Aa
Optical Coherence Tomography & MS
Hey, so I've been talking for weeks on end about these cool tests I did at UTSW. Here's the lowdown on what the tests involved, and what the results mean...
First of all, optical coherence tomography measures the retinal nerve fiber layer of the eye. Unlike the nerve fibers of the brain, the RNFL has no myelin. It shows atrophy much better than an MRI. An MRI looks for lesion activity, and as we know, some people with MS have very little lesion activity. They think now that there's several different kinds of MS, some with lesion formation, some without.
My 3T MRI, according to the radiologist, has a relatively light lesion load. Sure, there's lesions - brainstem, corpus callosum, cerebellum, and frontal lobe. But as my neurologist said, my variety of symptoms don't match up with the MRI - the evidence would indicate that I have invisible axon breakage going on. The only way to measure axon breakage and atrophy is through optical coherence tomography.
So what does this pretty picture mean? It's cool, isn't it? Looks like a trippy poster I used to have on the wall.
Well, the one on the left - the nerve fiber analysis - shows the RNFL thickness for both eyes. Where it's red, my nerve fiber is very thin - almost non-existent. The RNFL is pretty thin in other areas, too, but the red spots are basically blind spots.
The image on the right is a map of the blind spots for both eyes. For some reason, although I notice the black spots in my right eye, the left eye is actually worse off. The red quadrants indicate RNFL thickness of less than 1%.
I've also got a visual field test which I didn't post here. That test was cool too - they had me put my head inside a viewer, and I focused on a dot in the center. I was supposed to click every time I saw a little light. It looks like my peripheral vision is non-existent in the spots that are red on the OCT results.
This is a little distressing for me. We didn't really talk about the results, other than what the numbers meant. But what that tells me is that I am experiencing atrophy and loss of axons, without lesion formation. It also tells me I need to think about my eyes, and what to do if I lose more of my vision.
So what does this all mean for MS diagnosis? This test can prove that there's RNFL atrophy even before lesions form in the brain. It's a better predictor of MS, it's cheaper, and it's less invasive. No gadolinium contrast is required, and there's no restrictions because of metal implants.
Since most neurologists don't have access to this technology, unfortunately that leaves people in limbo. If we could encourage neurologists and neuro-opthamologists to work together, not just in the larger urban areas, but in rural areas and smaller towns, I can't help but think that many more people would be diagnosed conclusively with optical coherence tomography.
First of all, optical coherence tomography measures the retinal nerve fiber layer of the eye. Unlike the nerve fibers of the brain, the RNFL has no myelin. It shows atrophy much better than an MRI. An MRI looks for lesion activity, and as we know, some people with MS have very little lesion activity. They think now that there's several different kinds of MS, some with lesion formation, some without.
My 3T MRI, according to the radiologist, has a relatively light lesion load. Sure, there's lesions - brainstem, corpus callosum, cerebellum, and frontal lobe. But as my neurologist said, my variety of symptoms don't match up with the MRI - the evidence would indicate that I have invisible axon breakage going on. The only way to measure axon breakage and atrophy is through optical coherence tomography.
So what does this pretty picture mean? It's cool, isn't it? Looks like a trippy poster I used to have on the wall.
Well, the one on the left - the nerve fiber analysis - shows the RNFL thickness for both eyes. Where it's red, my nerve fiber is very thin - almost non-existent. The RNFL is pretty thin in other areas, too, but the red spots are basically blind spots.
The image on the right is a map of the blind spots for both eyes. For some reason, although I notice the black spots in my right eye, the left eye is actually worse off. The red quadrants indicate RNFL thickness of less than 1%.
I've also got a visual field test which I didn't post here. That test was cool too - they had me put my head inside a viewer, and I focused on a dot in the center. I was supposed to click every time I saw a little light. It looks like my peripheral vision is non-existent in the spots that are red on the OCT results.
This is a little distressing for me. We didn't really talk about the results, other than what the numbers meant. But what that tells me is that I am experiencing atrophy and loss of axons, without lesion formation. It also tells me I need to think about my eyes, and what to do if I lose more of my vision.
So what does this all mean for MS diagnosis? This test can prove that there's RNFL atrophy even before lesions form in the brain. It's a better predictor of MS, it's cheaper, and it's less invasive. No gadolinium contrast is required, and there's no restrictions because of metal implants.
Since most neurologists don't have access to this technology, unfortunately that leaves people in limbo. If we could encourage neurologists and neuro-opthamologists to work together, not just in the larger urban areas, but in rural areas and smaller towns, I can't help but think that many more people would be diagnosed conclusively with optical coherence tomography.
COMMUNITY LEADER
they do look cool, still double dutch but thanks for the explanation though. I had some pic's of my eyes done (not the same ones though) and they look freaky but cool too.
What exactly does it mean for you though, can anything be done or is it a case of by the time the evidence is there, no one can do anything about it? Hope not!!!!!
I'm sure the eyes if they could talk would tell a wild story, maybe this type of testing is now giving eyes a diagnostic voice so to speak, maybe lol pitty its not a common tool in the diagnostic process.
Cheers.........JJ
What exactly does it mean for you though, can anything be done or is it a case of by the time the evidence is there, no one can do anything about it? Hope not!!!!!
I'm sure the eyes if they could talk would tell a wild story, maybe this type of testing is now giving eyes a diagnostic voice so to speak, maybe lol pitty its not a common tool in the diagnostic process.
Cheers.........JJ
Hey Jens,
Good post. What doc tells you makes sense w/the axon loss w/out newly formed lesions and what we say here w/the disease always being active. Further proof is always good.
I think Quix and some others have had the OCT test too. This is an old study related post. You interested in digging up the update? If not, I can look too...
http://www.medhelp.org/posts/Multiple-Sclerosis/Vision-Test---Optical-Coherence-Tomography-/show/366336
-Shell
Good post. What doc tells you makes sense w/the axon loss w/out newly formed lesions and what we say here w/the disease always being active. Further proof is always good.
I think Quix and some others have had the OCT test too. This is an old study related post. You interested in digging up the update? If not, I can look too...
http://www.medhelp.org/posts/Multiple-Sclerosis/Vision-Test---Optical-Coherence-Tomography-/show/366336
-Shell
Many MS centers (including Rocky Mountain MS) are starting to do them early after diagnosis as a "baseline." I had mine done with my last relapse. They think it will be more sensitive to detect progression and be more objective. The current disability scores are way to subjective and the score vary greatly depending on who is scoring.
According to my doc, the first one has "limited value" other than as a baseline. It is the change in thickness over the change in time where they think the value comes in. As Jens said, they think this is going to be a more sensitive measure of axonal loss than looking for "Black Holes" on the T1 MRI sequences. The OCT produces more repeatable results than a radiologist counting "black holes" or estimating changes in brain volume.
Bob
According to my doc, the first one has "limited value" other than as a baseline. It is the change in thickness over the change in time where they think the value comes in. As Jens said, they think this is going to be a more sensitive measure of axonal loss than looking for "Black Holes" on the T1 MRI sequences. The OCT produces more repeatable results than a radiologist counting "black holes" or estimating changes in brain volume.
Bob
Thanks for posting this.
I'd like to have that test on my eyes.
I've had the Goldmann visual fields test. It showed that I had several scotomas (blind spots). Most were centrally located, but I think there were a couple peripheral.
I'd like to have that test on my eyes.
I've had the Goldmann visual fields test. It showed that I had several scotomas (blind spots). Most were centrally located, but I think there were a couple peripheral.
I have scotomas in my right eye too, and those seem to be neurological and due to damage to the optic nerve and tract. The OCT thickness measurements don't seem related to the visual field defects. In fact the the eye with Optic Neuritis actually has a higher RNFL thickness than the other eye. There is one area in my left eye that is dipping into the yellow.
Bob
Bob
Shell, thanks for posting that! I had forgotten about that thread...
Bob, that makes sense. When I have an appointment with Dr. C, we talk about a lot of stuff, and sometimes we don't explore topics we should have covered! I know I've had several cases of ON in the right eye, all pre-diagnosis.
JJ, I think the damage is done, and can't be reversed. It's good that I have a record of how my eyes are doing now, so we can have a baseline, like Bob says. Maybe I need to be on a more aggressive DMD - I don't know, and Dr. C didn't mention it.
Bob, that makes sense. When I have an appointment with Dr. C, we talk about a lot of stuff, and sometimes we don't explore topics we should have covered! I know I've had several cases of ON in the right eye, all pre-diagnosis.
JJ, I think the damage is done, and can't be reversed. It's good that I have a record of how my eyes are doing now, so we can have a baseline, like Bob says. Maybe I need to be on a more aggressive DMD - I don't know, and Dr. C didn't mention it.
I have an eye test tomorrow morning. I have been preglaucomic for decades. I don't mind telling you I am afraid for my eyes. I have been legally blind without my glasses since a preteen.
I now cannot even recognize the big E without my glasses. Since childhood I have praqcticed feeling my way around in the dark. Then I started losing the feeling in my hands and realized what a waste of time that was. I cannot even put wire earrings in because I cannot feel the wires.
In my last eye test, they could only correct my vision to a certain point. They can no longer bring my eyes up to 20/20. I no longer drive very much, but I still can drive. I am starting to prepare myself for taxi days and trying to find ways that it will make my life better.
But I can still feel my stomach going into flipflops over the thought that I could go blind - probably will go blind. And with no hands and no eyes, this stubborn woman will have to accept help - more help than I now need.
That food sure tasted good. It now feels terrible in my roiling stomach.
I now cannot even recognize the big E without my glasses. Since childhood I have praqcticed feeling my way around in the dark. Then I started losing the feeling in my hands and realized what a waste of time that was. I cannot even put wire earrings in because I cannot feel the wires.
In my last eye test, they could only correct my vision to a certain point. They can no longer bring my eyes up to 20/20. I no longer drive very much, but I still can drive. I am starting to prepare myself for taxi days and trying to find ways that it will make my life better.
But I can still feel my stomach going into flipflops over the thought that I could go blind - probably will go blind. And with no hands and no eyes, this stubborn woman will have to accept help - more help than I now need.
That food sure tasted good. It now feels terrible in my roiling stomach.
Last summer I had an OCT test done by my excellent NP. At least that was noted on the report, which I later requested, as always. I had no idea that's what it was at the time. She had some small gizmo to look at my eyes, and I think she turned the lights off first.
Apparently it was normal, though I didn't think to ask when I saw her a few weeks ago. But what is odd is that per MRI comparisons over 10 years, I definitely have brain atrophy. So I don't know what to make of this.
ess
Apparently it was normal, though I didn't think to ask when I saw her a few weeks ago. But what is odd is that per MRI comparisons over 10 years, I definitely have brain atrophy. So I don't know what to make of this.
ess
Hey, you should ask her what the results were - I'm sure it showed a thinning of the RNFL. It probably wasn't too bad, so she didn't say anything.
But if she's like my neuro, we get to talking, and things that I should have asked about get forgotten.
But if she's like my neuro, we get to talking, and things that I should have asked about get forgotten.
This is a test where I will be looking at a checkerboard and a computer will gage the performance of my eyes. There is another component to the test, but I cannot remember what it is.
Hey, I think that's a VEP? They stick some electrodes on your head, and have you look at a checkerboard. There's some readings that they get from your brain, so they're checking conduction - I think.
The OCT was very different. Basically I stuck my head in the viewer, looked at the placer dot, and a laser scanned across my eye. I could see the red line as it scanned, but otherwise everything was black.
The OCT was very different. Basically I stuck my head in the viewer, looked at the placer dot, and a laser scanned across my eye. I could see the red line as it scanned, but otherwise everything was black.
My new neuro-opth did the dual VEPs at my first appt with her yesterday. 2 years ago when I started along the diagnostic route, the other guy had to set me up with his retina guy, and it it took a whole 'nother appointment to have the OCT done on just the eye that has the scotoma. My new doc makes it sound like something she's going to do annually, and the ones she took yesterday are a baseline. I only have one yellow slice in my left eye pie chart. She had her nurse/assistant person do the test, and then she came into the exam room before doing all the bright lights inside the eye work, she pulled up the results on the exam room computer and pointed everything out.
What I'm saying is, it seems the OCT might be becoming more commonplace, or maybe my new doc is just plain better and always was.
What I'm saying is, it seems the OCT might be becoming more commonplace, or maybe my new doc is just plain better and always was.
I had a normal OCT, but then, I've never had optic neuritis. As far as looking for axonal loss, could OCT be related to axonal loss in other areas of the brain?
The OCT will not show retro-bulbar Optic Neuritis. The loss non-meylinated retinal fiber axons is thought to be an early indicator of axonal loss in the brain. The concept is that the OCT should thin before the MRI T1 Black Holes start to show up.
So a normal OCT is a very good thing!
Bob
So a normal OCT is a very good thing!
Bob
Thanks for the info. I have a better understanding of it now.
Back in 2008, when I first started to have visual SX, my eye doctors did run a visual field test that showed nonspecific lose. I still don't understand the results of that test and they were never explained to me..just that the opthamologist suggested that I needed to be seen by a good MS specialist.
I might have to look into this after my neuro checks out why my reflexes in my legs changed from hyper to hypo.
Back in 2008, when I first started to have visual SX, my eye doctors did run a visual field test that showed nonspecific lose. I still don't understand the results of that test and they were never explained to me..just that the opthamologist suggested that I needed to be seen by a good MS specialist.
I might have to look into this after my neuro checks out why my reflexes in my legs changed from hyper to hypo.
I go next week for my second OCT. The first one I showed loss in my right eye. I had ON in my right eye.
LA dx'd
LA dx'd
Thank you Jens...
This is fascinating! Not just for my health reasons but overall it's cool stuff! I have some real information to talk to my doctor about. Thank you!
I also think depending on what he says I'm going to take myself and my tests for second/third opinion or independent reading.
This is fascinating! Not just for my health reasons but overall it's cool stuff! I have some real information to talk to my doctor about. Thank you!
I also think depending on what he says I'm going to take myself and my tests for second/third opinion or independent reading.
I have a question. I am currently getting worked up for MS-- having had on and off symptoms for about 9 months. I went to an opthomologist who did an OCT test and said it was "abnormal" and wanted me to go to a neuro-opth. He looked at all my tests and was seemed all sorts of confident it wasn't MS, and that the OCT machine was outdated. THEN, he did an OCT on his machine, just a couple of months later, which showed thinning in the RNFL in both eyes. Then all of a sudden, he's all like: "it could be one of 3 things: early glaucoma (which he explained is unlikely bc of normal pressure), because I am very nearsighted, or MS." I am having a repeat test in 3 months- Sept 15. My question is this -- how do they know I have "thinning" if it was essentially the first test I had? How do they know its abnormal? I'm guessing they have comparisons? I don't know. The whole thing just ***** and I hate waiting. I had an LP, negative, after 4 months of symptoms and a complete waste-of-time MRI because it was done really early on and on a ridiculously low-strength machine-- I know better now. Anyway, I've posted on all of this before, I was just wondering how they know it's thinning if they've never seen my optic nerve before.
Bumping for Barb!
I wish I had seen someqs17's question earlier. The test shows your optic nerve and color-codes it according to how thick it is. Normal thickness is green to blue, thin or missing is black to red. Check out my embedded pic at the top for an example.
I wish I had seen someqs17's question earlier. The test shows your optic nerve and color-codes it according to how thick it is. Normal thickness is green to blue, thin or missing is black to red. Check out my embedded pic at the top for an example.
Have an Answer?
You are reading content posted in the Multiple Sclerosis Community
Top Neurology Answerers
Australia
ON
Queensland, Australia
Queen Creek, AZ
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
