Optical Coherence Tomography Applications in Multiple Sclerosis

Optical coherence tomography (OCT) has emerged as a non-invasive retinal imaging modality that provides high-resolution cross-sectional measurements of retinal layers, enabling quantitative assessment of neuroaxonal integrity in people with multiple sclerosis (MS). By capturing changes in the peripapillary retinal nerve fibre layer (pRNFL), ganglion cell–inner plexiform layer (GCIPL) and other inner retinal structures, OCT offers a surrogate marker of central nervous system neurodegeneration. These metrics correlate with clinical measures of disability, magnetic resonance imaging activity and visual function, making OCT attractive for both clinical trials and routine monitoring. Advances in spectral-domain OCT technology and automated segmentation algorithms have improved the reproducibility of layer-specific thickness estimates, while consensus quality-control criteria ensure standardised reporting. Applications span early detection of subclinical optic neuritis, prediction of relapse risk and tracking of progressive neurodegenerative change across relapsing-remitting and progressive MS phenotypes. Practical challenges include inter-device variability and measurement noise, which underscore the need for harmonised protocols. Taken together, OCT represents a cost-effective, side-effect-free imaging biomarker with global significance for elucidating disease mechanisms and guiding therapeutic decisions in MS.

Research from Nature Portfolio

A 2024 study of over 2 600 OCT scans from patients with relapsing-remitting, primary and secondary progressive MS demonstrated that thinning of the pRNFL and macular nerve fibre layer reliably predicts future clinical relapses and MRI activity. In relapsing-remitting MS, both macular RNFL and GCIPL thickness forecast new inflammatory lesions, while in progressive forms GCIPL measurements correlated with disability progression. The investigators highlighted substantial measurement variability, cautioning against reliance on single-patient longitudinal change without rigorous quality control.

Optical Coherence Tomography Applications in Multiple Sclerosis publication trend

The graph below shows the total number of articles in optical coherence tomography applications in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Optical coherence tomography (OCT): An imaging technique that uses low‐coherence light to produce cross‐sectional images of the retina, allowing precise measurement of individual retinal layers.

Peripapillary retinal nerve fibre layer (pRNFL): The layer of unmyelinated axons surrounding the optic disc, whose thickness reflects axonal integrity in MS.

Ganglion cell–inner plexiform layer (GCIPL): Combined layers comprising retinal ganglion cell bodies and their synaptic connections, serving as a marker of neuronal health.

Macular volume (TMV): The total volume of retinal tissue within the macula, providing an aggregate measure of inner retinal layer status.

Optic neuritis: Inflammatory demyelination of the optic nerve common in MS, often leading to acute vision loss and detectable retinal changes on OCT.

Spectral-domain OCT: An advanced OCT modality offering higher scan speed and resolution than earlier time-domain systems, enabling more reliable layer segmentation.

References

1. Evolution of retinal degeneration and prediction of disease activity in relapsing and progressive multiple sclerosis. Nature Communications (2024).
2. Diagnosis of Multiple Sclerosis by Detecting Asymmetry Within the Retina Using a Similarity-Based Neural Network. IEEE Access (2024).
3. Effect of Different Treatments on Retinal Thickness Changes in Patients With Multiple Sclerosis: A Review. CNS Neuroscience & Therapeutics (2025).
4. Inner Retinal Layer Changes Reflect Changes in Ambulation Score in Patients with Primary Progressive Multiple Sclerosis. International Journal of Molecular Sciences (2023).
5. The OSCAR-IB Consensus Criteria for Retinal OCT Quality Assessment. PLOS ONE (2012).
6. Reliability of Intra-Retinal Layer Thickness Estimates. PLOS ONE (2015).