Converting to MS

C
Perez-Rico C, Ayuso-Peralta L, Rubio-Pérez L, Roldán-Díaz I, Arévalo-Serrano J, Jiménez Jurado D, Blanco R.Evaluation of visual structural and functional factors that predict the development of multiple sclerosis in clinically isolated syndrome patients.
Invest Ophthalmol Vis Sci. 2014 Sep 4. pii: IOVS-14-14807



PURPOSE. To evaluate visual pathway structure and function in patients with clinical isolated syndrome (CIS) using spectral domain optical coherence tomography (OCT) and multifocal visual evoked potentials (mfVEP), predicting CIS conversion to clinically definite multiple sclerosis (MS). 
METHODS. This observational, longitudinal study assessed the eyes with no prior history of optic neuritis of twenty-nine consecutive patients with CIS according to the McDonald criteria. The relationships of the mfVEP results with the clinical findings, psychophysical and structural (OCT) diagnostic test data were investigated. 
RESULTS. The mfVEP amplitude responses (measure of nerve loss) showed abnormal cluster visual field defects in 48.3% of the CIS eyes, while mfVEP latency (measure of demyelination) analysis showed significant delays in 20.7%. OCT average RNFLT (retinal nerve fiber layer thickness. surrogate measure of optic nerve loss) was significantly reduced compared to the control group (P = 0.02). Significant differences between CIS eyes with abnormal and normal mfVEP latencies were found for the OCT RNFLT (P < 0.001) with a longer latency being linked to more severe axonal damage (More demyelination is associated with more nerve loss = more severe disease).  OCT average RNFLT was found to be independent predictor of clinically definitive MS diagnosis at twelve months. 
CONCLUSIONS. The combined use of OCT and mfVEP is helpful to detect significant subclinical visual pathways abnormalities and axonal loss in CIS patients. Retinal axonal loss measured by OCT is an important prognosis factor of conversion to MS in patients with clinically isolated syndrome in absence of symptomatic optic neuritis.

CIS is often the first major symptom of MS. This study looks at nerve loss in the visual system as a predictor of who will go on to develop MS. Nerve loss in the eyes which reflect nerve loss in the optic nerve is a reasonable predictor

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