Progression of retinal ganglion cell loss in multiple sclerosis is associated with new lesions in the optic radiations

Background and purpose The mechanism of retinal ganglion cell and retinal nerve fiber layer loss in multiple sclerosis (MS) remains unknown. This study aimed to investigate the association between temporal retinal nerve fiber layer (tRNFL) thinning and disease activity in the brain determined by T2 lesions on magnetic resonance imaging (MRI). Methods Fifty‐five consecutive patients with relapsing–remitting MS and 25 controls were enrolled. All patients underwent annual optical coherence tomography and high‐resolution MRI scans for tRNFL thickness and brain lesion volume analysis, respectively. Results Significant tRNFL thickness reduction was observed over the 3‐year follow‐up period at a relatively constant rate (1.02 μm/year). Thinning of tRNFL fibers was more prominent in younger patients (P = 0.01). The tRNFL loss was associated with new MRI lesions in the optic radiations (ORs). There was significantly greater tRNFL thinning in patients with new lesional activity in the ORs compared with patients with new lesions outside the ORs (P = 0.009). Conclusions This study supports the notion that retrograde transneuronal degeneration caused by OR lesions might play a role in progressive retinal nerve fiber layer loss. In addition, the results of the study also indicate that the disease‐related neurodegenerative changes in the retina start much earlier than the clinical diagnosis of MS.