# The potential of optical coherence tomography angiography in progressive multiple sclerosis

## TL;DR

This study explores how optical coherence tomography angiography (OCTA) can help detect and monitor retinal vascular changes in people with progressive multiple sclerosis.

## Contribution

The study is the first to evaluate OCTA as a potential tool for monitoring progressive multiple sclerosis, focusing on retinal vascular changes.

## Key findings

- Vessel density in the superficial vascular complex was reduced in progressive MS compared to healthy controls.
- Clinical disability scores correlated negatively with retinal vessel density in progressive MS patients.
- Disease duration influenced retinal vascular changes in younger progressive MS individuals.

## Abstract

Early detection and monitoring of neurodegenerative processes in persons with multiple sclerosis (PwMS) is currently a major challenge. Optical coherence tomography angiography (OCTA) is an emerging method to visualize retinal vascular architecture. However, its use has mainly been investigated in relapsing MS. We evaluated OCTA as a possible complementary method in progressive MS (PMS) in a monocentric, retrospective, cross-sectional study. Eyes with evidence of optic neuritis were excluded from analysis. OCTA images acquired using a Spectralis OCT (Heidelberg Engineering) were analyzed with an established deep learning-based segmentation algorithm. After rigorous quality control, 85 eyes of 62 PwPMS were compared with 64 eyes of 43 age and gender-matched healthy controls (HC). The vessel density in the superficial vascular complex (VDSVC (%)) was reduced in PMS compared to HC (p = 0.018). VDSVC correlated negatively with age in PwPMS and HC. Using a Johnson–Neyman analysis, we identified that the disease duration influences the VDSVC in PMS individuals < 57.5 years of age. PwPMS with disease duration > 10 years had reduced VDSVC compared to subjects with ≤ 5 years of disease duration (p = 0.049) (corrected for age). Clinical disability (EDSS) negatively correlated with VDSVC in PwPMS (β = −0.487, p = 0.010). These results suggest that OCTA might be suitable to detect retinal vascular changes in PwPMS. One consequence could be structured and harmonized OCTA investigations as part of routine clinical practice. External validation and longitudinal studies are necessary to further elaborate OCTA´s potential in monitoring PwPMS.

The online version contains supplementary material available at 10.1007/s00415-026-13659-7.