Abstract
Many studies have demonstrated the usefulness of some optical coherence tomography (OCT) parameters, like total macular volume (TMV) and retinal nerve fiber layer thickness (RNFL-T), for monitoring patients with multiple sclerosis (MS). However, there are no real-world, long-term studies on patients with relapsing-remitting MS (RR-MS) treated with fingolimod. Therefore, the purpose of this study was to describe retinal changes associated with fingolimod therapy during a two-year follow-up while considering previous episodes of optic neuritis (ON). Patients diagnosed with RR-MS and treated with fingolimod (46 in total) underwent a two-year follow-up. Based on previous ON history, we identified 16 ON+ and 30 ON− patients. The ophthalmological evaluations, including visual field (VF) examination and OCT, were performed at a baseline at 3–6, 12 and 24 months to evaluate the progression rate for each parameter. When analyzing the whole sample, OCT showed no cases of macular edema. Instead, we observed a significant reduction rate in the central retinal thickness (CRT) (p < 0.001), TMV (p < 0.001) and RNFL (p < 0.05). Moreover, we observed a significant difference in the progression rate between ON+ and ON− patients, relative to the VF and RNFL (p < 0.05) examinations. OCT highlighted a significant progression rate of retinal damage in MS patients despite fingolimod therapy, especially in MS ON+ patients.
Highlights
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and degenerative disease of the central nervous system which mostly affects females, with an age of onset between 20 and 45 years.multiple sclerosis (MS) shows an extremely variable clinical and temporal evolution [1,2]
The purpose of this work was to describe the long-term anatomical and functional retinal changes observed in relapsing-remitting MS (RR-MS) patients which started on fingolimod and were followed for two years, taking into account the effect of previous optic neuritis (ON)
−0.58 ± 0.24 dB/year, whereas the ON− patients showed a significant increase of +0.35 ± 0.08 dB/year, and the difference between the two groups was statistically significant (p < 0.001). In this two-year longitudinal retrospective study, we assessed the changes of retinal morphology through a multimodal approach, including optical coherence tomography (OCT), best-corrected VA (BCVA), low-contrast letter acuity (LCLA) and visual field (VF), in 46 RR-MS patients treated with fingolimod
Summary
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and degenerative disease of the central nervous system which mostly affects females, with an age of onset between 20 and 45 years. MS shows an extremely variable clinical and temporal evolution [1,2]. MS patients frequently experience include visual acuity (VA) reduction, altered contrast sensitivity, visual field (VF) abnormalities, dyschromatopsia and diplopia. A frequent acute neuro-ophthalmological manifestation of the disease is represented by the optic neuritis (ON) that occurs in ~20% of MS patients as a first clinical manifestation and in more than 60% of cases during the course of the disease [3,4,5,6].
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