PHOMS Linked to Disease Duration, Higher Disability in Primary Progressive MS

Peripapillary hyper-reflective ovoid mass-like structures (PHOMS), a novel finding in retinal optical coherence tomography (OCT) imaging during the assessment of multiple sclerosis (MS), may be associated with disease duration and progression in primary progressive MS (PPMS), according to study findings published in the European Journal of Neurology.

Previous research has found the presence of PHOMS in patients with advance stage MS with a mean disease duration of 20 years. However, there is no data on the development of PHOMS in early MS. The current study authors wanted to explore the occurrence of PHOMS in patients diagnosed with early relapsing remitting multiple sclerosis (RRMS) and see if there is any link between PHOMS and disease progression in patients with both PPMS and RRMS.

The study was a cross-sectional analysis of a cohort of patients with early relapse-remitting MS (RRMS; n=349) and a second cohort of patients with PPMS (n=66) and RRMS (n=65). Patients in the first RRMS cohort had a disease duration of <12 months. Those in the second cohort of PPMS were disease duration-matched to patients with RRMS.

Retinal OCT imaging was performed in all patients. A total of 2 experienced, blinded raters examined the images to identify the occurrence of PHOMS. In the early RRMS group, approximately 18.3% of patients (n=64) had PHOMS. The mean age of these patients was 31 years, while the mean disease duration was 1.0 months.

In the second cohort, a total of 12 patients with RRMS and 13 patients with PPMS had PHOMS. The mean ages of these patients were 41 years and 53 years, respectively, while the mean disease duration was 1.5 years and 6.5 years. No associations were found between the occurrence of PHOMS and age, duration of disease, and disability.

In the group of patients with PPMS, there were significant associations between the presence of PHOMS and longer disease duration (6.5 years vs 1.0 years; P =.0007) and higher scores on the expanded disability status scale (EDSS) (4.9 vs 3.5; P =.03). A multiple logistic regression analysis adjusted for EDSS, disease duration, age, and sex found that disease duration was more relevant for the occurrence of PHOMS (EDDS: odds ratio [OR], 1.33; 95% CI, 0.79-2.26; P =.28; disease duration: OR, 1.17; 95% CI, 1.00-1.40; P =.06).

Study limitations included the cross-sectional nature of the analyses as well as the lack of data on inflammatory disease activity and its impact on PHOMS occurrence.

Based on the findings, however, the researchers suggest “an association of PHOMS development with disease duration seems conceivable during PPMS whereas underlying causes remain unclear.”

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Wicklein R, Wauschkuhn J, Giglhuber K, et al. Association of peripapillary hyper-reflective ovoid masslike structures and disease duration in primary progressive multiple sclerosis. Eur J Neurol. Published online August 9, 2021. doi:10.1111/ene.15056