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Multiple Sclerosis l: Introduction

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...

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Assessing Optic Nerve Involvement in Multiple Sclerosis Using Optical Coherence Tomography and Magnetic Resonance

Gualco Alessandro¹, Boffa Giacomo^1,2, Razzetta Chiara²

¹Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.

European Journal of Neurology

|April 18, 2026

Summary

Optical Coherence Tomography (OCT) intereye difference (IED) effectively detects prior optic neuritis in Multiple Sclerosis (MS) but is less sensitive for subclinical optic nerve damage. MRI and OCT provide complementary insights into MS optic nerve pathology.

Keywords:

MRI multiple sclerosis optic nerve optic neuritis optical coherence tomography

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Area of Science:

Neuro-ophthalmology
Neuroimaging
Multiple Sclerosis Research

Background:

Optic nerve involvement is a key feature of Multiple Sclerosis (MS).
Optical Coherence Tomography (OCT) using intereye difference (IED) can detect optic nerve damage.
The 2024 McDonald criteria for OCT IED were applied to a large MS cohort.

Purpose of the Study:

To assess optic nerve involvement in a real-world MS cohort using the 2024 McDonald IED criteria.
To investigate the concordance between OCT and MRI in detecting optic nerve pathology in MS.
To evaluate the sensitivity and specificity of OCT IED for identifying prior optic neuritis and subclinical lesions.

Main Methods:

Analysis of peripapillary-retinal-nerve-fiber-layer (pRNFL) and ganglion-cell-inner-plexiform-layer (GCIPL) thickness from OCT in 740 MS patients.
Review of clinical histories for optic neuritis (ON).
Assessment of optic nerve lesions using 3D double inversion recovery MRI in 240 patients.

Main Results:

The OCT IED cutoff showed 83% sensitivity and 55% specificity for prior ON.
In the MRI subgroup, OCT IED had 67% sensitivity and 83% specificity for asymptomatic lesions.
OCT-MRI concordance was 77%; MRI detected lesions in 46% of patients without prior ON history, while OCT-IED was positive in 40%.

Conclusions:

The 2024 McDonald IED cutoff is highly sensitive for prior ON but less so for subclinical optic nerve involvement.
MRI demonstrated slightly higher sensitivity for detecting asymptomatic optic nerve lesions.
OCT and MRI offer complementary information for assessing optic nerve pathology in MS.