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Home - 02.10.2013 - Young Scientific Investigators’ Session 2

Young Scientific Investigators’ Session 2

Wednesday, October 02, 2013, 16:36 - 16:48

Accelerated retinal damage and vision impairment in African-American multiple sclerosis patients

D. Kimbrough, E. Sotirchos, J. Wilson, L. Balcer, E. Frohman, A. Green, P. Calabresi (Baltimore, Philadelphia, New York, Dallas, San Francisco, US)

Objective: The primary objective was to determine whether African-American (AA) multiple sclerosis (MS) patients have more severe manifestations of retinal damage and visual impairment compared to Caucasian-American (CA) MS patients. Background: MS patients of African descent reportedly suffer disabling symptoms more often than patients of Caucasian descent. Additionally, MS disease activity appears more burdensome in AA patients as evidenced by higher levels of inflammatory markers (IgG index, oligoclonal banding patterns) and greater T2 and T1 lesion volumes on MRI.
Design/Methods: Using mixed effects regression models, high and low contrast visual acuity and longitudinally acquired spectral-domain optical coherence tomography (Cirrus-OCT) measures of retinal architecture were compared between MS patients of self-identified AA or CA ancestry.
Results: OCT and visual acuity data were acquired for 693 MS patients (83 AA) and 137 healthy controls (31 AA) from 3 academic medical centers. For individuals with > 6 months of follow-up, the median follow-up duration was 1.6 years for both MS patients and healthy controls (HC), ranging from 0.5-3.6y and 0.73–2.0y, respectively. At baseline, there was no difference in the prevalence of an optic neuritis (ON) history between AA and CA. In HC at baseline, foveal thickness, macular thickness, and macular volume did not differ between AA and CA. Peripapillary retinal nerve fiber layer thickness (RNFL) among HC at baseline was 5.1um greater in AA compared to CA (p = 0.025). In MS patients, however, there was no baseline difference in the RNFL of AA and CA patients. During follow-up, RNFL decreased -0.31 um/y for CA patients and -1.1 um/y for AA patients (p-values equal to 0.005 and 0.003, respectively) with adjustment for history of ON, age, sex, and disease duration. Visual acuity, when analysed among MS patients without ON history, did not differ between CA and AA at any contrast level. However, AA patients with a history of ON suffered clinically significant vision loss beyond that of CA counterparts with prior optic neuritis (-1 line of Sloan letter acuity at both 100% and 2.5% contrast levels, p = 0.027 and p = 0.031, respectively).
Conclusions: AA MS patients appear to have accelerated retinal damage which may be independent of ON history; however, an ON history may predispose these patients to a greater degree of visual impairment compared to CA MS patients. This suggests a more aggressive MS disease course among AA MS patients or a subpopulation therein.

D. Kimbrough has no relevant disclosures. E. Sotirchos has no relevant disclosures. J. Wilson has no relevant disclosures. L. Balcer has no relevant disclosures. E. Frohman has no relevant disclosures. P. Calabresi has no relevant disclosures.