Objective:

This study aimed to identify clinical and radiological correlates of pRNFL thickness, evaluate whether pRNFL thinning predicts disability and cognitive decline, and examine the effects of DMTs on retinal neurodegeneration in Chinese MS patients.

Background:

Peripapillary retinal nerve fiber layer (pRNFL) thinning, detected by optical coherence tomography (OCT), is an early marker of neuroaxonal injury in multiple sclerosis (MS). Its prognostic value for long-term outcomes and responsiveness to disease-modifying therapies (DMTs) remain insufficiently explored, particularly in Asian populations.

Design/Methods:

We analyzed 355 Chinese MS patients who underwent OCT, neurological assessments, and brain MRI. Multivariate regression identified determinants of baseline pRNFL thickness. Logistic regression assessed whether annualized pRNFL thinning predicted disability or cognitive decline. Linear mixed-effects models evaluated longitudinal effects of DMT classes on pRNFL thinning.

Results:

Median pRNFL thickness was 105.0μm (range: 65.0-136.5). Thinner pRNFL was associated with younger age (p = 0.005), longer disease duration (p < 0.001), optic neuritis (p = 0.038), and increased paramagnetic rim lesions (p = 0.003). While pRNFL thinning rate was unrelated to EDSS progression, faster pRNFL thinning predicted Symbol Digit Modalities Test (SDMT) worsening (OR = 1.29, p = 0.018), alongside fewer years of education (OR = 0.84, p = 0.033) and secondary progressive MS phenotype (OR = 7.67, p = 0.006) were. No significant differences in pRNFL preservation were observed among DMT classes. 

Conclusions:

pRNFL thinning reflects disease severity and predicts cognitive decline in MS. Current DMTs provide limited retinal neuroprotection. These findings support the routine OCT-derived pRNFL monitoring and highlight the need for neuroprotective strategies in MS.