Monitoring the Course of MS With Optical Coherence Tomography

Retinae of patients with multiple sclerosis (MS), as part of the central nervous system (CNS), display inflammatory and neurodegenerative changes. There is increasing evidence suggesting that retinal changes, and in particular neurodegeneration, mirror global CNS alterations in MS. Spectral domain optical coherence tomography (SD-OCT) is an inexpensive, rapid, non-invasive, and reproducible imaging technique that generates high-resolution images of tissues such as the retina. An advantage of SD-OCT over magnetic resonance imaging techniques in the assessment of neurodegeneration may be its sensitivity to capture changes at the individual patient level. Several studies demonstrate that changes within the inner retina (primarily as a reflection of optic neuropathy), as assessed by OCT, correlate with reduced quality of life, visual dysfunction, and global disability in MS. Moreover, longitudinal studies suggest that inner retinal thinning is an early phenomenon in MS and that retinal thinning may occur independent of previous symptomatic episodes of optic neuritis, significantly correlating with inflammatory disease. Preliminary studies suggest that MS disease-modifying therapies may have differential effects on OCT-determined rates of retinal atrophy, supporting a potential utility for OCT to investigate the neuroprotective benefits of disease-modifying therapies in MS, as well as an outcome in trials of putatively neuroprotective strategies.