Modern diagnostic potentials of studying structural and functional changes of the retina and the optic nerve in multiple sclerosis patients

Purpose: to study significant functional and structural changes in the retina and the intraocular section of the optic nerve in multiple sclerosis (MS) patients and analyze how they are interrelated with electrophysiological changes in the visual analyzer.

Materials and methods. The study included 44 patients (88 eyes): group 1 (26 eyes) with MS duration ≤ 5 years and no history of optic neuritis (ON); group 2 (30 eyes) with MS duration from 6 to15 years and no history of ON; and group 3 (32 eyes) with MS duration ≤ 15 years with a history of ON. All patients underwent a complete ophthalmological examination and optical coherence tomography and had visually evoked potentials (VEP) and static automated perimetry registered.

Results. A decrease in functional and structural parameters progressing with the duration of MS was revealed. In particular, best corrected visual acuity (BCVA) fell to 0.860 ± 0.075, the photosensitivity index MD maximally fell to -3.78 ± 0.95 dB, the strength of the P100 wave amplitude dropped to 7.84 ± 2.98 μV, the latency index of VEP rose to 124.21 ± 1.36 ms, the thickness of GCL + IPL fell to 65.69 ± 7.85 μm, and RNFL thickness averagely fell a low as to 80.25 ± 8.81 μm. When analyzing the topography of GCL + IPL decrease by sectors, the maximum value was revealed in the upper temporal segment (67.63 ± 7.89 μm). Sectoral changes in RNFL arranged in descending order of thickness showed the following sequence: lower upper nasal temporal. As the disease progressed, structural and functional changes were accompanied by an increase in the depth and a decrease in the thickness of the lamina cribrosa, with a maximum value revealed in the group with prior ON (239.00 ± 11.93 μm). Strong correlations were found in all study groups between (1) ave. GCL + IPL and ave. RNFL (r = 0.69; 0.64; 0.88, p < 0.03), (2) ave. GCL+IPL and BCVA (r = 0.86; 0.75; 0.78, p < 0.05), (3) MD and ave GCL + IPL (r = 0.52; 0.69; 0.71, p < 0.03), and (4) MD and ave. RNFL (r = 0.67; 0.61; 0.66, p < 0.05), as well as between the parameters of the lamina cribrosa and the markers under study.

Conclusion. Significant functional and structural changes in the retina and the optic nerve were detected, correlating with the duration of the disease and with the clinical features of the course of multiple sclerosis. The presence of ON in history was accompanied by more pronounced changes, which can be considered as an important additional aggravating factor of the disease.

1. Kale N. Optic neuritis as an early sign of multiple sclerosis. Eye Brain. 2016 Oct 26; 8: 195–202. doi: 10.2147/EB.S54131

2. Krivosheeva M.S., Ioyleva E.E. Evaluation of the diagnostic and differential diagnostic value of SOCT and microperimetry methods in patients with visual disturbances due to multiple sclerosis. Russian ophthalmological journal. 2020; 13 (3): 21–9 (In Russ.). doi: 10.21516/2072-0076-2020-13-3-21-29

3. Eliseeva E.K., Neroev V.V., Zueva M.V., Tsapenko I.V., Zakharova M.N. Optic neuritis with multiple sclerosis (review of literature and own data). Point of View. East — West. 2018; 2: 112–5 (In Russ.). doi: 10.25276/2410-1257-2018-2-112-115

4. Chan JW. Recent advances in optic neuritis related to multiple sclerosis. Acta Ophthalmol. 2012 May; 90 (3): 203–9. doi: 10.1111/j.1755-3768.2011.02145.x

5. Acar G, Ozakbas S, Cakmakci H, Idiman F, Idiman E. Visual evoked potential is superior to triple dose magnetic resonance imaging in the diagnosis of optic nerve involvement. Int J Neurosci. 2004 Aug; 114 (8): 1025–33. doi: 10.1080/00207450490461332

6. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb; 17 (2): 162–73. doi: 10.1016/S1474-4422(17)30470-2

7. Cennamo G, Romano MR, Vecchio EC, et al. Anatomical and functional retinal changes in multiple sclerosis. Eye (Lond). 2016 Mar; 30 (3): 456–62. doi: 10.1038/eye.2015.256

8. T trai E, Sim M, Iljicsov A, et al. In vivo evaluation of retinal neurodegeneration in patients with multiple sclerosis. PLoS One. 2012; 7 (1): e30922. doi: 10.1371/journal.pone.0030922

9. Lee SH, Kim TW, Lee EJ, Girard MJ, Mari JM. Diagnostic power of lamina cribrosa depth and curvature in glaucoma. Invest Ophthalmol Vis Sci. 2017 Feb 1; 58 (2): 755–62. doi: 10.1167/iovs.16-20802

10. Strouthidis NG, Fortune B, Yang H, Sigal IA, Burgoyne CF. Longitudinal change detected by spectral domain optical coherence tomography in the optic nerve head and peripapillary retina in experimental glaucoma. Invest Ophthalmol Vis Sci. 2011 Mar 2; 52 (3): 1206–19. doi: 10.1167/iovs.10-5599

11. Burgoyne CF, Downs JC, Bellezza AJ, Hart RT. Three-dimensional reconstruction of normal and early glaucoma monkey optic nerve head connective tissues. Invest Ophthalmol Vis Sci. 2004 Dec; 45 (12): 4388–99. doi: 10.1167/iovs.04-0022

12. Hamamc M, K k B, Bayhan SA, Bayhan HA, nan LE. Can lamina cribrosa indicate optic neuritis in multiple sclerosis? Neurol India. 2022 Nov-Dec; 70 (6): 2366–70. doi: 10.4103/0028-3886.364057. doi: 10.4103/0028-3886.364057

13. Omodaka K, Takahashi S, Matsumoto A, et al. Clinical factors associated with lamina cribrosa thickness in patients with glaucoma, as measured with Swept Source Optical Coherence Tomography. PLoS One. 2016 Apr 21; 11 (4): e0153707. doi: 10.1371/journal.pone.0153707

14. Saidha S, Syc SB, Durbin MK, et al. Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness. Mult Scler. 2011 Dec; 17 (12): 1449–63. doi: 10.1177/1352458511418630

15. Andryukhina O.M., Ryabtseva A.A., Kotov S.V., Yakushina T.I., Kuchina N.V. Monitoring of ophthalmological indicators in patients with multiple sclerosis. Almanac of clinical medicine. 2015; 36: 53–8 (In Russ.). doi: 10.18786/2072-0505-2015-36-53-58