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Optical Coherence Tomography May Help Clinicians Predict MS Progression Years Ahead Of Time: VIDEO

Optical coherence tomography (OCT), which is used to measure retinal thickness, can help clinicians predict multiple sclerosis (MS) progression two to five years later, according to an international longitudinal cohort study presented at the 2016 AAN Annual Meeting and published in Lancet Neurology. Overall, the researchers found that thinning in the peripapillary retinal nerve fiber of patients with either clinically isolated syndrome, relapsing-remitting MS, or progressive MS, as measured by OCT, was associated with a twofold risk of disability worsening at two to three years of follow-up. But independent experts stress that use of OCT in MS should be limited to clinical trials at this point, and more research is needed to assess its clinical utility. Neurology Today Editor-in-chief. Steven P. Ringel, MD, FAAN, and Associate Editor Dr. Robert G. Holloway Jr., MD, FAAN, discuss the study with Peter Calabresi, MD, FAAN, director of the neuroimmunology division at Johns Hopkins University.

“OCT is not yet a standard exam, but I think this study should promote a change,” said Elena H. Martínez-Lapiscina, MD, PhD, a neurologist and associate researcher at the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) of the University of Barcelona in Spain. “You can send the patients for the OCT acquisition and get results in 20 minutes, without any processing of data. It’s very valuable information. Patients whose pRNFL thickness is lower than the proposed cut-off should be evaluated for defining the best therapeutic strategy.”

The study’s principal investigator, Pablo Villoslada, MD, a senior researcher at IDIBAPS — University of Barcelona and an adjunct professor of neurology at the University of California, San Francisco, noted that the study provides clinical validation for the first time that pRNFL can be used as a marker of disease progression two to five years in the future. “It is already being used for research in many centers, and for clinical care in some centers,” he said. “But until now, without the clinical validation that this study provides, people haven’t known how to use it.”

Dr. Villoslada, who has led the development of OCT testing for a decade, said the results are clear enough for clinicians to begin using it in their daily practice.

“OCT gives us information about what the short and long-term course of a patient might be and how we should consider treatment options,” said Steven Galetta, MD, FAAN, professor and chair of the department of neurology at the New York University Langone Medical Center. “This is a potential leading indicator of disease activity. It gives us a window of opportunity to consider changing medication for disease progression. If we’re going to consider a medication change based on MRI findings, we should certainly consider it based on reproducible OCT changes.”

Dr. Galetta added, however: “Not everyone is going to agree with that. Some will stand by the mantra that there has to be an overt clinical effect.”

Story Source: The above story is based on materials provided by MSUNITES
Note: Materials may be edited for content and length


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