No abstract

Retinal imaging has been proposed as a biomarker for neurological diseases such as multiple sclerosis (MS). Recently, a technique for non-invasive assessment of the retinal microvasculature called optical coherence tomography angiography (OCTA) was introduced. We investigated retinal microvasculature alterations in participants with relapsing–remitting MS (RRMS) without history of optic neuritis (ON) and compared them to a healthy control group. The study was performed in a prospective, case–control design, including 58 participants (n = 100 eyes) with RRMS without ON and 78 age- and sex-matched control participants (n = 136 eyes). OCTA images of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) were obtained using a commercial OCTA system (Zeiss Cirrus HD-5000 Spectral-Domain OCT with AngioPlex OCTA, Carl Zeiss Meditec, Dublin, CA). The outcome variables were perfusion density (PD) and foveal avascular zone (FAZ) features (area and circularity) in both the SCP and DCP, and flow deficit in the CC. MS group had on average higher intraocular pressure (IOP) than controls (P < 0.001). After adjusting for confounders, MS participants showed significantly increased PD in SCP (P = 0.003) and decreased PD in DCP (P < 0.001) as compared to controls. A significant difference was still noted when large vessels (LV) in the SCP were removed from the PD calculation (P = 0.004). Deep FAZ was significantly larger (P = 0.005) and less circular (P < 0.001) in the eyes of MS participants compared to the control ones. Neither LV, PD or FAZ features in the SCP, nor flow deficits in the CC showed any statistically significant differences between the MS group and control group (P > 0.186). Our study indicates that there are microvascular changes in the macular parafoveal retina of RRMS patients without ON, showing increased PD in SCP and decreased PD in DCP. Further studies with a larger cohort of MS patients and MRI correlations are necessary to validate retinal microvascular changes as imaging biomarkers for diagnosis and screening of MS.

Purpose: Retinal imaging has attracted much interest as a non‐invasive low‐budget biomarker for neurological diseases such as multiple sclerosis (MS). Optical coherence tomography angiography (OCTA) is a functional extension of OCT and allows for the non‐invasive visualization of the retinal and choroidal microvasculature. We investigated retinal microvasculature changes in patients with relapsing–remitting MS (RRMS) without history of optic neuritis (ON) and compared them to a healthy control group. Methods: The study was performed in a prospective, case–control design, including 58 participants (n = 100 eyes) with RRMS without ON and 78 age‐ and sex‐matched control participants (n = 136 eyes). OCTA images of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) were obtained using a commercial OCTA system (Zeiss Cirrus HD‐5000 Spectral‐Domain OCT with AngioPlex OCTA, Carl Zeiss Meditec, Dublin, CA). Perfusion density (PD) and foveal avascular zone (FAZ) features (area and circularity) in both the SCP and DCP, as well as flow deficit in the CC were used as outcome variables. Results: MS patients showed significantly increased PD in SCP (p = 0.003) and decreased PD in DCP (p < 0.001) as compared to controls when data were corrected for confounders. A significant difference was also noted when large vessels (LV) in the SCP were removed from the PD calculation (p = 0.004). Deep FAZ was significantly larger (p = 0.005) and less circular (p < 0.001) in the eyes of MS patients compared to healthy controls. Neither LV, PD or FAZ features in the SCP, nor flow deficits in the CC showed any statistically significant differences between the MS patients and the controls (p > 0.186). Conclusions: Our study shows that MS patients have microvascular changes in the macular parafoveal retina even without ON. They show increased PD in SCP and decreased PD in DCP. To which degree retinal biomarkers in MS are associated with the progression of MS remains to be studied.