Optical coherence tomography in multiple sclerosis and neurologic disorders

Jacqueline T Bernard MD (Dr. Bernard of Oregon Health and Sciences University served as lead investigator for trials sponsored by Biogen and has received consulting fees from Genzyme and Novartis.)
Annabel Boeke BA (Ms. Boeke of Pritzker School of Medicine has no relevant financial relationships to disclose.)
Darin Rosen BA (Mr. Rosen of Pritzker School of Medicine has no relevant financial relationships to disclose.)
Anthony T Reder MD, editor. (Dr. Reder of the University of Chicago served on advisory boards and as a consultant for Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Malinkrodt, Serono, and Teva-Marion.)
Originally released November 5, 2013; last updated August 4, 2016; expires August 4, 2019

Overview

Optical coherence tomography (OCT) is a high-resolution, noninvasive imaging technique using infrared technology to measure retinal nerve fiber layer thickness and macular volume. The retinal nerve fiber layer is the inner-most layer of the retina and is derived from unmyelinated axons. The axons arise from ganglion cell neurons located in the ganglion cell layer, which is directly below the retinal nerve fiber layer. The layers of the retina ultimately form the optic nerves and become myelinated. Optical coherence tomography takes advantage of the accessibility of the retina to study the CNS. The retina is unique in the CNS in that it contains axons and glia but no myelin, thus, potentially an ideal structure to study neurodegeneration, neuroprotection, and possibly even neurorestoration in multiple sclerosis and neurodegenerative disorders.

Optical coherence tomography is a commonly used retinal imaging technique employed to diagnose and monitor eye disease. Because the technology is capable of rapid and reproducible measurements of the retina, which is a direct projection of the central nervous system, it can quantitate certain neurodegenerative pathologies. It is emerging as a valuable technique for characterizing neurologic diseases and has already been studied extensively as a biomarker for multiple sclerosis. OCT provides a low risk technology that can greatly improve clinical acumen for both clinically oriented and research based neurologists.

Key points

 

• Currently, optical coherence tomography (OCT) is utilized as an ancillary test to assist with the diagnosis of multiple sclerosis and to distinguish multiple sclerosis from other demyelinating diseases, such as neuromyelitis optica (Galetta et al 2012).

 

• OCT has also been used to follow demyelinating disorders over time in individuals.

 

• OCT is an excellent tool for monitoring therapeutic benefits of multiple sclerosis treatments in individuals and has become a standard metric or “biomarker” for multiple sclerosis clinical trials.

 

• Correlations between OCT and other biomarkers, such as low contrast vision, visual evoked potentials, color vision, and brain diffusion tensor imaging have been reported (Dorr et al 2011).

 

• Using multiple sclerosis as the initial model, OCT has demonstrated its potential as a biomarker for neurologic diseases. With the ongoing development of new technology and the growth of neurologic OCT research, more applications for OCT are constantly being discovered. It is now possible to achieve more precise layer analysis in the macula with the advent of automated segmentation of the retina and extended depth imaging of the choroid.

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