Abstract
Background“Non-invasive, faster and less expensive than MRI” and “the eye is a window to the brain” are recent slogans promoting optical coherence tomography (OCT) as a new surrogate marker in multiple sclerosis (MS). Indeed, OCT allows for the first time a non-invasive visualization of axons of the central nervous system (CNS). Reduction of retina nerve fibre layer (RNFL) thickness was suggested to correlate with disease activity and duration. However, several issues are unclear: Do a few million axons, which build up both optic nerves, really resemble billions of CNS neurons? Does global CNS damage really result in global RNFL reduction? And if so, does global RNFL reduction really exist in all MS patients, and follow a slowly but steadily ongoing pattern? How can these (hypothesized) subtle global RNFL changes be reliably measured and separated from the rather gross RNFL changes caused by optic neuritis? Before generally being accepted, this interpretation needs further critical and objective validation.MethodologyWe prospectively studied 37 MS patients with relapsing remitting (n = 27) and secondary progressive (n = 10) course on two occasions with a median interval of 22.4±0.5 months [range 19–27]. We used the high resolution spectral domain (SD-)OCT with the Spectralis 3.5 mm circle scan protocol with locked reference images and eye tracking mode. Patients with an attack of optic neuritis within 12 months prior to the onset of the study were excluded.Principal FindingsAlthough the disease was highly active over the observation period in more than half of the included relapsing remitting MS patients (19 patients/32 relapses) and the initial RNFL pattern showed a broad range, from normal to markedly reduced thickness, no significant changes between baseline and follow-up examinations could be detected.ConclusionsThese results show that caution is required when using OCT for monitoring disease activity and global axonal injury in MS.
Highlights
Multiple sclerosis (MS) is supposed to be a chronic inflammatory disease of the central nervous system (CNS) causing demyelination and axonal degeneration [1]
It is undisputed that advanced high resolution spectral domain (SD-)optical coherence tomography (OCT) technique is a prerequisite [19,20,24,26,27,28,29]. For this purpose we studied a large cohort of 27 RRMS and 10 SPMS patients with a new advanced Spectral Domain Optical Coherence Tomography (SD-OCT) technique over a long observation period of approximately 22.460.5 years
The results of our study performed with the high resolution SDOCT can be summarized briefly as follows
Summary
Multiple sclerosis (MS) is supposed to be a chronic inflammatory disease of the central nervous system (CNS) causing demyelination and axonal degeneration [1]. Underlying pathogenetic mechanisms are regarded to be complex and heterogeneous. They may be triggered from outside of the CNS, but may become compartmentalized within the CNS [2,3,4,5,6,7,8,9]. In most patients the disease follows a relapsing-remitting (RRMS), and only rarely a progressive course right from the disease onset (PPMS, primary progressive MS). After an uncertain period of time, many RRMS patients change into secondary progression with or without superimposed relapses (SPMS, secondary progressive MS). Each MS patient follows his own individual disease course [10]
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