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OCT-detected retinal layer loss reflects underlying progression in MS, even without relapse or MRI evidence. 

A study published in the June 2025 issue of Journal of Neurology reported that structural changes in the retina, as detected by optical coherence tomography, may serve as indicators of neurodegeneration in multiple sclerosis (MS), independent of relapse activity or MRI findings.   

Researchers assessed the link between optical coherence tomography (OCT) markers and progression independent of relapse activity (PIRA) in MS.   

They analyzed data from the Swiss MS Cohort Study, including patients with at least 1  OCT. Mean thicknesses of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell-inner plexiform layer (mGCIPL), and macular inner nuclear layer (mINL) were calculated, excluding eyes with asymmetry, and assessed the PIRA over a minimum of 4 years before OCT. Associations between retinal layer thickness and PIRA rates were calculated by linear regression adjusted for disease duration, age at onset, sex, body mass index, treatment, and annualized relapse rate. A sensitivity analysis investigated the association between retinal layers and PIRMA (PIRA without magnetic resonance imaging activity).   

The results showed that 171 people with MS (pwMS) were analyzed (median age: 51 years [y], Expanded Disability Status Scale: 2.5, pRNFL: 94 µm,mGCIPL: 67.2 µm, mINL: 35.4 µm, observation time: 8.1 y). The PIRA occurred in 67 patients (39%). Each PIRA event per decade was linked to a mean decline of −2.28 µm in pRNFL (95% CI [−4.32; −0.24], P= 0.029) and −1.70 µm in mGCIPL (95% CI [−2.97; −0.42], P= 0.010), while mINL showed no significant change (beta = −0.33, CI [−0.75; 0.1], P= 0.133). In the sensitivity analysis, all 3 OCT measures were associated with PIRMA: pRNFL (beta = −3.70, 95% CI [−6.23; −1.17], P= 0.005), mGCIPL (beta = −2.49, 95% CI [−4.12; −0.87], P= 0.003), and mINL (beta = −0.58, 95% CI [−1.11; −0.05], P= 0.031).   

Investigators concluded that retinal thinning estimated by OCT served as a sensitive indicator of disease progression in pwMS. 

Source: link.springer.com/article/10.1007/s00415-025-13185-y