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New research · Ophthalmology
European journal of neurology · 1d
Cohort studyEuropean journal of neurology · 2026

Assessing Optic Nerve Involvement in Multiple Sclerosis Using Optical Coherence Tomography and Magnetic Resonance Imaging.

Gualco Alessandro, Boffa Giacomo, Razzetta Chiara … Inglese Matilde
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OphthalmologyCohort study

Optical Coherence Tomography eye-to-eye difference detected prior optic neuritis with 83% sensitivity in Multiple Sclerosis.

Assessing Optic Nerve Involvement in Multiple Sclerosis Using Optical Coherence Tomography and Magnetic Resonance Imaging.

Gualco Alessandro … Inglese Matilde
European journal of neurology · 2026
Background

Optic nerve involvement in Multiple Sclerosis (Multiple Sclerosis) can be detected with Optical Coherence Tomography (Optical Coherence Tomography) based on intereye difference (intereye difference).

Purpose

We aimed to assess optic nerve involvement in a large real-world Multiple Sclerosis cohort applying the 2024 McDonald intereye difference cut off criteria, and to investigate OCT-MRI concordance.

Methods

Three-dimensional double inversion recovery MRI sequences for optic nerve assessment were available for 240 patients.

n = 240 patients
Results

eye differences flagged prior nerve damage in most patients who'd had it

Sensitivity (prior ON)
83%
Specificity (prior ON)
55%
More results

MRI identified lesions in 46% of patients without a prior history of optic neuritis, whereas OCT-IED was positive in 40%, resulting in an overall OCT-MRI concordance of 77%.

More results

Among asymptomatic patients (n = 164), 25 were Optical Coherence Tomography-negative/MRI-positive (11 with bilateral optic nerve involvement) and 15 were Optical Coherence Tomography-positive/MRI-negative, mostly with isolated ganglion-cell-inner-plexiform-layer or RNFL asymmetry.

“
Conclusion · 1 of 2

The 2024 McDonald intereye difference cutoff demonstrates high sensitivity for prior optic neuritis but reduced sensitivity for subclinical optic nerve involvement.

Conclusion · 2 of 2

MRI appears slightly more sensitive, with both modalities providing complementary information on optic nerve pathology.

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