Reduced retinal neuronal injury as a consequence of high efficacy DMT treatment: an OCT study

Objective: To assess the impact of disease-modifying treatments (DMTs) on retinal ganglion cell-inner plexiform layer (GCIPL) thickness. Methods: We analyzed 174 retinal optical coherence tomography (OCT) scans from 90 MS patients (female-to-male ratio 3:1; mean age 39.3 years; median EDSS 2.0; mean disease duration 8.1 years). Bilateral macular scans were obtained at baseline and follow-up using spectral-domain OCT (Spectralis, Heidelberg Engineering, Germany) between 2017 and 2023. Patients were divided into moderate-efficacy (ME-DMT, N = 34) and high-efficacy (HE-DMT, N = 56) groups. The primary measure was global GCIPL thickness, with analysis conducted via independent t-tests and a mixed linear regression model to determine annualized GCIPL change. Results: The HE-DMT group had a significantly lower annual GCIPL atrophy rate (0.07 +/- 0.38 & micro;m/year) compared to the ME-DMT group (0.64 +/- 0.86 & micro;m/year, p < 0.0001). Mixed linear regression confirmed these findings, accounting for covariates and baseline characteristics. Conclusions: HE-DMTs appear to slow GCIPL atrophy, suggesting a potential neuroprotective effect. These results underscore the value of retinal imaging in tracking MS treatment efficacy and neurodegeneration.