Eye examinations reveal a lot about a person’s general health. With multiple sclerosis, what is found deep inside an eye may yield an initial diagnosis of the chronic disease, and yearly checkups can help to measure disease progression.
With the acquisition of an Optical Coherence Tomography (OCT) machine, vital for neuro-ophthalmologists, the Corinne Goldsmith Dickinson Center for Multiple Sclerosis has expanded its capacity to provide comprehensive care. A generous gift from the Muzio Family Foundation enabled the Center to purchase the OCT machine.
Sylvia Klineova, MD, MS
In this Q&A, Sylvia Klineova, MD, MS, who specializes in multiple sclerosis (MS) eye health, explains why routine exams are essential for MS patients, how an OCT works, and the benefits of offering it at the Center. She is also an Associate Professor of Neurology at the Icahn School of Medicine at Mount Sinai.
“OCT tests are a new part of how we’re assessing our patients and should be incorporated in MS comprehensive care,” she says.
Why are regular eye exams important for multiple sclerosis care?
You can think of eyes as sort of a surrogate for changes in the brain of someone with multiple sclerosis. The “retinal nerve fiber layer” (RNFL) are the nerves in the back of the eye that are the beginning of the pathway for vision into the brain. Loss of thickness in the RNFL has been correlated to the degree of brain atrophy in MS patients, particularly in those with prior optic neuritis, a condition in which the optic nerve, which connects the eye to the brain, becomes swollen or inflamed. An MRI, however, cannot precisely measure the thickness of retinal nerve fiber layer, or accurately determine the effects of lesions in optic nerves. Optic neuritis is one of the most common initial attacks of MS, so a precise diagnosis is important. Even in patients without optic neuritis, we can see the impact of MS on retinal nerve fiber layer thickness.
Why do multiple sclerosis neurologists use an OCT?
The OCT, first introduced in 1991, was predominantly used by ophthalmologists for care in glaucoma, a very common reason for people developing optic neuropathy, or damage to optic nerves. Since the optic nerves are often affected in people who have MS, researchers who focused on eyes concluded that an OCT is more sensitive than an MRI in uncovering optic nerve lesions. The technology can help attain an earlier diagnosis of MS or confirm diagnoses in patients where the use of MRI doesn’t reveal an optic nerve lesion.
An OCT also is used to help to distinguish optic neuritis in MS versus other demyelinating diseases like neuromyelitis optica (NMO). After an MS optic neuritis attack, doctors use OCT to monitor how much optic nerves are damaged. Looking at changes in thickness of the neural layer can help to predict the degree of vision recovery in six months or a year after the attack. In imaging of a patient’s eyes over time, doctors look for any sign of changes of a neural layer in optic nerves and macula, the area with the highest number of cells that form optic nerves.
How does OCT work?
An OCT machine looks a little bit like a big computer. You put your chin on a chin rest and look straight ahead without shifting your eyes. A scanning light, moving across your line of vision, reaches deep inside tissues of the retina, and comes back with pictures of different cell layers. The test lasts about 15 minutes, is painless and non-invasive, and the results are quickly available to the physician.
The OCT will be part of the newest multiple sclerosis diagnostic criteria (the McDonald Criteria), which have been widely discussed at international conferences and will be published in 2025. The older criteria did not specifically single out optic nerves as one of the locations where doctors would look for lesions.
Why did Mount Sinai’s Center get an OCT?
The OCT program began in December 2023 when the Center added an OCT to its onsite equipment. Our Center staff take the images. The only thing needed from a patient is to sit and not move their eyes. With the OCT installed at the Center, patients do not need to go to another facility for a test that is recommended as a part of their comprehensive care. The exams usually are scheduled by providers as part of patients’ regular clinical visits.
Are OCT tests necessary?
Annual OCT exams are recommended for many MS patients. How the nerve layer around the optic nerve and retina looks can tell neurologists something about how MS is affecting the whole nervous system.
OCTs are particularly useful for tracking progression in patients who had optic neuritis. Whether and how much these patients lose vision depends on the extent of damage to the optic nerve as well as the macula, the place of sharpest vision. Evaluating the loss of thickness in optic nerves and macula can help to predict the degree of vision recovery.
For patients without prior optic neuritis, doctors can see how MS affects thickness of the neural layer. They are looking for stability of the thickness over time. And since neuroprotective or remyelinating drugs have not yet been developed, if a significant drop in retinal thickness occurs, then advancing to a more effective MS therapy can be discussed.
By Kenneth Bandler, a multiple sclerosis patient, advocate, and member of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Advisory Board