Schematic of OCT cross-sectional imaging and retinal layers. The resulting interference pattern is processed to render cross-sectional fundoscopic-like images (called a deviation map, Figure 1A), a 3-dimensional map, and retinal layer measurements (Figure 1B).įigure 1. OCT is analogous to high-resolution, light-based “ultrasound.” A light beam is directed at the retina and each retinal layer reflects that light differently. OCT measures with the most robust data for clinical use in demyelinating diseases are the peripapillary retinal nerve fiber layer (RNFL) and the macular ganglion cell-inner plexiform layer (GCIPL) thicknesses. Although not yet completely validated to guide clinical decision making in MS, OCT offers useful information in the context of other clinical factors. This review, focused on practical applications of OCT in MS and ON, summarizes some of the existing evidence and is informed by experience at our center. OCT measures correlate with key MS outcomes, including but not limited to low-contrast visual acuity (VA) and disability 4-6 response to disease-modifying therapy (DMT) 7 whole brain, thalamic, and gray matter atrophy 8 future relapses 9 disability progression and the likelihood of eventually meeting clinically definite MS criteria. OCT has shown value for evaluating acute inflammatory events as well as quantifying insidious neural atrophy resulting from local or distant contiguous axon pathology in MS, as well as many other conditions with neurodegeneration. OCT is noninvasive, inexpensive, rapid, highly reproducible, and able to quantify, on the scale of microns, discrete retinal layers. Retinal optical coherence tomography (OCT) is a useful research tool increasingly being incorporated into routine clinical care for MS. Sensitive, pragmatic biomarkers are needed to aid diagnosis, prognosis, and monitoring in demyelinating diseases (eg, multiple sclerosis and optic neuritis ).
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