OCT tool to MS progression
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The document discusses the use of Optical Coherence Tomography (OCT) as a method to objectively assess multiple sclerosis (MS) progression, highlighting its ability to accurately quantify retinal atrophy. It details findings related to the inner and outer retinal layers and the implications for patient diagnosis and management. The presentation emphasizes OCT's strengths and weaknesses, as well as its significance in understanding neurodegeneration related to MS.
OCT tool to MS progression
- 1. OCT: A Tool to objectively assess MS Progression? 16th STATE OF THE ART Symposium, SMSS Saturday 11-JAN-2014, 12:05-12:30, axel petzold
- 2. Disclosures SC: OCTiMS study (Novartis)
- 3. To be covered • The method: OCT • Accurate quantification of atrophy in MS • Time course of atrophy • Inner and outer retinal layers • What does it mean for the patient?
- 4. How does it work? Petzold et al. TLN 2010
- 5. What information can be gained? • Normal • Too thick • Too thin
- 6. Too thick ● Fingolimod associated macular oedema ● Microcystic macular oedema (MMO) Gelfland et al. 2012 (15 patients) ● INL thickening predicts disease activity Saidha et al. 2012 (10 patients)
- 7. Microcystic macular oedema (MMO) Burggraaff et al. IOVS 2014
- 8. Burggraaff et al. IOVS 2014 MS ERM RION VMT CRION Diabetic retinopathy NMO Vascular occlusion LHON/DOA Optic neuropathy Harding's disease CSR Endemic optic neuropathy RP ARMD Optic nerve glioma Retinal teleangiectasis Medication The clinical spectrum of MMO
- 9. How accurate is OCT? Optic disc no EBF with EBF no EBF with EBF Global mean 0.94 0.96 0.98 1.00 Temporal 0.79 0.85 0.94 1.00 PMB 0.67 0.69 0.89 1.00 Balk and Petzold IOVS 2013 Inter-observer ICC Intra-observer ICC
- 10. Summary of time-domain data MSON vs CTRL (n=2063): -20.38 μm MSON vs non-MSON (n=4199): -14.57 μm Non-MSON vs CTRL (n=3154): -7.08 μm Petzold et al. TLN 2010
- 11. To be covered • The method: OCT • Accurate quantification of atrophy in MS • Time course of atrophy • Inner and outer retinal layers • What does it mean for the patient
- 12. Lesion location is relevant for the time course of atrophy Petzold et al. TLN 2010
- 13. OCT trial power-calculations A. Henderson et al. BRAIN 2010 Power (80%, for different models and effect size) at: 3 months: 38-1024 subjects 6 months: 14-358 subjects 12 months: 15-292 subjects
- 14. More severe atrophy in PPMS? RNFL: Henderson (2008) 23 PPMS: no Henderson (2010) 16 PPMS: no (longitudinal !) Siepman (2010) 29 PPMS: no Albrecht (2012) 12 PPMS: no Pulicken (2007) 12 PPMS: trend (p=0.08) Gelfland (2012) 33 PPMS: yes Oberwahrenbrock (2012), 41 PPMS : yes RNFL + other layers: Balk (in press), 29 PPMS: no
- 15. 20 years later: how “benign” is MS? Balk et al. MSJ 2014 MSNON eyes n=61 n=85 n=126
- 16. To be covered • The method: OCT • Accurate quantification of atrophy in MS • Time course of atrophy • Inner and outer retinal layers • What does it mean for the patient
- 17. Balk et al. JNNP (in press) Inner and outer retinal layers
- 18. Does progression stop in the eye? Balk et al. JNNP (in press)
- 19. Does progression stop in the brain? Gabilondo et al. ANN (in press) OCT 0.6 um of RNFL loss <=> MRI 1cm3 visual cortex loss
- 20. Plasticity L. Balk et al. JNNP (in press)
- 21. To be covered • The method: OCT • Accurate quantification of atrophy in MS • Time course of atrophy • Inner and outer retinal layers • What does it mean for the patient
- 22. Why OCT in MS? Visual impairment ranked 2nd for reduced QoL (Heesen 2008) MS damages the anterior visual pathways (Oppenheim 1887) in >90% of patients (Lisch 1933, Lumsden 1970, Ikuta 1976, Mogensen 1990, Green 2010) A tool to investigate the cascade of neurodegeneration in MS (Waxman 2007)
- 23. What does it mean for the patient ?
- 24. Conclusion • OCT is accurate and reliable (QC !) • Evidence for inner retinal layer atrophy • Strength: acute optic neuritis, early CIS • Weakness: PPMS, long disease duration • Trans-synaptic axonal degeneration
- 25. Thank you !