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

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.