A systematic review and meta-analysis of OCT-based ophthalmic changes in amyotrophic lateral sclerosis.

Upon applying a Design Effect variance inflation model to address fellow-eye non-independence, the pooled estimate remained robustly significant across a conservative range of intraclass correlations (SMD ranged from -0.256 to -0.249).

Subgroup analyses revealed that retinal nerve fibre layer thinning was particularly pronounced in spinal-onset amyotrophic lateral sclerosis (SMD = -0.54, 95% CI: (-0.98, -0.10).