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OCT’s Role in Improving Early MS Diagnosis

Early diagnosis of multiple sclerosis (MS), crucial for initiating disease-modifying therapies (DMTs) to halt disease progression, remains a significant challenge. In their article “Diagnostic Performance of Adding the Optic Nerve Region Assessed by Optical Coherence Tomography to the Diagnostic Criteria for Multiple Sclerosis,” Austrian researchers propose modifying current diagnostic criteria to facilitate earlier MS diagnosis. MS is diagnosed based on clinical symptoms and MRI evidence of central nervous system lesions (DIS). This study suggests that measuring retinal thickness using optical coherence tomography (OCT) could aid in detecting MS sooner.

The study involved 267 patients experiencing their first demyelinating event. Alongside standard diagnostic methods, OCT was used to detect reduced retinal fiber thickness within six months of the initial event. Combining retinal thickness measurement with existing criteria (DIS + OCT) was more accurate in predicting a second demyelinating event than using DIS alone.

Key findings:

  • Of the 175 individuals who experienced a second attack, 107 had abnormal OCT findings.
  • DIS + OCT was more accurate in predicting a second demyelinating attack than using DIS alone.
  • DIS + OCT was associated with a greater risk of a second attack than DIS alone.
  • OCT detected abnormal retinal thickness in both symptomatic and asymptomatic optic neuritis.

Implications for managing MS

OCT is a quick, reliable tool that can improve the accuracy of diagnosing MS. Early detection enables prompt initiation of DMTs, which is crucial for slowing disease progression.

Future directions

The authors propose revising MS diagnostic criteria to include OCT but acknowledge the need to confirm results in a more diverse population. They also caution that while OCT improves predicting future demyelinating events, clinical findings consistent with MS remain essential for diagnosis.

Citation:

Bsteh, G., et al (2023). Diagnostic Performance of Adding the Optic Nerve Region Assessed by Optical Coherence Tomography to the Diagnostic Criteria for Multiple Sclerosis. Neurology, 101(8), e784–e793. https://doi.org/10.1212/WNL.0000000000207507