Measuring retinal nerve fibre layer (RNFL) thickness and assessing the optic nerve region with optical coherence tomography (OCT) could enable earlier diagnosis for people with multiple sclerosis (MS). 

A team of researchers say their study supports the use of OCT alongside existing methods to allow treatment to start sooner.

MS is diagnosed if new central nervous system damage is identified, or previous symptoms return at two different time points in at least two of four areas – the periventricular, juxtacortical/cortical and infratentorial regions of the brain, and the spinal cord.

Researchers have suggested that optical nerve damage and RNFL changes be added to this list (Brownlee et al, 2018 ). 

Researchers at the Medical University of Vienna analysed records of people who had an initial attack of symptoms attributed to neurological damage associated with MS between 2014 and 2022. OCT was used to assess the optic nerve region and track RNFL thickness.

Of the 267 individuals in the study, 100 later had a second attack or relapse. Including the optic nerve region in the diagnostic criteria produced a similar risk of second attack compared with using the original criteria, as the difference in the level of risk using each method did not reach statistical significance.

However the accuracy of the new approach was 81%, compared with 66% for the standard method, providing support for the widening of MS diagnostic criteria (Bsteh et al, 2023 ). The findings were published in the journal Neurology.

Further research may be needed as the researchers used data from a previous study, opening up the risk of selection bias, and, as they acknowledged, participants were almost exclusively Caucasian.