. The correlation between worse colour vision and increasing T2 lesion load suggests that colour dysfunction reflects overall greater disease burden. Quantitative evaluation of colour vision in addition to OCT may be useful to assess disease severity in patients after a first demyelinating event.
我们使用光学相干断层扫描（OCT）和脑部磁共振成像（MRI），对首次脱髓鞘事件发生15年后的长期颜色和对比度视觉结果及其结构相关性进行了研究。
招募首次发生脱髓鞘事件的患者，约15年后邀请他们接受临床评估、OCT和脑部MRI检查，并根据多发性硬化症（MS）表型进行临床分类。线性混合模型评估视觉结果、MS表型和OCT测量之间的关联。
94例患者在中位时间14.3年后接受了评估。研究了111只受视神经炎影响的眼睛和77只未受影响的眼睛。视神经炎眼睛的颜色视觉比未受影响的眼睛差。在复发缓解型MS和继发进展型MS（SPMS）中，未受影响的眼睛比临床孤立综合征的眼睛颜色视觉更差，而OCT测量没有类似的鉴别能力。然而，在预测所有视觉结果方面，神经节细胞内丛状层（GCIPL）优于视乳头周围视网膜神经纤维层（pRNFL）。较差的颜色视觉与较低的视网膜厚度和较高的脑部T2病变负荷相关；将MRI体积测量值添加到黄斑GCIPL预测指标中并不能改善视觉结果的模型预测。
未受影响的眼睛存在颜色视觉受损，尤其是在SPMS中。GCIPL变薄比pRNFL更能支持这种损害，表明神经轴突丢失是病理生物学基础。较差的颜色视觉与增加的T2病变负荷之间的相关性表明，颜色功能障碍反映了总体上更大的疾病负担。除OCT外，对颜色视觉进行定量评估可能有助于评估首次脱髓鞘事件后患者的疾病严重程度。
