Jacobson Lecture - Optic Neuritis: Past, Present, and Future (PDF)

OCT has provided a basis for correlating structural aspects of anterior visual pathway axonal and neuronal loss with visual function in ON as well as in MS. It is now known that patients with MS have thinning of the retinal nerve fiber layer (RNFL, axons) and ganglion cell/inner plexiform layer (GCL+IPL, neurons) even in the absence of a history of acute ON. Such patients have clinically meaningful worsening of vision and quality of life (QOL). We now also recognize that is an inter-eye RNFL and GCL difference that may predict an underlying optic nerve lesion. Newer techniques such as retinal nerve fiber layer textual analysis may provide additional sensitivity in defining more subtle forms of optic nerve injury. Our ability to separate out the anterior and posterior visual pathway contributions to RNFL loss by hemi-segmentation techniques will be important to understand the location of the disease burden in MS. When coupled with new MRI sequences such double inversion recovery images, symptomatic and asymptomatic optic nerve lesions will become easier to verify. Going forward, OCT is a powerful tool that may be used to assess neuro-repair and neuroprotective mechanisms in both acute and chronic optic nerve injury.