gms | German Medical Science

Purpose: To assess the structural and microvascular chorioretinal changes in patients with multiple sclerosis (MS). We also investigated whether these changes correlate with the severity of fatigue and cognitive impairment in patients with MS.

Patients and Methods: This prospective study included 77 patients with confirmed MS and 30 healthy, age-matched control subjects. All participants underwent both optical coherence tomography (OCT) and OCT angiography (OCTA) with enhanced depth of image (EDI). Outcome measures included: Best corrected visual acuity (BCVA), superficial capillary plexus vessel density (VD), perfusion density (PFD), foveal avascular zone area (FAZ), retinal nerve fiber layer thickness (RNFL), retinal ganglion cell layer thickness (RGCL), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT). The severity of the patients’ fatigue was determined using the Modified Fatigue Impact Scale (MFIS), while cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA) test.

Results: Compared to control subjects, there were no significant differences in age, gender, BCVA and SFCT. However, MS patients showed significantly larger FAZ surface (0.25±0.13 vs 0.19±0.08 mm², p=0.01), lower macular VD (18.1±3.5vs 19.2±5.1 mm/mm², p=0.02) and PED (42.1±7.9 vs 44.5±4.5%, p=0.02), thinner RNFL in nasal subfields and thinner RGCL in all macular subfields. The MFIS showed a significant negative correlation with the superior perifoveal RGCL thickness, while the MoCA test showed a significant negative correlation with the foveal VD and PFD.

Conclusions: Compared to healthy individuals, MS patients exhibited larger FAZ surface area, lower macular PED, along with thinner RGCL and nasal RNFL. In addition, higher perifoveal RGCL thickness might be correlated with less fatigue, while higher foveal perfusion density might be correlated with less cognitive impairment.