Journal of Neuro-Ophthalmology, December 2012, Volume 32, Issue 4

Should Optical Coherence Tomography Be Used to Manage Patients With Multiple Sclerosis?

Over the past decade, optical coherence tomography (OCT) has become widely used in neuro-ophthalmology, mostly to assess the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular volume (1,2). OCT allows for objective and quantitative assessment of structural damage in the visual pathways, with a multitude of clinical and research applications. Thinning of RNFL and loss of macular volume have been found in multiple sclerosis (MS) patients, both with and without distinct episodes of optic neuritis (ON) suggesting ongoing loss of axons and neurons within the anterior visual system (1-3). There is strong evidence that accrual of neurologic dysfunction in MS correlates best with axonal and neuronal loss (rather than demyelination), but the magnetic resonance imaging (MRI) techniques available to measure such loss are cumbersome, expensive, and time consuming. OCT has emerged as a noninvasive and relatively inexpensive technique for capturing what we infer to be loss of central nervous system CNS) axons and neurons.