OCT nerve fibre and ganglion cell thinning predicts multiple sclerosis progression, an AAO review finds

Design

Systematic evidence assessment of 21 studies (2 level I, 8 level II, 11 level III)

Population

Adults with multiple sclerosis, clinically isolated syndrome or radiologically isolated syndrome

Primary outcome

Association of OCT pRNFL and GC-IPL measures with disability, relapse and MRI progression

Effect

Thinner, faster-thinning or asymmetric layers associated with future progression

An American Academy of Ophthalmology Ophthalmic Technology Assessment reviewed 21 studies — two rated level I, eight level II and 11 level III — on whether retinal OCT predicts disease activity in adults with multiple sclerosis, clinically isolated syndrome or radiologically isolated syndrome.

Lower baseline thickness, faster thinning and larger differences between eyes in the peripapillary retinal nerve fibre layer and the macular ganglion cell–inner plexiform layer were associated with future disability, relapses and MRI progression. Multivariable models supported an association independent of other factors.

The panel supports developing these measures as progression biomarkers, but noted that thresholds differ between OCT manufacturers and that the place of OCT alongside MRI is not yet defined. For ophthalmologists, a baseline OCT in a patient with demyelinating disease is increasingly useful information for the neurologist.

• Offer baseline OCT of the nerve fibre and ganglion cell layers to patients with multiple sclerosis or optic neuritis.
• Report interocular asymmetry as well as absolute thickness; asymmetry carried prognostic value.
• Use the same OCT device for follow-up, since values are not interchangeable between manufacturers.
• Share OCT results with the treating neurologist rather than filing them in the eye record alone.

Why it matters

OCT is quick, cheap and widely available, including in India, where MRI follow-up can be costly.

Don't overread it

OCT is not yet a validated stand-alone predictor; device thresholds differ and its role beside MRI is undefined.

The statistics, in plain English

Level I studies are the strongest evidence in this rating scheme; most included studies were levels II and III. 'Independent association' means OCT still predicted progression after accounting for other measured predictors, not that it outperforms MRI.

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