An American Academy of Ophthalmology panel reviewed 21 studies, two rated level I, on whether OCT of the retina predicts disease activity in adults with multiple sclerosis or its precursor syndromes, clinically and radiologically isolated syndrome.
Lower baseline thickness, faster thinning and greater difference between the eyes in the peripapillary retinal nerve fibre layer (pRNFL) and the macular ganglion cell-inner plexiform layer (GC-IPL) were associated with later disability progression, relapses and MRI activity. Multivariable models supported an independent association.
The panel concluded that the evidence supports developing these measures as biomarkers, not that OCT should yet guide treatment. Values from different OCT machines are not directly comparable, and most cohorts were not diverse.
For ophthalmologists who scan patients with MS, the practical step is consistency: use the same device, record pRNFL and GC-IPL with inter-eye difference, and share results with the neurologist.
- Record pRNFL and macular GC-IPL thickness, including inter-eye difference, in patients with MS.
- Scan on the same OCT device over time; values differ between manufacturers.
- Share OCT results with the treating neurologist.
- Do not use OCT alone to make MS treatment decisions.
Why it matters
An eye scan many patients already have may help neurologists judge who is likely to progress.
Don't overread it
The panel supports development of OCT as a biomarker; it is not yet a validated decision tool.
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