Patients with multiple-system atrophy but no visual symptoms exhibit a progressive thinning of the retinal nerve fiber layer and, to a lesser extent, of the macular ganglion cell complex.
MSA is caused by a deposition of misfolded alpha-synuclein primarily in the Oligodendroglia. In contrast, in patients with Parkinson’s disease, the alpha-synuclien is on the neurons.
This creates an understanding of what differentiates MSA from Parkinson’s disease, the way that the retina is affected early is different among these diseases.
REFERENCE: DECEMBER ISSUE OF MOVEMENT DISORDERS.